The Life of the Skin - Hardcover

Balin, Arthur K.; Balin, Loretta Pratt; Balin MD, Loretta Pratt; Whittlesey, Marietta

Hardcover

ISBN 10: 0553097199 ISBN 13: 9780553097191

Publisher: Bantam, 1997

Synopsis

"Above all others, the skin is the organ of meeting. The skin meets the eyes, the skin of others, the environment. It gives identity and shape to the human form, lends us our appearance, hides our innards. The glands within the skin lend us our unique scent, and the skin reflects on its surface the feelings of the being within..."



This witty and elegantly-written book explores the fascinating, paradoxical life of the skin and how it affects us throughout our lives. It takes us into the world of two eminent dermatologists, husband and wife, who we first meet as they rejoice over the perfect skin of their newborn baby--and contemplate the central role it will play in her life and health.



Each chapter that follows contains a fascinating case history exploring one of the mysteries of the skin: its essential role in the immune system, its exquisite sensory sensitivity, the way in which it communicates everything from sexual signals to dysfunction deep in the body. Drs. Balin and Pratt are particularly alert to the psychological dimension of skin--how important it is to our identity, how it brings mind and body together. Their passion for their subject and their care for their patients are evident on every page.

About this title

From the Inside Flap

Above all others, the skin is the organ of meeting. The skin meets the eyes, the skin of others, the environment. It gives identity and shape to the human form, lends us our appearance, hides our innards. The glands within the skin lend us our unique scent, and the skin reflects on its surface the feelings of the being within..."</i><br><br><br><br>This witty and elegantly-written book explores the fascinating, paradoxical life of the skin and how it affects us throughout our lives. It takes us into the world of two eminent dermatologists, husband and wife, who we first meet as they rejoice over the perfect skin of their newborn baby--and contemplate the central role it will play in her life and health.<br><br><br><br>Each chapter that follows contains a fascinating case history exploring one of the mysteries of the skin: its essential role in the immune system, its exquisite sensory sensitivity, the way in which it communicates everything from sexual signals to dysfunc

Reviews

A husband-and-wife team of dermatologists use fascinating clinical tales about their patients to share their knowledge of the body's outer wrapping. The Balins have a joint practice outside Philadelphia, where they treat patients with diseases common and uncommon as well as men and women who simply want to enhance their appearance. The skin, they explain, is an organ of communication, and they are clearly fluent in its language. Among the more unusual patients whose stories they relate are Elaine (pseudonyms are used to protect their patients' privacy), whose skin hardens into such a rigid carapace that she comes to think of herself as the ``turtle woman,'' and Chandrika, an Indian woman who is desperate to hide the white spots on her skin because she fears her husband will divorce her for having leprosy (she doesn't). Less exotic but especially absorbing is the story of Anne, a 40-plus outdoorswoman with seriously sun-damaged skin, who undergoes various treatments to undo what the sun has done, and Nancy, who has a luxurious head of hair but imagines that it's falling out. Perhaps the capper, though, is Arthur Balin's story of how he came to give his own father a facelift. Woven into these stories are short lectures on the structure and function of normal hair and skin, and information on the techniques available for rejuvenating aging skin. The harmful effects of sunlight are a pet peeve of the Balins'; consequently, there is a wealth of information about these, ranging from deadly melanoma and other skin cancers to premature wrinkling. If the book has one take-home message, it could be said to be ``Don't leave home without your sunblock.'' Occasionally too graphic for comfort, but overall, entertaining and instructive. -- Copyright ©1997, Kirkus Associates, LP. All rights reserved.

