Dermatillomania by Kat Williams
On a white hot Texas afternoon, I drill holes in the drywall, holes to fill with screws to secure a rack for my bike to hang on in my new apartment. A drill would be so handy, dermatologically speaking. Far more effective on stubborn nodules than a looped extractor. I pause the stream of sweat on my forehead with a grease-darkened rag and think of my organs as oil caught in the capacious pore of my body, infections inside the deepest sort of cyst. I imagine drilling through every dermal layer, through muscle and fat into my liver or gallbladder or lung. This would bring relief, I think. But not even a power drill is powerful enough to purge the most tenacious impurities.
A daydream of elbows, of the spot behind the earlobe, of the line where chin meets neck. Of caressing these with the slightest, lightest fingertips. Of unearthing treasure: a trove of whiteheads, the beginnings of cyst, a mature pustule.
A wet dream of sedating a lover and bearing down on each forbidden pore. I wake up slick, and imagine securing the tip of a blackhead between the tweezer’s curved blades, of hearing the dense darkness of sebaceous filament slide out with a slick thwock.
I have spent so much time intently squeezing skin, not to mention those hours lost to daydreams. Ask any dermatillomaniac—they wish they had more time. More time to search the skin. To squeeze and peel, to excavate and drain.
There is never enough time, is there?
Dermatillomania, or excoriation disorder, is defined by the DSM-5 as a mental illness related to obsessive compulsive disorder, falling within the family of body-directed repetitive disorders. Its hair-pulling cousin, trichotillomania, is perhaps the better-known disorder. Dermatillomania itself is defined as “repetitive and compulsive picking of the skin which results in tissue damage.”
Psychologists argue that skin excoriation is the enactment of a problematic need for instant gratification. Skin pickers have satisfaction issues, they say. But I maintain that the average dermatillomaniac is uncommonly patient and calculated. She waits until the prey is fully grown and screaming Pick me! to pounce.
My last boyfriend—fiancé, actually—gave me gloves to wear at night, during prime picking activities: eating, reading, writing. He reminded me to put them back on whenever he saw me slip them off for a quick scratch. He saw the picking and resultant scabs as a problem to be solved. I saw the picking as solution, a simple one: flatten the surface of the body. Purge the oils, the dirt, the pus.
Not solution, really, but salvation.
And the allure of possession. How can one feel those tender points of tension beneath their fingertips and not think: mine? Those who see a pore begin to expand, watch it distend hotly yellow for days and then slap a Band-Aid on it strike me as unwell, victims of a psychosis that renders them incapable of acknowledging their deepest desires.
How else can one so easily achieve their dreams?
I have a recurring dream, one in which I squeeze my breasts the way one attacks the stubbornest cysts. I push and knead until every bit of fat and tissue exudes out from the nipple. Before I wake, the wounds are healed to small red scabs in the center of each areola.
I told this to the gender therapist I used to message online. Did you draw some meaning from the dream? she asked. Do you think it relates back to your uncertainty about top surgery?
I just wish it were that easy, I said. A hard squeeze and they’re gone.
Did you know that biological sex cannot be determined by examining a swath of skin? All epidermis scars the same.
In a lavender-scented bath, my fingers tap the tub’s acrylic as I wait for the skin’s defenses to soften and melt away. In water, a pore under pressure never quite bleeds, because the blood cannot accumulate. It dissolves into the clear.
The presence of blood is just one way pathologized skin picking, or dermatillomania, gets distinguished from merry, benign pimple popping. The disorder is indicated by the compulsive excoriation of sometimes even blemish-free skin, digging that results in oozing wounds. Wounds where none would have otherwise been.
When you see blood, you know you have a problem.
When you see blood, you know you are getting to the heart of things.
There is a dermatologist in LA, a woman named Sandra Lee. She is more widely known as Dr. Pimple Popper. She has 2.5 million followers on Instagram; her most popular YouTube videos have been viewed more than 10 million times. A fan of her accounts, or “popaholics,” will occasionally come across a picture of the woman herself: she is as lovely, thin woman with high cheekbones, unlidded, darkly outlined eyes and silken black hair whose pride in appearance is made clear through well-applied makeup and shining teeth. Her teeth complement her white, white coat. She looks more or less like a hot dentist.
Though her beauty is striking, she does not rely on looks for follows—only her hands and hooked extraction tool make regular appearances in her videos. Her physical appeal is secondary to the beauty of her pops and squeezes. She is not a cult of personality, but a cult of content.
Her videos and .gifs feature pustules the size of postage stamps, blackheads that emit masses of dirt and residue not unlike Tootsie Rolls. Thick “waterfall”-style pops resemble silky, knotted scarves plucked from the depths of a magician’s sleeve. Popaholics recognize repeat clients with noses like minefields and cry out in the comments for more of Mr. Wilson or The Fireman!
In a recent post, she writes, We all have issues, but popping pimples isn’t one! This is in response to the haters, the ones who look away when scalpel parts skin and jokingly shudder You need therapy to their giddy Popper friends. But the post also serves to exclude—fascination is welcome until it cedes to compulsion, harmless until voyeur becomes participant.
