When Obsession With Skincare Becomes Dermorexia

An interview with Serena Mcniff.

In Dead Weight: Essays on Hunger and Harm, author Emmeline Clein makes the argument that phases of capitalism influence eating disorders. “If bulimia was the eating disorder of Reaganomics and millennial girlbossery, and anorexia was the eating disorder of aughts-era austerity,” she writes, then the current class of injectable weight loss drugs “might foster an eating disorder for a new age of technocapitalism, wherein we try to recast hunger as just another inconvenience we can eliminate with an app.”

Reading this, I could not help but think of skincare, and the other basic human features we’ve recast as inconveniences to be eliminated: pores, pigmentation, the process of aging.

I previously used the term “dermorexia” to describe a number of obsessive behaviors enabled and encouraged by the skincare industry today: teens devising multi-step anti-aging routines for fear of future wrinkles; adults going into debt to needle and laser their faces; a frantic, cross-generational preoccupation with retinoids and acids and glazing. I hesitated to suggest such an illness-coded word at first, but as Clein said in an interview for Mental Hellth, “it’s useful to have diagnostic categories so that people can get medical care.” And in the case of disordered skincare use, medical care is sometimes necessary; many of the above behaviors negatively affect skin health and mental health, especially for younger users. I hesitated again since the cause of “dermorexia” is more cultural than anything else, then considered orthorexia, which entered the diagnostic lexicon in the late 1990s to describe an obsession with health, wellness, or exercise and took off as a clinical diagnosis as the health, wellness, and fitness industries grew to define American culture in the 2010s. “Eating disorders are complicated biopsychosocial illnesses, the result of an interplay between environment and genetics that must be analyzed from many angles,” Clein writes. Though some experts are “still resistant to centering cultural explanations,” there’s proof that the slim ideal plays a “pivotal role in the disease.” One could argue that the same thing is happening in the skincare space today, and that the youthful ideal, or the filtered ideal, is playing a pivotal role in the development of what we could call dermorexia.

Editors at theSkimm asked to interview me about this concept a few months ago. Their published piece on dermorexia features input from me as well as board-certified dermatologists, plus data that suggests a widespread and still-widening infatuation with skincare (for example, “subscribers to a popular Reddit thread, r/SkincareAddiction, increased more than 60% in the past year”). You can read it here.

Most of my interview with theSkimm didn’t make the final article, so I’m sharing my full conversation with editor Serena Mcniff below. Read on for more about the medicalization of beauty standards, the science behind the Brain-Skin Axis, and new research that seeks to categorize certain cosmetic use as a “substance-related disorder.”

Photo by Sinitta Leunen on Unsplash

---

Serena Mcniff: I'm curious about your thought process around this term and why you think that it's an apt term to describe the place that some women, and particularly young women, are in with regard to skincare and anti-aging. 

Jessica DeFino (me): I’ve reported on skincare and the expansion of the skincare industry for a while now, and based on a lot of the research I’ve come across, what strikes me the most is that modern, industrialized skincare is not actually very good for our skin. If you ask any dermatologist, they'll tell you that a simple routine is the best in terms of supporting skin health and function. We have a growing body of research now — now that the skin barrier and the skin microbiome are more of a focus — on how the skin actually functions and what it needs in order to  function well.

What I like to start out with is recognizing the skin is an organ. It's an organ that serves a purpose. It is part of our immune system. It is a protective layer, and it has a lot of essential functions for keeping us healthy and safe beyond what it looks like.  And basically, research shows that the more we apply modern skincare, the more we use all of these very excessive skincare products, the more we are wearing away at the skin’s inherent ability to protect us by disturbing the skin barrier and disrupting the skin microbiome.

So really, this obsession with skincare is detrimental to the health and functioning of our skin, which is why I I think it's appropriate to start looking at it as a sort of disordered obsession. Because in the name of reaching this aesthetic goal — what we think healthy skin looks like, or beautiful skin looks like, or “good” skin looks like — we're actually hurting our skin in the long term. I think it’s pretty similar to the way in which many eating disorders, though certainly not all eating disorders, are a response to the desire to embody society’s aesthetic ideal of “health” — thinness — in a way that's actually very detrimental to the health of the body.

So for me, that's kind of like the baseline; to ask, What is the goal of the skin? What purpose does it serve? and Is modern skincare enhancing that purpose? Is it helping us or is it hurting us? The answer is that it's hurting us, and still the skincare industry is growing bigger and bigger and bigger and reaching younger and younger and younger customers, whose skin is naturally more vulnerable because it's still developing.

