Save Your Skin

It’s the era of skin worship.

Bare skin. Tanned skin. Pierced skin. Tattooed skin.

Mutilated. Dermabraded. Shaved and decorated.

What Americans are doing to their skin these days is no less than a cultural revolution, says the scientist and philosopher Marc Lappe.

After two centuries honoring Puritan ideals and even purer skin, we’re obsessed with painting a picture of our souls on our bodily palates.

To some, this trend is cool. To others, merely fascinating. But is it healthy?

In his entertaining new book, Lappe, a founder of the Hastings Center--the nation’s first bioethics institute--says Americans’ treatment of skin is far from healthy. Instead of viewing skin as a sensitive organ, we are caught up in cosmetology.

In “The Body’s Edge: Our Cultural Obsession With Skin,” (Henry Holt), Lappe forgives teenagers for their skin mutilations and markings, matrons for their overuse of peels and potions, and Dennis Rodman for everything. According to Lappe, we all have profound psychological reasons for doing what we do to our skin.

However, he is far less forgiving of the medical profession. Saying scientists should know better, Lappe scolds doctors--cosmetic surgeons and dermatologists, in particular--for giving in to trends and fads that damage the skin.

“We used to have a strong cultural bias against doing anything except protecting the skin’s uniformity,” Lappe says. “Markings were considered marks of a lower culture. Now, the skin has become an emblem of personal identification. Demarcations, coloration, piercings, tattoos are ways of making a declaration of ourself. I think this is a fad that’s penetrating the culture very deeply.

“The skin is the new battleground for defining the self.”

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Lappe is director of the nonprofit Center for Ethics and Toxic Substances in Gualala, a small Northern California town in redwood country. It was here that Lappe, a specialist in chemical substances, had his own consciousness raised. During the early 1980s, he encountered a forestry worker who had been systemically poisoned by an herbicide that had seeped through his clothing during the course of his work. The man suffered nerve damage.

“That’s what cued me to the idea of skin as a portal of entry to hazardous substances and got me started thinking about this skin,” he says.

Contrary to our largely philosophical notion of our skin as a protective shield, skin is porous and vulnerable to outside elements.

“We have developed through the use of language and metaphors, this notion of the skin being a barrier, a defense against the outer world. But one of the most valuable lessons you can teach someone is that your skin is very open to the world,” Lappe says.

That fact has not been lost on the pharmaceutical industry, which is turning out medications embedded in skin patches and devices to measure hemoglobin and other substances in the blood without piercing the skin.

On the other end of the knowledge spectrum, says Lappe, is the Occupational Health and Safety Administration, which has only recently begun to test workplace chemicals for their skin permeability and to warn workers.

“There is a whole slew of occupational risks that are subtly and quietly affecting a growing number of workers because of the permeability of skin to toxic substances,” he says.

Dermatologists have been too slow to recognize this risk as well, Lappe says. He scoffs, for example, at a recent survey of dermatologists revealing that fungal infections of nails and tattoos make up a majority of the “most important” problems in the field.

“Dermatology, as a specialty, could use an infusion of vision,” he writes. “Instead of concentrating solely on the superficial problems such as fungal infections of nails or tattoos . . . clinicians would do well to recognize the skin’s role as a border between wellness and dysfunction.”

He also cites the dramatic increase in cases of melanoma, which is widely believed to be caused by severe sunburn. And he complains that the kind of outrage and call for lifestyle changes in other countries with high skin cancer rates--such as Australia--has not been generated in the United States.

Lappe charges that dermatologists have a conflict of interest in preaching against sun exposure.

“Such an incredible portion of the practice of dermatology today is from solar injury,” he says. The American Dermatological Assn. has made some strong pronouncements about sun protection in recent years, “but they have been very late in preventing tanning parlors. And they have not endorsed good sunscreens.”

That kind of criticism doesn’t sit well with dermatologists like Dr. Perry Robins, founder of the Skin Cancer Foundation. He defends dermatologists and calls Lappe’s remarks “without foundation.”

Robins admits that until about 15 years ago, sun protection wasn’t doctors’ “highest priority.” But in recent years, Robins says, “I think the American Cancer Society and the other organizations involved in educating the public have done a marvelous job.”

Dr. Albert Kligman, the man who invented Retin-A, also says it’s not doctors’ fault if Americans are tough on their hides.

“People are careless and reckless about their skin,” says Kligman, who recently presented research that the acne medication Retin-A may help prevent skin cancer in people whose skin is already sun-damaged. “Most Americans are simply unhygienic. They are doing everything they can to wreck their bodies. I’m very pessimistic. Using something like a moisturizer sounds easy. But when it comes to do something that really helps--like staying out of the sun--we are not very successful.”

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In promoting the skin as a valuable bodily organ--it’s also the body’s largest organ--”The Body’s Edge” also takes aim at the professions and industries that aim to alter the skin’s natural appearance and function.

Lappe argues that many of the anti-aging potions marketed within the billion-dollar industry lack scientific proof of effectiveness. Moreover, the long-term effects of using such products as moisturizers, alpha-hydroxies and astringents are unknown, he says.

Even Retin-A and Renova, a milder anti-wrinkle cream, should be viewed with caution, he claims.

“It’s not clear whether in the long run . . . that it will not cause a catastrophic failure of some of the systems in the skin,” he says. (As an advisor to the March of Dimes, Lappe also argued in 1991 that the FDA should ban Accutane, the medication for cystic acne, because of its link to severe birth defects. However, he was outvoted.)

But instead of trying to understand the reasons so many people want to embellish or reshape their skin, cosmetic and plastic surgeons promote the concept of skin as changeable, Lappe argues.

“My own bias is that cosmetic surgeons are capitalizing on human foibles and weaknesses to present an art that has nothing to do with the curative powers of medicine,” he says. “There is nothing wrong with beautification for beautification’s sake. But cosmetic surgeons have the tendency to promise more than they can offer.”

If that is true, then what accounts for the booming trend in cosmetic surgery? asks Dr. Robert Singer, past president of the California Society of Plastic Surgeons.

“Why would it be the phenomenon it is if there weren’t proven results?” says Singer, who adds that he has not read Lappe’s book.

But Singer disagrees that the desire to alter one’s appearance is new or, for that matter, mystifying.

“Focusing on looking good and focusing on skin is not unique to this generation and not even unique to this culture,” says the La Jolla surgeon. “As far back as ancient Egypt and Greece, people used fruit juices to improve their skin.”

Viewing the skin as changeable may be human nature, he suggests. But each individual seeking cosmetic surgery has his or her own private motivation.

“People do this for their own reasons,” Singer says. “Many have a physical characteristic troubling to them, such as a large nose out of proportion with their other features. If they can change that and enhance the quality of their life, why not?”

But Lappe suggests that Americans do more internal reflection on the reflection in the mirror.

And he offers some simple advice on skin care: “Basic nutrition is as important as anything you can put on your skin.”