Racked is no longer publishing. Thank you to everyone who read our work over the years. The archives will remain available here; for new stories, head over to Vox.com, where our staff is covering consumer culture for The Goods by Vox. You can also see what we’re up to by signing up here.

Leviticus says a lot of things, most of which we blessedly don’t have to listen to anymore, if we ever did. But it’s a reminder that attention has always been paid to skin. According to Leviticus 13:3-4, if you had a zit, you were quarantined for a week, and if it was worse, you had to burn your clothes or were kicked out of the neighborhood. If you squint, you can maybe see how fear of infection and disease led to such practices. It’s not fair, but it’s there. Zits have been a sign of not just hormones or genetics, but moral turpitude.

We know, individually, that skin cannot be “bad” or “good” — or, at least, we should

Like you, I have seen the rise of skin care. I’m not sure what caused it. Maybe it’s white people exoticizing elaborate Korean routines, once again assuming there is some “ancient [nonwhite culture] secret” the rest of the world has been hiding from them. Maybe it gives us a sense of control in an increasingly chaotic political world. Maybe it’s because a generation of prominent writers have hit their 30s and have noticed their cheeks losing the plumpness of age 26. It’s probably all that and more, but I, too, have been inspired to ask my grandmother why her skin looks so good (genetics and sweet almond oil).

We know, individually, that skin cannot be “bad” or “good” — or, at least, we should. But talk to any dermatologist, makeup artist, or skin care enthusiast and the phrase “bad skin” will come up. There are “bad skin habits” to avoid, and bad skin is something that must be dealt with. In some ways, it feels too obvious to even unpack. “Bad skin” is blemished, with zits or cysts or rashes, and often painful. And since one of the main drives of humanity is to avoid pain as much as possible, of course we’d do what we can to clear those things up.

But the basic language of making skin about “good” or “bad” ties it to morality, to our souls and the very idea of virtue. I hated the pain of a particularly memorable eighth-grade zit, sure, but more than that, I feared the ridicule and the stares, that boys would not be attracted to me (they already weren’t), that I would be burned and quarantined and outcast until I felt the Gusher-like pop of my skin and its sweet release.

We treat not just the skin as bad, but the person under it. The problem is even though drinking water and using SPF and getting sleep helps, some people are just more prone to cystic acne or seborrheic dermatitis, the way others are prone to thick hair or small feet. But that hasn’t stopped us from moralizing any of those qualities and seeking to “improve” our own condition with anything available. And those resources typically become more available the more money you have.

Skin is at once an organ and a presentation, an issue of medicine and of cosmetics. So *insert bad high school essay voice* since the dawn of time, humankind has sought to have “good” skin. Whether it was Romans using a paste made with barley flour, Indians changing their diets based on ayurvedic practices, or the French covering up smallpox scars and sores caused by the lead in their face makeup with beauty patches, we tried to either get rid of perceived blemishes or cover them up.

Since the dawn of time, humans have done that thing we do where we take something morally neutral (not wanting to have bleeding and oozing things on your face) and turn it into an issue of right and wrong

For Dr. Evan Rieder, an assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, the concept of “good skin” is mutable. “The first question you have to ask when you want to learn what good skin means is what it means to the patient,” he told me over the phone. For some, it’s a pristine, poreless face. For others, it’s living without the constant itch of eczema. “It’s different for different people; their complexion means different things to them.”

Also, since the dawn of time, humans have done that thing we do where we take something morally neutral (not wanting to have bleeding and oozing things on your face) and turn it into an issue of right and wrong. Skin is the largest organ of the body. But it’s also the most visible, and thus is subject to a lot more judgment. We do not see if someone has high cholesterol, osteoporosis, or gallstones, but we see pimples and wrinkles and dry patches. The same way “bad” teeth and weight are (incorrectly) interpreted as signs that someone is just not taking care of themselves, so is skin.

As with most cultural constructs, origins based on falsehoods lead to very real consequences (as anyone who has ever tried desperately to cover up a zit before a high school date already knows). “I’ve seen examples where people have taken their children out of pools because someone with an inflammatory skin condition is in the water, because they thought they were going to be infected,” says Rieder. And even though their judgment is coming from a fearful and ignorant place, it has real ramifications for the person in the pool.