There is some irony in how Dr. Lee has turned her account into a platform for the sale of products like anti-acne serums and blackhead-clearing scrubs, as Lee must know that a contingency of her fan base, riled up by all the close-up, anesthetic-enabled depressions, resort to less patient measures than her branded comedone extractors. Measures that leave skin worse for wear.
Fingernails are not the only unauthorized tool, of course, though they have the advantage of access, availability. I have taken the tips of extra-sharp precision tweezers to an ingrown hair on my thigh, an excavation so deep the blue shadow of its presence remains. I collect mini sewing kits from fancy bathrooms so I can unsheath the needles on a persistent little cyst just inside my right labia majora. That one once turned blue, too, from all the bloodletting below the surface. But only a week passed before the bruise dissipated into a natural pinkish red, giving clearance to further pricking. I own a medical-grade lancet for what sewing needles fail to yield.
Pore strips are far less damaging but expensive, and they disappoint with the shallow depth of their reach. They remind me that there is a limit to what I can access.
As a young child, I would daydream about paring away at my fat with a special pair of scissors, scissors with safety blades that slide thickly through flab. The adipose slabs fell from my body cleanly, bloodless, and sat beneath me like cut hair on the barbershop floor. The result was just me, but thin. All wounding was magically cauterized, erased.
When I daydream now my fat is gone, but so is most of my skin. Muscle fibers in my legs and arms bulge wetly; the viscera of my torso glistens and steams. Eventually the body will bleed all the way out, but I don’t picture that imminence. Instead I imagine myself as a medical dummy of sorts, a human turned inside out. My face a skeletal shadow of the one I see in the mirror, there is little left to excavate.
I think of myself like this and feel something close to beautiful.
Excoriation remains the best way for me to engage in self-injury without doing much damage, relatively speaking. I have never mentioned my skin picking to a therapist or medical professional. The compulsion is a low priority on my list of less-than-desirable behaviors. While vomiting ruined my thyroid function and the dentin layer on my molars, while burning my ankles and wrists with candle wicks turned flesh green until it stunk with rot, while failing to eat at all eroded my bones and put me at risk of heart failure, picking at pores causes nothing but pinprick red scars that fade quickly to pink, then light brown, then white. As harmful as a freckle.
The real issue is that these freckles and their fresher, bloodier predecessors are far more visible to others than the slow but sure winnowing of bone. The punctures and cuts and scabs and scars are embarrassing, unsightly, yes. Especially those on my face, which can’t be covered with clothing. Makeup can conceal their color, but not the textured pocks they leave on my chin, my cheeks, the tip of my rounded nose. I know and accept that I’m causing damage.
Skin picking demands little secrecy—I can worry a follicle on my cheek while ordering coffee or waiting for the bus. My hair is closely shaven, almost a buzz, and I find ways to dig oils out of my scalp’s pores. Friends and partners and sometimes even strangers watch my hand move across my face or shoulder blade or elbow, then reach for my wrist and say You’re hurting yourself. More than one overweening woman in line behind me at a coffee shop has tapped me on the shoulder to declare that I am bleeding profusely from the top of my head.
Oh sorry, I respond, removing my fingers from the wound and taking a step back, as if to hide. Instead of sorry, I want to cry, But I could hurt myself so much worse. We are indifferent to the pain of others until that pain rises to the surface, until it manifests itself concretely.
When the heart is exposed without context, the ragged flesh glows like an alarm, and others are compelled to care.
My boyfriend told me he needed a break from sex. He demurred for days when asked why. Finally he admitted to the presence of an ingrown hair on the shaft of his penis. It hurts to touch, he said, but I was afraid to show you because I knew you'd get all weird about it. Obsessed.
I shined my phone’s flashlight on it to get a better look. The hair was deep and the pore swollen with benevolent pus, buttercream inside a halo of pink. A little needle prick, I said, and the infection will dissipate. You'll be good as new in less than a day.
I'm not letting you stab my dick with a needle.
It won't really hurt, I said, running my fingernails over the bump, depressing the tautness as much as I dared. He flinched. Not more than touching it does. Anyway, it has to hurt more before it hurts less.
He left town for the weekend and at night, I dreamt of him coming home to me with the bump ready to burst. He rushed me into the bathroom the way he does when he wants to fuck me from behind without getting me wet first. He pulled his cock out of his boxers and there the cyst gleamed pulsating warmth from one hot point. I ran a sewing needle through a butane flame and hovered over the pustule. Hands shaking in ecstasy, I slid the sharp end into the beautiful pale yolk.
My need to purge my skin of aging dirt and oil is not unlike my need to rid my digestive system of the fats and carbohydrates and perceived toxins in food. The metaphor shared by skin picking and vomiting is relatively obvious to me: both are ways of arriving at a fresh start, a clean slate, a purified body.
I have wondered if my desire to remove my breasts is a continuation of this compulsive purification. I sometimes believe removal will radically diminish my depression, my anxiety, my overall psychic pain, but then I think of my skin, and know that delightfully dead flesh is always replaced, that not long after the oozing has stopped, another pore begins to spout. I am afraid of the stillness top surgery may bring because I fear a new type of pain will flourish atop my flattened chest.
What is enough?
It has to hurt more before it hurts less.
Kat Williams is a dog parent and writer living in Austin, TX. They received their MFA from the University of Wyoming. Their chapbook, What You Have Left Is Me, is forthcoming from Cutbank.