Skin Deep (House)

"Skin Deep (House)"

"Skin Deep" is the thirteenth episode of the second season of House, which premiered on the Fox network on February 20, 2006. The episode aired in a special Monday night time slot. In this episode, the team treats a teenage supermodel who collapsed on the runway. Meanwhile House deals with a sudden increase in the amount of pain in his leg.

Plot

Dr. House treats a teenage supermodel, Alex (Cameron Richardson), for heroin addiction and uncovers startling secrets about her. Meanwhile, Wilson hopes that House's increased leg pain indicates that his leg nerves are regenerating.

Before falling on the runway, Alex complains of nausea, experiences double vision and disorientation, and lashes out at a fellow model who tries to assist her. In the hospital, she begins to sweat profusely. The team assumes that she is suffering from heroin withdrawal, along with other hypotheses: juvenile multiple sclerosis and Parkinson's syndrome. To confirm what is wrong, the team treat Alex with opioid antagonist drugs and induce a coma in order to relieve the extreme pain of this treatment.

While in the coma, Alex suffers from some sort of cardiac complication and afterwards displays anterograde amnesia, or the inability to store new information in the long term memory. House is convinced that she is suffering from posttraumatic stress disorder resulting from sexual abuse from her father (Tom Verica). To find the cause of the complication, the team conducts a lumbar puncture which show protein levels in her cerebrospinal fluids. After being confronted by House, the father admits he had sex with Alex "one time".

House orders a brain biopsy, which reveals no white matter disease, leading the team to start focusing on the cerebral cortex. House suggests paraneoplastic syndrome, in which the body reacts against cancer by making antibodies against the tumor which accidentally attack the person's own body instead, causing symptoms such as weakness, memory loss and problems with coordination, as such matching Alex's symptoms to an extent. After taking IV immunoglobulin, which stops the antibodies, Alex stops twitching. As such, the team runs a series of tests, looking for a tumor, but finds none. The team is at a loss again.

When Cameron confronts Alex about denying her father's abuse, it turns out that Alex deliberately seduced him in order to get what she wanted. Cameron, disgusted, tries to tell Alex there are other ways to do things because she is young and smart. Alex tells her that she's not that smart but that she is that beautiful.

House finds the correct diagnosis when he is treating a clinic patient, a man with excess estrogen having a sympathy pregnancy for his wife. After getting an MRI of Alex's pelvic area, he determines that Alex has male pseudohermaphroditism (specifically, androgen insensitivity syndrome, also known as testicular feminization syndrome), and the tumor is located in her testes which, due to the syndrome, had never dropped. As the surgical removal of the tumor is set, a consult with a psychiatrist is scheduled as well, for Alex to cope with the discovery of the complicated nature of her gender.

House is also noted saying "the ultimate woman...is a man", alluding to the fact that Alex's condition allows only female hormones to be produced and allowing Alex to develop the desirable characteristics of women, such as large breasts and clear skin, and to the fact that she does not menstruate. This is also an ironic parallel to the condition of the clinic patient, whose wife complains that her husband is not helping her through labor due to his own "pregnancy". House had commented to her that "You've got yourself the perfect man - a woman."

At the end of the episode, House is seen in Cuddy's office asking to be given another injection of morphine for his leg. Cuddy then reveals that her first dosage of morphine was actually saline used as a placebo, which shows that House's loss of pain in his leg was psychological. Later, at home, House plays his piano (the Allemande from Bach's French Suite No. 5).

Story Arcs

• The series continues to reference the romantic relationship between House and Stacy Warner which was first mentioned by Wilson in the episode Sports Medicine (House)
• References are made to House not taking kindly to his team members, going over his head to his superiors (Cuddy and previously Edward Vogler), which has been a recurring theme throughout the series thus far.

Trivia

• The condition that his patient in the clinic suffers from gives House an idea as to the nature of the supermodel's problem.
• Cuddy gives House a placebo in place of the heroin that he requests, which mirrors House' decision to give Alex a placebo to check if she's subconsciously faking the abatement of her symptoms, the difference being that in House' case the placebo works, showing that the physical pain he is experiencing is of psychological origin.
• The physical pain in House' leg is attributed by Wilson to Stacy's departure from his life, which relationship has been a recurring theme in the series since the Season 1 episode Three Stories

External links

• "Skin Deep" at Fox.com
• "Skin Deep" at IMDb
• Template:Tv.com episode
• Review after watching this episode