I want to get back to the signs that you see that this is sort of everywhere. But I also want to talk briefly about something that you mentioned there, which I'm just struggling to reckon with a little bit. If we're talking about things like retinoids, retinol, acids, chemical exfoliants — how do you reckon with the growth of these kind of ingredients for skincare products grew out of dermatologists recommending them … Where is the line?

The line is hard to draw but a couple things are coming up for me. One is the idea that yes, dermatologists use certain ingredients in their practices when patients come to them, the same way that a doctor or nutritionist might recommend a particular medication to a patient, or recommend avoiding a food they have an intolerance to. The problem is pathologizing our skin to the point where we’re giving it medical treatment and medical-level interventions on a daily basis. Many popular skincare ingredients serve a purpose in clinical settings when there's a medical issue to address. Basically, what skincare culture is doing is framing our skin as an active medical crisis every day. We don't need medical intervention every day! The average consumer does not need prescription-level intervention every day.

If someone is experiencing a skin issue, it's sensible to go to a dermatologist, ask for their recommendation, and use the products they recommend, sure. But we have pathologized just normal, basic human skin to the point that we are medically intervening when we should not. These are very specific interventions that we've universalized. 

The other thing I will say is that dermatologists are people, and people are conditioned by beauty culture. And there are a lot of ways that beauty culture shows up in dermatology, the same way diet culture shows up in the medical system, right? So I think what's happening is doctors aren't spared from beauty culture, and we've seen a lot of dermatology practices veer from medical treatment to aesthetic treatment, which conflates those two things, and they are not the same. For example, if you go to your dermatologist for your yearly skin cancer screening — which I of course recommend — you'll typically hear about potential cosmetic interventions that you can undergo at the same office, like Botox or filler. So we're really seeing this merging of  medical care and aesthetic standards. I think the line is very hard for dermatologists to determine as well, because we live in a very beauty-centric culture and those standards really permeate all levels of society. We see this in the medical system too, again, with fatphobia, and using BMI to measure health when it’s not an accurate measure of health, and recommending weight loss surgeries that are actually harmful to a lot of patients.

The third thing that I would say there is, I think it's helpful to re-contextualize skincare as any other sort of beauty treatment. A lot of things that we use on our hair or our teeth, for example, are meant to achieve an aesthetic goal, not a health goal, and I think it's really hard to understand that with skincare because the word “care” is right there. But for instance, think of blow-drying your hair, getting a blowout. We know that blowouts lead to heat damage over time, yeah? But we want that aesthetic anyway, right? The goal is not health, the goal is the look. I think teeth whitening is a great example of this too — teeth whitening strips are terrible for teeth. They wear away at enamel, they increase sensitivity. But they help us reach a look that society celebrates: white teeth. Skincare is very much the same. If we're looking for this sort of ageless, poreless perfection — that's not a health goal, that's an aesthetic goal, and meeting it actually compromises the health of the skin much like teeth whitening strips compromise the health of the teeth.

That makes sense. What signs do you see that that our obsession with anti-aging skin care has gone too far?

I  mean, I think just the fact that it's become this all-consuming source of fear and anxiety is probably a telltale sign. We're seeing data come out all over the place that indicates anti-aging being a bigger priority across age demographics, whether that's a 60-year-old woman who’s hit with all these Facebook ads or a 10-year-old girl on TikTok suddenly consumed by fear of having wrinkles in 20 years and starting a daily regimen  to prevent that. I think all anti-aging stuff is disordered in a way. It’s a nonsensical goal. You cannot anti-age. If you're lucky, you get to grow old. Wrinkles come with the territory. And I think this obsession with stopping time and making sure you don't look as if you're growing older is disordered, especially when you look at all of the products and procedures we use to meet this nonsensical goal. We’re throwing billions and billions and billions of dollars into this industry, so we are losing a major source of economic power — our money — and we're sacrificing it to the pursuit of this unmeetable goal, right? We're willing to forego rational thought for the hope that we’ll never look as old as we actually are. We’re willing to risk all of these potential health issues and side effects that come with products and procedures too. It’s very irrational and illogical on the health and wellness level.

I saw this article in Bloomberg recently that was talking about longevity undertones in branding — kind of what I was saying about the ingredient-first branding and people being familiar with like terms like niacinamide. Do you think that that is one of the signs?

