Skin Deep (House episode)

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House episode
"Skin Deep"

Episode no.	HOU-213
Airdate	February 20, 2006
Writer(s)	Russel Friend & Garret Lerner & David Shore (teleplay) Russel Friend & Garret Lerner (story)
Director(s)	Jim Hayman
House Season 2 September 2005 - May 2006
Acceptance Autopsy Humpty Dumpty TB or Not TB Daddy's Boy Spin Hunting The Mistake Deception Failure to Communicate Need to Know Distractions Skin Deep Sex Kills Clueless Safe All In Sleeping Dogs Lie House vs. God Euphoria, Part 1 Euphoria, Part 2 Forever Who's Your Daddy? No Reason
All House episodes

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.

1 Synopsis
2 Diagnosis
3 References
4 Trivia
5 External links

[edit] Synopsis

Spoiler warning: Plot and/or ending details follow.

Dr. House treats a teenage supermodel for heroin addiction and, in the process, uncovers startling secrets about the girl. Meanwhile, Wilson hopes that House's increased leg pain indicates that his leg nerves are regenerating. Alex, the supermodel, is played by Cameron Richardson.

A fifteen year old supermodel, Alex, complains of nausea before getting on the runway and is given a Valium and some champagne by her father to ease her ill feelings. She finally goes down the runway, but when returning, starts stumbling, experiencing double vision and disorientation, and lashes out at a fellow model who tries to assist her, slapping her then punching her off the runway's side. As she continues, she collapses on the floor, eyes still open.

In the hospital, another symptom is acknowledged: she has sweated profusely for the past few days, besides general nausea. Having the drug screen turn out positive, 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, it is decided to put Alex into rapid detox, involving medically inducing a coma and feeding her body Naltrexone, which will block the opioid receptors and accelarete the process. While potentially dangerous, this allows for the detoxing process to occur overnight.

While in the coma, Alex suffers from some sort of cardiac complication and afterwards displays faulty short term memory (as evidenced in a dialogue with Chase and her father in which she repeats herself), the second of which is interpreted by the doctors as possibly being a consequence of the first (due to oxygen deprivation resulting in brain damage), except for House, who is convinced that she is suffering from Post-Traumatic Stess Disorder resulting from sexual abuse from her father. To determine which of the two, he orders an MRI and a Lumbar Puncture. The MRI is however impossible to complete as Alex develops a muscle twitch, while the LP reveals increased protein levels in her cerebrospinal fluids. These suggest she might have one of a series of brain diseases, such as viral encephalitis, cytomegalovirus and Creutzfeldt-Jakob Disease. 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 grey matter. Foreman suggests a series of different neurological diseases while House suggests paraneoplastic syndrome, in which the body reacts against cancer by making antibodies against the tumor which accidentally end up attacking 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. House's diagnosis is supported by the fact that when given IV immunoglobulin, which is expected to stop the antibodies, Alex stops twitching. As such, the team runs a series of tests, looking for a tumor.

Doubt is cast when no such tumor is found. However, when dealing with a clinic patient — a man with excess estrogen having a sympathy pregnancy for his wife — House has an insight into Alex's case. 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 come to drop and had not been predicted. As the surgical removal of the tumor is set, a consult with a psychiatrist is as well, for Alex to cope with the discovery of the complicated nature of her sex.

[edit] Diagnosis

Androgen Insensitivity Syndrome

[edit] References

[edit] Trivia

This is the only episode of House to start with music playing.
This is the first episode in which we actually see House's right leg. After he has asked Cuddy for a shot of morphine, he lowers his pants and shows her his leg, saying that he is in unbearable pain.