Much of this engaging book is about husband-and-wife dermatologists Arthur and Loretta Balin's patients, their diagnoses and treatments. The skin--not, by the way, the body's largest organ; that distinction belongs to the digestive tract--has many and various problems all its own, and it warns of such problems within the body as Hodgkin's disease. Its main enemy is sunlight. The Balins, identifying Coco Chanel as instigator of the mass yearning for a "good, healthy" tan, say that much can be done to overcome some sunlight damage, but that the best thing is to avoid it by using sunscreens and clothing against prolonged exposure. And still, one of the Balins' best stories is about a nun who didn't object to facial sun-marks because they reminded her of the pleasant times she had spent in the garden. In addition, Arthur Balin cites good examples of basic research paying off in clinical usefulness, and there are some strong statements here about many HMOs' opposition to specialists, which often subjects patients to unnecessary dangers. William Beatty

Excerpt. © Reprinted by permission. All rights reserved.

Naked to the Light

It was the end of the day on a hot August afternoon. Loretta was already at home with our baby daughter, Allison. I had one more patient to see, but I was hopeful I would be able to dine with my wife and get to bed before midnight for the first time in many busy weeks.

One of the nurses put her head in the door. "Mrs. Sloan is waiting for you in room one, Dr. Balin."

Mrs. Sloan was a new patient. Glancing at the form she had filled out in the waiting room, I saw that she was fifty-five years old and the wife of a well-known orthopedic surgeon in the area.

My first impression of the patient who awaited me was that she looked at least ten or fifteen years younger than the age stated in her chart. In startling contrast to the many sun-damaged faces confronting me every day, here was the luminous milk-white complexion that hadn't been fashionable in over half a century. Clearly, this was a woman who understood how to care for her skin and had the self-assurance that allowed her to defy the still strongly felt preference for a summer tan. There would be no need to discuss with Mrs. Sloan the life-threatening danger of sunlight. My dinner with Loretta seemed almost assured. I would carefully survey Mrs. Sloan, answer any questions she might have about caring for her skin, and be on my way.

"How do you do, Dr. Balin," she said, rising from her chair. "I'm glad to meet you."

As Mrs. Sloan extended her hand to shake mine, the sleeve of her dress slid back, and I was surprised to see a very large, very dark mole a few inches above her wrist. My heart sank. Although I couldn't be certain, of course, until I sent it out to be biopsied, it had all the outward features of a malignant melanoma, one of the most virulent and least treatable of all cancers. No matter how many times we see melanomas and other serious skin diseases, no professional armor lessens the sadness we feel upon meeting a patient bearing one of these potentially deadly emblems.

Dermatology is the most visual of all medical specialties. Where other physicians may need invasive instruments and esoteric imaging techniques to enter deep within their patients' bodies and listen to or see organs invisible to the eye, so much of what we treat lies on the surface, for all to see. Yet although they may be clearly visible to everyone, these surface signs are usually meaningless to all but trained eyes, as Mrs. Sloan so poignantly demonstrated. I could tell by her forthright and confident gaze that she was completely innocent of the cutaneous Sword of Damocles on her arm.

Struggling to control my expression so as not to alarm her, I said, "I see you're here to have your skin checked. Is there any particular concern you have?"

"Well, yes, Dr. Balin, there is. I feel sort of silly coming here, because I just saw my regular dermatologist back in May when I had poison ivy and she didn't mention anything amiss. But I was having lunch with a friend the other day, and she noticed this mole on my arm. I've had it for a long time, but I think it's a little bigger than I remember. My friend made me promise to have it looked at. I didn't go back to my own dermatologist, because I didn't want her to think I was questioning her. I know she saw it--how can you miss it?--but she said my skin was in great shape."

"Did your doctor do a skin survey when you saw her?"

"Well, if you mean did she look at all my skin--no. She just looked at the poison ivy on my legs, and she looked at my face."

"From what I can see, your skin looks very well cared for, but I want to ask you some questions, and then I'll do a complete skin survey. That's just routine in this office."

For the next twenty minutes, I asked Mrs. Sloan detailed questions not only about the mole that she had noticed--how long she had had it and whether it was changing--but also about her own and her family's medical history.

In the middle of the history-taking, she said, "I'm surprised at all these questions. I don't mind answering them, but what does heart disease and kidney disease and my parents' and children's health have to do with this mole?"

