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.

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 arm 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 so young. 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 doesn't 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).

External links

• "Skin Deep" at Fox.com
• "Skin Deep" at the Internet Movie Database
• "Skin Deep" at TV.com