When I was thirteen years old, the skin on my chest was overtaken by a mysterious outbreak of inflamed red dots. I attended an all-girls boarding school in the Dehradun Valley, in India, where our bodies were carefully watched over—our height, weight, molars, incisors, fevers, and vaccinations each measured every term. Spots on the face were deemed normal, maybe even healthy, vanity being one of the undesired traits that the institution promised to eradicate. A smattering of inflamed spots across your chin or cheekbone might even earn you sympathetic offers from your peers. (“Do you want me to buy you a new loofah the next time I go out?”) But, as I discovered that year, the neck marked an invisible geographical border, and the appearance of acne below it turned magnanimity into suspicion among friends and authority figures alike: “Is that a rash?” “Are your sheets clean?” “Are you bathing every day?” The wide square neckline of our school uniforms made my breakout impossible to conceal. Despite walking around with my forearms carefully folded across my rib cage, I quickly acquired a reputation as the girl with the chest pimples.
After begging the school nurses to let me see a dermatologist, I was sent for an appointment with Dr. Judge, whose clinic signage pronounced him a specialist in “Skin Diseases and Leprosy.” He was a pale, thin man, with uncommonly gray eyes. He didn’t speak a single word to me, or ask any questions about when or how the breakout had begun. But he peered sympathetically at the damage, scribbled some things on a pad, and proffered 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 a week, but in my desperation to be cured I instead slathered my chest generously several times a day. By Day Three, the pimples seemed to have dried up. By Day Seven, the first flakes of dry skin were floating off my chest and settling on my sweater. I took this as evidence that the cream was finally working, and rubbed it on with even more dedication, carrying the tube around like a talisman. By Day Fifteen, triumph turned to horror: the cream had certainly cleared out the zits, but it had also obliterated the entire layer of skin that they’d occupied. In its place now were a multitude of angry, pink dry patches that peeled off in the shower in grotesque sheets. With the casual cruelty that comes so easily to teen-agers, a girl in my dorm took a look at my chest and offered that, if she were me, she’d be contemplating suicide by now. I threw out the tube of cream and endured the chafing of a woollen scarf until the peeling finally stopped. During the winter holidays, my mother, a firm believer 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 at Sephora in apothecary-inspired bottles, enhanced with added azulene oil and blue tansy. But the original, all-chemical, prescription-only retinoid skin cream is not a glamorous product. Nearly indistinguishable from hemorrhoid cream, the blue-and-white, plastic-capped metal tube doesn’t lend itself to performative #selfcare on Instagram. Its design is seemingly immune to the passage of time, having remained true to the same aesthetic since 1971, when it first got F.D.A. approval. My mother credits her teen-age commitment to the cream for the singularly lineless forehead and wrinkle-free nasolabial folds she now sports in her fifties.
Within the field of dermatology, retinoid and its family of Vitamin-A-derivative compounds—retinoid’s less potent offspring, retinol; its purest form, tretinoin, or retinoic acid, of which Retin-A is 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 an astonishing 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, treat skin lesions before they turn cancerous. Whether you’re hoping to get rid of wrinkles or acne or malignant cells, though, a retinoid-improved visage cannot be attained without enduring the carnage of red, inflamed, and flaking dry skin along the way. And whether you adhere to using the cream once a week, or go overboard, as I did, peel you will—perhaps not enough to elicit suggestions of suicide but enough to make onlookers do a double take, as if to silently confirm that, yes, that is indeed your face, and it seems to be doing something usually seen only in National Geographic specials about snakes and crustaceans.
Since Internet access was strictly forbidden at my Indian boarding school, it wasn’t until my second major breakout, at the age of twenty-three, when I was living in New York, that I found the reams of message boards, subreddits, blog posts, and magazine articles devoted to what are fittingly called the “retinoid uglies.” It was my face, this time, that erupted in cystic pustules that ached and throbbed angrily if I smiled too widely. I’d wake up with pinpricks of blood littering the spot 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 to yourself?”
I saw an Upper West Side dermatologist—tall, blond, with intimidatingly great skin—who prescribed me another round of Retin-A. This time, previous experience, and the advice of strangers on the Internet, had prepared me for the flake-pocalypse. I stuck to the prescribed treatment, a thumb-size dab once a week. A couple of months into the regimen, the “purge” began. “Think of it as your skin taking out the trash from inside the house,” my dermatologist explained. She wrote me prescriptions for moisturizers, separate ones for morning and night. I began lying on my left side in bed when the right side of my face became too inflamed to position flat on the pillow.
Having adult acne is far from the worst way your body can betray you. It was a blow to my vanity, certainly, and a minor indignity—even as a tax-paying, apartment-renting, health-insurance-having citizen of the world—to have to battle once again a condition I thought I’d left behind along with braces and weeknight curfews. But there is a unique cruelty in Retin-A’s way of making the problem worse before it gets better. The before-and-after photos on Reddit didn’t prepare me for what I underwent in between—the farce of maintaining eye contact during conversations, even as I could see the person I was talking to glance involuntarily toward the raw patches along my jawline. Unlike the wounds from a face-lift or a surgical procedure, the recovery caused by Retin-A does not take place underneath bandages. The inevitable shedding of skin violates one of the tenets of being an adult—and, especially, a woman—in polite society: it is a public display of the concerted, and occasionally painful, effort that goes into maintaining an appearance of outward normalcy.
Like love and bankruptcy, clear skin, when it finally came, did so gradually, then all at once. It’s been two years since I uncapped a new tube of Retin-A 0.1% and more than six months since a zit last invaded my face. My forehead now emits a truck-headlight-like glare in iPhone photos owing to its somewhat artificial, Barbie-esque smoothness. Occasionally, I still feel the throbs of a nascent pimple that threatens to emerge from deep underneath my skin, but it never actually does. Just in 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 shots to Reddit—my phone fell into a puddle and all the photos from my retinoid years were wiped out. But, last month, my mother peered into the grainy screen of our weekly WhatsApp video call. “Skin looks good, Iva,” she said.