Reddit is littered with stories of people feeling thoroughly unlovable because of their skin. Teens are bullied or develop low self-esteem. Studies have shown that prominent “facial blemishes” distracted interviewers and meant applicants were less likely to get a job, and that women who wear makeup (but not too much) are deemed more competent. People skip school, work, and social engagements because of acne.

“Sometimes stress makes eczema worse, and sometimes the mere fact of knowing you have eczema can increase stress levels and make it flare up”

According to Rieder, these stresses begin to form a cyclical relationship with inflammatory skin conditions. For example, eczema. “Sometimes stress makes eczema worse, and sometimes the mere fact of knowing you have eczema can increase stress levels and make it flare up,” he says. And if having a flare-up of eczema or acne results in suspicion and judgment, the stress is compounded. Which is why Rieder says he advocates for self-care not as a luxury but as an essential part of skin health. “People who have stressful jobs or kids at home, it makes it really difficult, but to maximize those areas will do wonders for your skin that a skin care regimen will be an adjunct to, but will not do on its own,” he says.

However, considering how common all these skin issues are, the question becomes why can’t we just all cut each other some slack? Who doesn’t suffer pimples and dull skin? The answer is, often, the wealthy, which is not to say that their skin is immune to problems, only that they have the resources to devote to it. They can afford to cover their teeth in veneers, spend thousands of dollars and hours with a personal trainer, and drop $450 on La Mer moisturizer and cortisone shots for their zits.

If wealth is our reward for a job well done and a life well lived, good skin becomes outward proof of goodness. Because we assume society is a meritocracy, we assume those at the top are there because they’ve done something right. And if they have straight teeth, toned bodies, and smooth skin, that must be “right” too. It’s not that we think having bad skin is a moral failing. It’s that we think poverty is.

One of the best parts of the current skin care craze is that on the surface, it’s available to everyone. Sheet masks and retinols can be found for cheap, and there are YouTube channels to hold your hand if a “mandelic acid serum” sounds terrifying. Drugstore products can have the same efficacy as $100 creams. “Good skin” can be had by all, and participation is also completely voluntary — though, like most things, that comes with a big caveat. Sheet masks may be cheap, but health insurance isn’t.

Unfortunately, the modern state of health care and dermatology often keeps the privileged dripping in serums. Dermatologists are still rare and are heavily clustered in big cities. “And even in some of these places, dermatologists don’t take the full panel of insurance,” says Rieder, “so if you don’t have top-notch insurance or if you don’t have insurance at all you may not be able to see a dermatologist.”

And even though we’ve all learned that the most common type of cancer is skin cancer, for many, getting a yearly skin check hasn’t entered into a regular medical routine the way going to the dentist or a PCP has. Dermatology as a whole is still seen as a luxury.

Rieder says some of that is the industry’s fault: “Dermatology is a specialty of medicine, but we haven’t done a great job of, especially in the recent years, networking with the rest of the house of medicine.” But it’s also because if you can only afford to go to one doctor’s appointment, well, acne isn’t going to kill you.

Acne isn’t going to kill you. But what doesn’t kill you can still make your life worse.

But what doesn’t kill you can still make your life worse. Poverty, or just not being rich, easily joins the cycle between stress and skin. Even if you have a stressful executive job that exacerbates your psoriasis, you are more likely to be in a position where you can see a dermatologist, afford treatment, and maybe destress by treating yourself to some nice products. But if that’s not available to you, whether by geography, class, or lifestyle, then your condition remains, you face social consequences for it, and the cycle continues.

We’re at the precipice of the democratization of skin care. While access to a dermatologist may still be out of reach for many, Rieder says the increasing acceptance of the concept of self-care can help people get a handle on inflammatory skin conditions. As with any revolution, it remains to be seen how far the democratization of skin care will go. If everyone had access to the same resources, would the concepts of good and bad skin disappear? I’m not sure. But in the meantime, eat the rich and bathe in their serums.