'We take it for granted.' Author Phillipa McGuinness on why we should think differently about our skin.

Phillippa McGuinness is the author of Skin Deep, a deep dive into the body's largest organ and how it makes us who we are.

The book takes a broad-ranging and rigorously researched look into every facet of skin: its purpose, its diseases, and its politics.

So, we decided to ask Phillippa about her biggest takeaways after writing Skin Deep, and how researching a book like this changed her thinking about her own skin.

Why were you interested in writing a book about skin in the first place? 

"I think it had probably been latent for a long time. But I didn't really realise until one day I was sitting in the waiting room of Eastern Suburbs Dermatology at Bondi Junction, which is a really large dermatological practice and it is always frantically busy, the waiting room is packed. 

But on this particular day, it was so busy that I couldn't see the view and found myself looking at my fellow patients. And I was there to have my semi-regular skin check. My background is Celtic and I grew up by the beach, mainly in the years before the 'Slip Slop Slap' campaign. So, I am very prone to skin cancer. And the skin cancers I've had have all been non-melanoma skin cancers, which people dismiss as being trivial.

And looking around at my fellow (mainly, but not entirely, white Australian) patients, it just seemed like everyone had had something hacked out of their face or their arms. People would have been there for skin checks, but also to get stitches removed or get biopsy results or whatever it might be, and I found myself thinking 'This isn't normal.'

We're all aware of the need to be careful in the sun, but the paradox is that we're a country that adores the sun, worships the sun even, reveres the beach, and loves hanging out in the great outdoors. And it's killing us – in some ways less than it used to, but it's costing the health system an absolute fortune every year. And we've completely normalised it.  

But the other thing that I'll throw into the mix is that, of course, not everyone was there just for skin cancer. There were teenagers there who were clearly there for acne mainly to get accutane prescribed and that is just agony for so many young people and yet it's dismissed and trivialised.

And of course, inevitably there would have been people there with eczema, psoriasis, you know, vitiligo – any number of other skin conditions.

And then finally, because of the world we're in (a fairly prosperous suburb that this is all happening in), quite a few of the visitors to that practice are there for aesthetic treatments – injectables.

So, I ended up thinking, 'This is a really interesting story' because we can read so much about ourselves through skin and each other – and often we don't even realise that we're doing it."

You write in detail about skin cancer in Skin Deep but what were your biggest takeaways from that research? Was there anything that surprised you? 

"One of the most striking takeaways was that, in many ways, the news is better than it has been for a long time. And this is because the incidence of melanoma, which is the deadliest skin cancer (though more treatable than ever before) in younger people is declining. And that's entirely because of public health campaigns – so that is good news. 

The bad news is, as a public health expert said to me, the 'No hat no play' campaign, all the caution that goes into sun protection, falls off a cliff when young people enter high school. 

It's not [considered] cool, you know? To wear a big hat and a rashie to the beach as a teenager or young adult.

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We need a whole new round of education campaigns that focus on high school students. Of course, there's only so much space in the curriculum, when kids are being told not to vape, not to binge drink and not to fall into online traps. So there are a lot of competing anxieties and I think, very often, that sun protection doesn't seem very pressing.

But I would love to see more resources going into education aimed at teenagers."

We have such a strong tendency to criticise ourselves for the blemishes on our skin, whatever they may be, and I wonder if learning about skin made you more compassionate towards your own skin?

"I got really swept up in the amazingness of skin as an organ. I read a lot about the physical properties of skin and the mechanics of how it works. And I just think it's extraordinary. Before I started, I hadn't even heard of the integumentary system, which is the system of the human body related to skin and hair and fingernails. We all know about the nervous system and the digestive system and so on, but I had literally never heard of the integumentary system, and found myself thinking 'Why not? It's so amazing.'

But I think that is the paradox of skin: we take it for granted. Until we stare in the mirror and look at a blemish or crinkles, or until we get a rash or rosacea, when we can't really take it for granted in the way that we might when everything is going fine.

I read and talk to so many people about appearance, whether that was to do with skin colour or skin conditions or perceived imperfections. What really struck me very often was how accepting we can be of other people, particularly other people in our lives – friends and family who we know and love and accept them no matter what. But we're so critical of ourselves and 'angst' over tiny things that, very often, the people around us don't notice. So there's that.

But there's also the fact that we're in a really unique moment in human history, where we are surrounded by images, including of ourselves, more than ever before. And that puts a lot of pressure on people, particularly young people, but I think it makes us more self-conscious about how we look.

Before, you might go to a party and there would be a couple of photos taken that would be printed in due course. And chances were, you would never see them. But in the digital age, you see them in real-time. And so often, I've noticed moments where I see someone look at a photo that's about to be uploaded to Instagram or whatever, and you can almost see them spiralling and I often want to say, 'You look great, you look fine'. 

But it does, I think, exacerbate and sometimes amplify a self-consciousness that we all feel at some point. The Instagrammable nature of everything – of every moment of our lives – can make it much worse."

Speaking of Instagrammable skin, you speak in the book about cosmeceuticals, skincare and injectables. What do you think about the way we attempt to alter our skin, and do you judge people or the companies who are trying to profit off that self-consciousness?

"I don't think the companies should be demonised and I really try hard to think and write about these topics without judgement – because it's very subjective. Sometimes I might get on my high horse and pontificate and say, 'It's just big companies or big corporations feeding on our anxieties and making us feel deficient, somehow, and vulnerable'. And other times, I'll be thinking, 'I really want to try that new lipstick, it makes me feel great. I love the colour.' And I don't think both of those things are incompatible... I don't think we need to completely eschew everything because these corporations are exploiting us.

If it gives you life, if it makes you feel good – why not? We've all got to get through the day.

However, when people become obsessed and other great things about being human and being alive are obscured because so much time and money is going into enhancement and improvement (whether it's surgical or allegedly non-invasive, or just spending so much time undergoing various treatments) – if it eats into everything else – that's probably not healthy. 

But to be honest, sometimes I look in the mirror and I think 'Phwoar, maybe I need to try a better serum' or 'Maybe I should have something a little more invasive done.' I haven't – but never say never.

Watch: The Mamamia team talk about the things they've learned about beauty and skincare below. Article continues after video. 

So, I think most of us know to a degree that we're being marketed to, we're being manipulated. But I just hope most of us have a sense of self to put it into perspective and realise that it's not the sum total of who we are – or who we want to be."

Have you changed anything in your own skincare routine as a result of researching this book? 

"I think I am even more careful in the sun than I was before. And I am more vigilant about not just putting SPF on my face when I go out, even when I'm just walking up the street to get a coffee or something. Of course, we need vitamin D, but incidental sun damage is a thing.

It's not in the book but I did a couple of makeup tutorial classes at one of the big cosmetics superstores. So that is probably something that really did change my everyday routine. Not that I'm necessarily wearing more makeup but I'm wearing it differently and using different products because, you know, I'm not of the YouTube makeup tutorial generation, so I thought, 'There's something here I can learn.'

And the third thing I learned through my experience is... retinol. I don't want to be promoting any products, generic or otherwise... But I think all those vitamin A products actually do work. And there's more evidence to show that they do than with about a million other products."

Phillipa McGuinness' book 'Skin Deep: The Inside Story of Our Outer Selves' is out now. 

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