I explained to her that although this amount of detail might seem irrelevant to her skin problem, I would be uncomfortable doing an incomplete history and exam. Often, in the course of taking such a thorough history, I discover symptoms of diseases unrelated to the skin.

In our practice, every new patient, even those coming in for treatment of a simple rash, undergoes a meticulous examination of every inch of skin, including the scalp and even places rarely exposed to the sun, such as between the toes and under the arms. We do this wearing magnifying glasses that permit us to note very small spots that could easily be missed by the naked eye. We then take photographs for the patient's chart, so we can be aware of any changes that occur between visits. If we see something we don't like, it comes off then and there and is sent to a lab for biopsy. Our policy is not to let a patient with a potentially serious lesion leave our office until we have biopsied it. Sometimes a patient will come in with a mole or other presently benign growth that has the potential to transform itself and become cancerous. Such moles are photographed and then the patient is given a definite appointment, so we can recheck the mole in a couple of months. If there is any change whatsoever in the mole's size, shape, or color, then it will be removed at that time. Unfortunately, many people have gotten the idea from magazines and television that skin cancer is not in the same league as other cancers, like lung cancer and leukemia, and can be ignored. Indeed, skin cancers, when caught early, can usually be treated easily long before they have the chance to spread. But some can spread if left untreated, and they can even be fatal.

I left the room so Mrs. Sloan could change and went to call Loretta. It was clear our dinner together would have to wait.

I was fairly certain Mrs. Sloan did, in fact, have a melanoma. Her mole was large--nearly the size of a dime--irregular in shape, jagged at its edges, and an ominous mixture of red, blue, and black. Certainly I wanted to waste no time in removing it. If caught when still on the surface of the skin, a melanoma is as curable as any other skin cancer. But if it penetrates into the deeper layers, it can metastasize throughout the body. When this happens, it is virtually a death sentence. The cure rates are dismal. No presently known therapy can reliably stanch these dreadful tumors.

Even though we are taught that the unusual is routine in medicine, I was surprised to see a melanoma in someone whose skin appeared so pristine and undamaged. I put on my magnifiers and checked over every millimeter of Mrs. Sloan's skin. She had none of the typical stigmata of a sunbather--no wrinkles, no sagging jowls and wattles, not even any of the miscellaneous barnacles that often grow on sun-damaged skin. Nor did she at first glance appear to have many moles, another risk factor for melanoma.

"Have you ever had a sunburn, Mrs. Sloan?" I asked.

"Oh, heavens yes!  I was an army brat, and my father was posted to lots of tropical countries. My mother always tried to keep us out of the sun--she was kind of old-fashioned in that way--but for a couple of years when I was a teenager, I sunned myself every chance I got. Unfortunately, with this white skin, I just cooked myself instead. I used to come home peeling and in so much pain I could barely lie down. But I never really got tan. Soon enough, I decided to give up and try to look like Marilyn Monroe instead. My husband says that's why I don't have very many wrinkles."

Loretta and I often say that if our therapeutic armamentarium contained only one weapon, the most lifesaving, as well as the most youth-preserving, would be the advice to avoid tanning. But whereas most patients are willing to listen to--are in fact clamoring for--advice on beautifying, improving, turning back the clock on their skin, so many resist this most urgent prescription in favor of quick fixes and after-the-fact repairs. To convince our patients to protect themselves in the sun is a far more difficult task than convincing them to adopt other health measures, like quitting cigarettes or restricting their fat intake.

Although sunlight has benefits--vitamin D synthesis requires sunlight--long, unprotected sunbaths are not necessary to provide this benefit. Only a few minutes of exposure per day is adequate. Still, the association between sunlight and health persists deep within the human psyche even today, when the power of sunlight to wound and damage is increasingly clear.



    


From the Trade Paperback edition.

Edition details

• Publisher: Bantam
• Publication date: 1997
• Language: English
• ISBN 10: 0553097199
• ISBN 13: 9780553097191
• Binding: Hardcover
• Number of pages: 272