When I was thirteen years old, the skin on my chest was overtaken by amysterious outbreak of inflamed red dots. I attended an all-girlsboarding school in the Dehradun Valley, in India, where our bodies werecarefully watched over—our height, weight, molars, incisors, fevers, andvaccinations each measured every term. Spots on the face were deemednormal, maybe even healthy, vanity being one of the undesired traitsthat the institution promised to eradicate. A smattering of inflamedspots across your chin or cheekbone might even earn you sympatheticoffers from your peers. (“Do you want me to buy you a new loofah thenext time I go out?”) But, as I discovered that year, the neck marked aninvisible geographical border, and the appearance of acne below itturned magnanimity into suspicion among friends and authority figuresalike: “Is that a rash?” “Are your sheets clean?” “Are you bathingevery day?” The wide square neckline of our school uniforms made mybreakout impossible to conceal. Despite walking around with my forearmscarefully folded across my rib cage, I quickly acquired a reputation asthe girl with the chest pimples.
After begging the school nurses to let me see a dermatologist, I wassent for an appointment with Dr. Judge, whose clinic signage pronouncedhim a specialist in “Skin Diseases and Leprosy.” He was a pale, thinman, with uncommonly gray eyes. He didn’t speak a single word to me, orask any questions about when or how the breakout had begun. But he peeredsympathetically at the damage, scribbled some things on a pad, andproffered a small, unimpressive-looking tube of ointment labelled “0.1% tretinoin.”
Dr. Judge’s prescription said to apply a thin layer of the cream once aweek, but in my desperation to be cured I instead slathered my chestgenerously several times a day. By Day Three, the pimples seemed to havedried up. By Day Seven, the first flakes of dry skin were floating offmy chest and settling on my sweater. I took this as evidence that thecream was finally working, and rubbed it on with even more dedication,carrying the tube around like a talisman. By Day Fifteen, triumph turnedto horror: the cream had certainly cleared out the zits, but it had alsoobliterated the entire layer of skin that they’d occupied. In its placenow were a multitude of angry, pink dry patches that peeled off in theshower in grotesque sheets. With the casual cruelty that comes so easilyto teen-agers, a girl in my dorm took a look at my chest and offeredthat, if she were me, she’d be contemplating suicide by now. I threw outthe tube of cream and endured the chafing of a woollen scarf until thepeeling finally stopped. During the winter holidays, my mother, a firmbeliever in impeccable self-presentation, and never one to mince words,took one look at me and asked, “What have you done to yourself?”
Today, hundred-and-five-dollar retinol serums can be purchased atSephora in apothecary-inspired bottles, enhanced with added azulene oiland blue tansy. But the original, all-chemical, prescription-onlyretinoid skin cream is not a glamorous product. Nearly indistinguishablefrom hemorrhoid cream, the blue-and-white, plastic-capped metal tubedoesn’t lend itself to performative #selfcare on Instagram. Its designis seemingly immune to the passage of time, having remained true to thesame aesthetic since 1971, when it first got F.D.A. approval. My mothercredits her teen-age commitment to the cream for the singularly linelessforehead and wrinkle-free nasolabial folds she now sports in herfifties.
Within the field of dermatology, retinoid and its family ofVitamin-A-derivative compounds—retinoid’s less potent offspring,retinol; its purest form, tretinoin, or retinoic acid, of which Retin-Ais a common brand name—are spoken of with mythic reverence. Retin-A,which works by purging old skin cells and forcing new ones to form at anastonishing rate, is the insufferable overachiever of skin treatments,known not only to blast away acne but to boost collagen production,dissolve unwanted pigmentation, and, as if that weren’t enough, treatskin lesions before they turn cancerous. Whether you’re hoping to getrid of wrinkles or acne or malignant cells, though, a retinoid-improvedvisage cannot be attained without enduring the carnage of red, inflamed,and flaking dry skin along the way. And whether you adhere to using thecream once a week, or go overboard, as I did, peel you will—perhaps notenough to elicit suggestions of suicide but enough to make onlookers doa double take, as if to silently confirm that, yes, that is indeed yourface, and it seems to be doing something usually seen only in NationalGeographic specials about snakes and crustaceans.
Since Internet access was strictly forbidden at my Indian boardingschool, it wasn’t until my second major breakout, at the age oftwenty-three, when I was living in New York, that I found the reams ofmessage boards, subreddits, blog posts, and magazine articles devoted towhat are fittingly called the “retinoid uglies.” It was my face, thistime, that erupted in cystic pustules that ached and throbbed angrily ifI smiled too widely. I’d wake up with pinpricks of blood littering thespot where I’d been sleeping. When I visited home, in October of 2015,my mother took one look at me and asked, “What have you done toyourself?”
I saw an Upper West Side dermatologist—tall, blond, withintimidatingly great skin—who prescribed me another round of Retin-A.This time, previous experience, and the advice of strangers on theInternet, had prepared me for the flake-pocalypse. I stuck to theprescribed treatment, a thumb-size dab once a week. A couple of monthsinto the regimen, the “purge” began. “Think of it as your skin takingout the trash from inside the house,” my dermatologist explained. Shewrote me prescriptions for moisturizers, separate ones for morning andnight. I began lying on my left side in bed when the right side of myface became too inflamed to position flat on the pillow.
Having adult acne is far from the worst way your body can betray you. Itwas a blow to my vanity, certainly, and a minor indignity—even as atax-paying, apartment-renting, health-insurance-having citizen of theworld—to have to battle once again a condition I thought I’d left behindalong with braces and weeknight curfews. But there is a unique crueltyin Retin-A’s way of making the problem worse before it gets better. Thebefore-and-after photos on Reddit didn’t prepare me for what I underwent in between—the farce of maintaining eye contactduring conversations, even as I could see the person I was talking toglance involuntarily toward the raw patches along my jawline. Unlike thewounds from a face-lift or a surgical procedure, the recovery caused byRetin-A does not take place underneath bandages. The inevitable sheddingof skin violates one of the tenets of being an adult—and, especially, awoman—in polite society: it is a public display of the concerted, andoccasionally painful, effort that goes into maintaining an appearance ofoutward normalcy.
Like love and bankruptcy, clear skin, when it finally came, did sogradually, then all at once. It’s been two years since I uncapped a newtube of Retin-A 0.1% and more than six months since a zit last invadedmy face. My forehead now emits a truck-headlight-like glare in iPhonephotos owing to its somewhat artificial, Barbie-esque smoothness.Occasionally, I still feel the throbs of a nascent pimple that threatensto emerge from deep underneath my skin, but it never actually does. Justin case, I keep a gnarled, half-squeezed tube of Retin-A on my dresser,dusty from disuse. I didn’t get to post my own before-and-after shotsto Reddit—my phone fell into a puddle and all the photos from myretinoid years were wiped out. But, last month, my mother peered intothe grainy screen of our weekly WhatsApp video call. “Skin looks good,Iva,” she said.
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