Growing up, I struggled with acne. All during the spring of my junior and senior years of high school, I carried around a rash of pimples that corresponded with the chin strap of my lacrosse helmet. I’d also get cystic acne that required regular visits to the dermatologist. Dr. Castiglione (a Yale College graduate) prescribed topical gels that kept the regular acne under control and helped me salvage a shred of self-respect; eventually, the cystic acne was treated with isotretinoin, better known as Accutane. Meanwhile, my parents offered helpful recommendations about my diet: limit the intake of milk, chocolate, and greasy foods. But nothing, not even a full course of Accutane, stopped the acne from returning. In fact, it is a problem with which I still struggle today—though as an adult with many accomplishments to my name, my self-esteem is more durable than it was 25 years ago.
Although acne is what causes many people, like myself, to interact with a dermatologist, the field of dermatology involves much more than what I experienced as a teenager. Human skin is a delicate and extraordinarily complex organ that serves a great number of functions in the body. It has been only over the past 20 to 30 years, with the unlocking of the human genome and an understanding of the roles microbes play in the induction and development of the body’s immune system, that researchers have been able to say with certainty what causes a particular condition or disease to affect one person’s skin while leaving that of others totally untouched.
The skin is also the vector of cultural and sociological bias and worse. Skin, the superficial, is how humans have misjudged each other (and themselves) for centuries—millennia, even. Understanding what skin does and how to keep it healthy isn’t just a matter of biology and chemistry; it’s also a question of digging deeper than first impressions or age-old prejudices.
Dermatology at Yale is interdisciplinary and cutting-edge science at its very best: science that transforms the quality of people’s lives along multiple axes. For that reason, and also because I know firsthand the power that dermatologic conditions can have on a life, I’m excited to bring you the “More Than Skin Deep” issue of Yale Medicine Magazine.