Yeah, I think we can look at it in terms of like something like orthorexia, which is already established as a disorder, and we have a bit more like data as far as what to look for, and can draw some comparisons there. This obsession on the ingredient level — with being a walking encyclopedia of skincare ingredients, and scientifically knowing how each ingredient is going to manipulate your appearance — that's sort of a justification that we can use, right? This is a justification where we absorb all of this knowledge about our obsession as a way to assert its importance — as a way to imbue this illogical thing with a certain type of logic. Think of it as someone with disordered eating obsessing over calorie counts or grams of protein per serving — it’s using science to rationalize a compulsive behavior, even to create a compulsive behavior. The focus on the science of skincare ingredients is also an attempt by the industry, and by the individual, to really intellectualize beauty standards as a way to justify adhering to them.

I agree, but I do think in some ways, there are some good elements to like the simplification of products down to their ingredients.

There are benefits to it and there are downsides to it. I think it would be much more beneficial if people wanted to gather all this knowledge about skincare but were actually learning about their own skin and bodies, rather than products they can apply to them. If we all did that, this this issue would kind of be moot because we would realize, Oh, most products out there are disrupting the skin barrier and the skin microbiome and we don't even need to bother learning about them.

Of course there are positives to really niching down into ingredient data in terms of sustainability and in terms of safety. But again, there's a line there. It's same with diet culture, you know — you can strip food down to these certain things... Gluten can cause inflammation, or a certain preservative can trigger a reaction, or whatever, and that knowledge is very useful to a certain set of people. But when it becomes an obsession, where you are worried about the purity of your ingredients or the efficacy of your product above all else, that kind of micro-knowledge can enable disordered, obsessive thinking. It really is hard to draw the line because there are useful things about knowing what's in our products in terms of sustainability and safety… but I'm not really seeing too much of that. I'm seeing an obsession with how it will affect our faces and bodies aesthetically.

In terms of factors that contributed to this — how do you think we got here? I was thinking about Get Ready With Me videos and social media and just beauty culture, celebrity culture, all of those being factor. What do you think are the main things that contributed to this?

There is so, so, so much. It's kind of hard to pinpoint. I do think social media and Get Ready With Me Videos have a lot to do with it. Especially celebrities on social media. Maybe 20 years ago, 30 years ago, you would expect a certain standard of beauty from a celebrity, but that wasn't necessarily expected of the average person, right? Now that we can see celebrities in their everyday moments on Instagram, and average people are posting their highlight reels on Instagram and can become celebrity influencers themselves, the same beauty standards apply across the board. There's not really a difference in what's expected of a celebrity in terms of anti-aging procedures and what's expected of like, your college roommate. We're all kind of undergoing the same procedures — injectables especially — and using the same products and expected to meet the same standard of beauty. 

In terms of anti-aging and why it's catching on with a younger cohort, I do think a lot of it has to do with social media filters, photo editing apps, things like that — like Instagram Face. Looking like a digitally-enhanced version of yourself and anti-aging have a lot of overlap in terms of the standard that’s set — poreless, ageless, no fine lines or wrinkles, no texture on the skin. A lot of young people are attempting to look more like their filtered photos, and anti-aging products are helping them meet that ideal. So it's maybe not necessarily an obsession with aging so much as an obsession with emulating their digital avatars in real life.

Yes, and health and wellness too. Just overall, the idea of no-makeup, makeup and that you should just radiate this beauty. 

100%. I mean, if you look at the wellness category, so much of it is just how to look well, which is really beauty. That’s the beauty category or, you know, I like to call it the appearance category. I think calling it beauty is very misleading. All of this is about appearance, right? So yeah, with the rise of wellness culture, you see the rise of skincare culture and cosmetic surgery because the end goal is looking “well.”

I think there's some more overlap with diet culture, eating disorders, and orthorexia if we zoom out a little bit and look at the rise of body-positive content, or at least, the decline of body-negative content. Maybe 10 years ago or so, we really saw this strong surge in body positivity where it was suddenly taboo for a women's magazine to be like, Here's how to lose 15 pounds. And as we saw those weight-centric methods of controlling our appearance become taboo for the women's media to include in their coverage, we saw the rise of beauty culture and skincare culture specifically. Skincare culture rose up to take diet culture’s place in women’s media. As we were consuming content about loving your body, body positivity, fat activism, all of this, we were relocating those obsessions to our skin. The underlying obsession — control of the body and conformity — was relocated above the neck, and never dealt with in any real way.

