During my internal medicine residency, I rotated through various subspecialties, but the one that always gave me thought-provoking perspectives at the end of the day was dermatology. I was very excited to work in derma and learn how to treat basic clinical conditions like acne, hair fall, dermatitis, etc., at the back of my hand. However, my daily clinics opened my eyes to a new Pandora’s box of issues in society that I was probably oblivious to.
Case 1: I saw a five-year-old girl losing hair on her forehead and developing skin scars. As we delved deeply into the triggers, we discovered that she had moved from a shared family space to a nuclear family setup. She had lost friends and the deep connection she shared with her grandma. The girl had been grumpy and had now developed extensive hair loss, requiring topical immunosuppressants. From this experience, I learned that depression is a serious disease and manifests differently in children. In this case, it was triggered by alopecia areata.
This little lady made me aware of how depression in youngsters can manifest differently than in adults. One needs to be exceptionally good at communicating and taking notes to read the subtle clues. Although we might be able to temporarily solve her hair condition, she will continue to present with other problems until we address the underlying issue.
Case 2: A teenager walked in with a painful skin lesion covering her eye. What initially appeared to be a domestic or acid burn victim turned out to be a beauty hack gone wrong. The girl had injected herself with vitamin C at home, thinking it would make her fair. This alarmed me, as the lesion was progressing towards permanent disfigurement.
This serves as a subliminal warning to everyone who mindlessly follows beauty hacks to exercise caution and consult with a doctor before experimenting with needles. It increased my understanding of how blindly following what one sees on the internet can cause harm due to lack of awareness.
Case 3: Another case I encountered involved a girl with a darker complexion who desired a fair complexion. She struggled to understand our explanations. Tired and desperate to get married, she lived in a failed shell simply because she did not meet the beauty standards of Southeast Asian culture. She was willing to go the extra mile to change her skin color, resorting to expensive intravenous injections of glutathione in high doses, despite data supporting liver damage. She would even resort to bleaching or applying a popular formula cream in our region containing steroids and bleaching agents with known dangerous implications.
Understanding: While it is easy to sit back and talk about color, our society holds concrete ideas about the perfect age to marry, the definition of beauty and success. This girl fails to see her achievements as a successful and inspiring teacher and instead longs for a change in skin color because many potential suitors have rejected her. Her family drops subtle hints on how to improve her skin color when features are inherited and cannot be easily changed. These stories of women fighting for beauty are distressing.
Case 4: A young man walked into the clinic with severe acne, and when questioned about the trigger, he mentioned getting a facial at a local salon before his brother’s wedding. It was a treatable condition, but it alerted me to the importance of being aware of the places we go to when dealing with our skin. In this case, the tools used were likely not properly sanitized, leading to the problem.
As I treat patients with skin conditions, I observe people’s persistent pursuit of perfection every day. The desire for fairer skin, flawless complexion, more hair, increased volume, and improved texture seems endless. It made me ponder how unsatisfied we are with our current situation. Our skin tone is genetically determined and unrelated to our racial or ethnic heritage. We don’t have bald spots or lack hair volume, yet we strive to resemble the celebrities we admire.
In my discussions, I focus on consultations with individuals who do not have serious skin conditions but rather take arbitrary walks driven by an obsession with beauty. I witness the tests gone wrong and the cultural pressures that contribute to mental health problems, which in turn worsen underlying skin diseases. When patients enter our clinic, as doctors, we must address these concerns and, if possible, help reshape their concrete conception of beauty.
The experiences of our patients mobilize, transform, and challenge our perceptions of life in lower-middle-income nations. These stories make us aware of the common complexes people possess, how they influence their behavior, and how they contribute to illness. These stories have given me a better understanding of how individuals view beauty and how they are driven to go above and beyond to achieve the pinnacle of perfection.
Natasha Khalid is a physician in Pakistan.
