Cultural Sensitivity

In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”

“Did your face get red?” I asked.

“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”

“But you said tretinoin dries you out.”

“It only does when the seasons change.”

Maybe you know what Kaleigh means. I don’t.

Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?

Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?

I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?

Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.

“I can’t use this moisturizer. It dries me out.”

Say what?

If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.

I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.

It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.

The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.

The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.

I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.

What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.

Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?

“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.

The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.

“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.

Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.

Usually works. I’m a sensitive guy.

In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”

“Did your face get red?” I asked.

“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”

“But you said tretinoin dries you out.”

“It only does when the seasons change.”

Maybe you know what Kaleigh means. I don’t.

Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?

Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?

I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?

Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.

“I can’t use this moisturizer. It dries me out.”

Say what?

If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.

I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.

It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.

The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.

The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.

I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.

What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.

Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?

“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.

The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.

“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.

Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.

Usually works. I’m a sensitive guy.

In February I switched Kaleigh to adapalene because she said that tretinoin “was drying me out.” Yet, in June she’d stopped the adapalene “because it burned.”

“Did your face get red?” I asked.

“No, but it felt funny for a while after I put it on. So I went back to tretinoin.”

“But you said tretinoin dries you out.”

“It only does when the seasons change.”

Maybe you know what Kaleigh means. I don’t.

Patients often say they have “sensitive skin.” The traditional medical way to analyze this is physical: What conditions affect the cells, nerves, and blood vessels so skin looks and feels a certain way?

Another way to look at it is psychological: What about this person makes her or him pay attention to small changes in appearance or feeling?

I propose a third way: cultural. Whom does this person hang out with who experiences and describes sensations this way?

Aestheticians and patrons of skin care counters talk a lot about how their skin looks and feels in terms that sound strange in a medical context.

“I can’t use this moisturizer. It dries me out.”

Say what?

If patients on clindamycin lotion say it dries them out, I can protest in vain, “But it’s a moisturizer!” “It makes me feel dry,” they reply (or shiny or oily.) Saying this at the salon gets their money back, no questions asked, not just because it’s good business but because the aesthetician or clerk understands exactly what they mean and finds it quite reasonable.

I haven’t made a systematic study of cultural differences in the way people feel things on their skin. I just present several observations in the hope that someone might organize and make sense of them some day.

It’s known, for instance, that black patients may prefer moisturizers and hair pomades that a white patient would find too oily. Without moisturizing, black patients call their skin “ashy,” a word assumed to mean dry. It can’t be measured as dry, however, though it certainly feels that way to people who feel they have ashy skin.

The elderly often feel dry, too, though it’s far from established that they actually are: Wrinkling and itching don’t correlate with transepidermal water loss. From time immemorial, old age has been assumed to drain away vital body fluids. The elderly know they’re all dried out, so they feel that way.

The sexes differ too, in this as in so much else. Most women don’t feel right unless they’ve moisturized. (It wards off aging, they imagine.) Many men hate the feel of cream on their skin. Being of the male persuasion myself, I can testify that even the thought of applying sunscreen makes my flesh crawl; I have to grit my teeth to put it on.

I’m sure that, like me, you see long-married couples, where the wife says, “Look how dry he is, Doctor. Make him moisturize!” Hubby helplessly rolls his eyes. I mediate but do encourage him to eat his Cream of Wheat.

What do men and women “feel” that leads to their respective proclivities? I don’t know, but I’m pretty sure it won’t be found in the anatomy of sensory C fibers.

Likewise, I’m sure that you meet people with long-term rashes who are convinced they have “poison ivy” when they don’t. What makes them think so?

“It itches like poison ivy,” they insist. What does poison ivy itch like? I don’t know but they do, with great conviction. Somehow, not just appearances but sensations get diffused in the general culture. Something similar happens when patients diagnosed as not having zoster sigh with relief. “It burned just like shingles,” they say.

The other day I saw a woman with juicy, steroid-fed tinea corporis. “I’m sure it started as an insect bite,” she said. “How come?” I asked.

“It tingles,” she replied, “just like an insect bite.” Again, I don’t how an insect bite tingles, but she does.

Until someone explains all this, when one of my sensitive patients insists that the cream or pill I prescribed is drying them out or the moisturizer I suggested is “prunifying” them, I’ll just nod sagely and recommend something else that will, assuredly, not offend their sensitivities.

Usually works. I’m a sensitive guy.