Unfortunately, I think that’s what’s given us the tools to justify diet culture again, in terms of calling our own physical manipulation “empowering” and an act of “body autonomy.” These are phrases we see associated with skincare and cosmetic surgery all the time. All of these nice-sounding words that we use to describe skincare culture, we're now seeing them be applied to the body again — I’m thinking of Ozempic and how “heroin chic” thinness is back, and people are taking out their butt implants and their breast implants. I really think that skincare culture specifically gave us the language to justify these harmful behaviors elsewhere again.

Why does this matter? What are your thoughts on how spending this much time and money on skincare and feeling pressure around anti-aging actually affects people, and why it is something that we should be paying attention to?

It matters on so many levels. There's obviously the physical level — we are damaging our skin. We are damaging its immune functions. We are damaging its ability to protect us in the name of meeting this aesthetic goal. Studies show that over-using skincare over time can lead to all sorts of inflammatory disorders or trigger underlying disorders. An impaired barrier can’t adequately protect us against skin cancer. So on a physical level, that's  a problem.

On a psychological level, we're often told that “skincare is self care” — that by using skincare, we're caring for ourselves, that this is healthy, that this is part of wellness and confidence and self-love. But the data shows the exact opposite. We are seeing higher instances of appearance-related anxiety, depression, facial dysmorphia, body dysmorphia, obsessive thoughts, obsessive behaviors, self-harm, and even suicide. These things are all associated with the pressure to meet a standard of beauty that is unrealistic and inhuman.

What it comes down to is basically this: these habits are not enhancing our lives. These products are not enhancing our lives physically or psychologically, long-term. We just have to stop pretending they do. I mean, if people are armed with all of this data and understand how these products and procedures are affecting them physically and psychologically and they still want to go ahead and do it, whatever. I just think it's a matter of public health that people are armed with information on what's actually happening. And what's actually happening is that we are becoming more anxious, more depressed, more dysmorphic, more self-hating. Our skin is getting weaker and less able to protect us. It just doesn't make sense on any level.

But at the same time, people often carry out these behaviors despite knowing better. “I know my skin doesn’t need these products, but they’re part of my self-care routine,” a source told me while I was reporting an article on how skincare products damage the skin. Another said something like, “I know it’s irritating my skin, but I just love the ritual of skincare.” These justifications suggest disordered behavior — an inability to act rationally, despite the presence of rational thought.

I want to point out that I'm not a doctor, obviously. I am not trying to diagnose the masses, but I do think it's important as a reporter to point out these trends and similarities when I see them, and help bring them into the public consciousness — so hopefully there will be more research in the future on whether this could be considered clinically disordered or compulsive. The precedent is there. For instance, in 2021, a research paper came out categorizing repeated cosmetic procedure use as a "substance-related disorder” — so I do think there is scientific precedent here to look into the obsessive, excessive use of cosmetics as disordered. 

Totally. Is there anything else you're thinking about within this that you think is interesting?

There are a couple things that are coming to mind. I was recently researching for another story and I saw a survey of teens about body image. And the highest ranked “problem area” — the part that teens said they don't like about themselves — is now their skin. Weight was ranked underneath skin. And so I think we can really see how this cultural obsession with skincare is affecting us here. The more we're focusing on our skin, the more it's becoming a source of self-consciousness and self-hate, particularly for teen girls.

The other thing that I would point out is that there is an inherent link between the skin and the brain. The Brain-Skin Axis. This is the basis of the field of psychodermatology. It's the basis of the rise in the “neurocosmetics” market. There is a real, scientific, deeply-studied link that shows things that happen in our brain can affect our skin. Blushing is a good example of that, or breaking out in a nervous sweat. And things we do to our skin can affect our brain in return. There is a pathway there. We also see this through disorders like dermatillomania, which is skin picking, or dermatillomania, which is hair pulling. So I just want to point out that this brain-skin link is very clearly established, with decades of research behind it. It's not something that's coming up out of nowhere. These two things are deeply intertwined on a nerve and neuron and hormone level.

And it sounds like brands are trying to capitalize on that. 

Yes, and they're only pointing out the positive connotations between this brain-skin link, but I think it's really important to note that if the brain skin link is powerful in positive ways it can also be powerful in negative ways, and those ways deserve just as much — if not more — attention from the beauty industry, from dermatologists, from psychiatrists.

---

This interview has been edited and condensed for clarity.