Why skin is the forgotten frontier of the beauty acceptance movement

I was 18 when I developed psoriasis. What started as a constellation of tiny red dots on my torso quickly spread,becoming entire islands of angry red patches that covered my body from the neck down. A late bloomer,I was awkward and slightly overweight,experiencing a phase most of my peers had already gone through years earlier. With all the idealism and naivete of a teen,I had envisaged my high school graduation as a time of reckless abandon and self-discovery. Instead,I spent my Schoolies week in hoodies and long pants,and the rest of that summer mostly holed up in my bedroom.

At 18,I had already been struggling with depression since my mid-teens,but the appearance of psoriasis sent me spiralling. I gave myself second-degree burns wielding an at-home treatment device that promised to clear psoriasis and scrubbed away at my skin in vain with all manner of exfoliators. While my psoriasis is no longer severe – in part due to my dermatologist and a proper treatment plan – the experience has left an indelible mark on my understanding of beauty and selfhood.

The beauty industry has yet to embrace skin diversity,and the consequences are grim for people with skin conditions.

The beauty industry has yet to embrace skin diversity,and the consequences are grim for people with skin conditions.iStock;Bella Management

Many studies have shown a clear link between skin conditions and mental health. Arecent study that surveyed literature on psoriasis between 1946 and 2017 found that sufferers were more likely to engage in suicidal ideation and exhibit suicidal behaviours. Anotherstudy inThe British Journal of Dermatology found that 63 per cent of those diagnosed with acne suffer from depression within the first year.

Dr Annika Smith,a dermatologist at the Skin Hospital and senior lecturer at the University of Sydney specialising in psoriasis,says that psoriasis sufferers can get caught up in a self-fulfilling cycle of depression and anxiety. “Having a skin condition itself is stressful,” she says. In turn,this stress can “impair or exacerbate inflammation”.

The effects of the condition,she says,can be wide-ranging. “It affects how one feels about oneself and interacts with the world,” impacting sleep,work,and social perception.

Rachael Wilde,founder of tbh skincare.

Rachael Wilde,founder of tbh skincare.Supplied

In treating psoriasis,Smith says dermatologists take a holistic approach,taking into account the “psychosocial and psychological wellbeing of sufferers”. The DLQI (Dermatology Life Quality Index) is an assessment tool commonly used in the field to gauge the impact of a skin condition on a patient’s life. The improvement of psoriasis often develops in lockstep with improved mental health,she says,which in turn is reflected in the DLQI.

Rachael Wilde,26,suffered from acne from a young age. During her teen years,she felt incredibly low and struggled to get out of bed most mornings for school. “I struggled to make friends,” she says. “People who haven’t experienced acne before don’t understand just how isolating it can feel.”

“It’s a hard thing to do when you become so hard-wired about covering up your skin for so long.”

Wilde founded the successful skincare brand tbh,which often reposts images of customers on social media with their bare skin and blemishes. She attributes this to their very vocal base of Gen Z customers who she says are demanding greater representation from brands than generations before. “I think that it has really been a bottom-up movement where customers have demanded a more balanced and more realistic portrayal of beauty.”

The acceptance of different skin types,and the language around how we talk about skin,trails behind other movements,like body positivity. Beauty writer Jessica DeFino agrees,saying that skincare still has “a lot of catching up to do.” What’s missing,she says,is a challenge to the idea of “healthy skin” or “normal skin”. “The body positivity movement has benefited immensely from challenging the idea that fat equals unhealthy. The skincare space needs to have that same reckoning in order to move forward with a meaningful movement of acceptance.”

Model Onella Muralidharan wants there to be greater awareness of conditions like vitiligo.

Model Onella Muralidharan wants there to be greater awareness of conditions like vitiligo.Bella Management

Onella Muralidharan won Bella Management’s Unsigned Model Competition in 2021. The 23-year-old curve model has vitiligo,a condition in which parts of the skin lack pigmentation,and says she never thought she would be a model. “I’m curvy,and I have a skin condition that is quite apparent. I didn’t really feel like I hit those beauty standards.”

While she says she never really struggled with accepting her vitiligo,she certainly faced judgment from the outside world. “When I worked in retail,customers would come up to me and ask,‘What happened to you?’,‘What’s on your face?’” She adds that the most ignorant comments have come from adults,rather than children. “Fully grown adults often feel like they’re entitled to an answer from people who look different.”

The fashion industry is slowly changing,she says. She has featured in campaigns for beauty brand Mecca,appeared on morning showStudio 10,and walked in Australian Fashion Week. Makeup artists will consult her about what’s she comfortable with,and adapt their use of makeup to her needs. “I don’t want my different skin tones covered up,” says Muralidharan. “Mum put some foundation on me when I was about 7,and after that,I have never wanted to cover it up.”

For Muralidharan,the key to spreading acceptance for conditions like vitiligo is education about what it is and how to act considerately around others.

Visibility for a range of skin conditions is certainly growing. Celebrities likeKim Kardashian,Cara Delevigne andCyndi Lauper have been open about living with psoriasis.Kendall Jenner has walked the red carpet with acne andAlicia Keys has forgone makeup altogether. This kind of visibility is important,says Smith,to “enhance public understanding,break barriers,minimise social stigmatisation,discrimination,and humiliation.”

It’s impossible,however,to consider the importance of these celebrity stories without accounting for the immense privilege they hold. They all fit a certain beauty ideal and have a level of wealth that gives them access to top-of-the-line beauty products,treatments and medicines.

Cara Delevigne chose not to cover her psoriasis at the 2022 Met Gala.

Cara Delevigne chose not to cover her psoriasis at the 2022 Met Gala.Getty Images

“It’s much easier (and therefore less effective or revolutionary) for celebrities and influencers who conform to traditional beauty standards in other ways – white,thin,pouty lips,wide eyes,youthful-looking – to reveal a perceived ‘flaw’ and still be considered beautiful,” Defino says.

Rather than only slightly widening the goal posts to include a privileged few,we need to create a world without any such goal posts at all.

Lifeline 13 11 14.Beyond Blue 1300 22 4636.

Make the most of your health,relationships,fitness and nutrition with our Live Well newsletter. Get it in your inbox every Monday.

Lauren is a lifestyle writer at the Sydney Morning Herald.

Most Viewed in Lifestyle