Facing up to Dermatological Disease in the Cinema
I was recently watching an old film - “American Gigolo” starring Richard Gere and noticed his large Becker’s naevus on his shoulder. Even the stars have skin problems! As we all know, dermatological conditions affect a significant proportion of the population and most of us have a diagnosable condition somewhere on our skin. In cinema though, the inclusion in fiction of characters with visible skin conditions is interesting and can be a reflection of public perception in our society. One dermatologist, with a keen interest in cinema has his own website depicting the array of dermatological conditions amongst our idols (www.skinema.com).
Skin disease in the movies, whilst it maybe included as “historical” fact, for example Robert the Bruce’s father in "Braveheart" with Leprosy, it may not be entirely accurate – there is some evidence of psoriasis in their family lineage and it is quite possible his father did not have leprosy but indeed psoriasis (the clinical conditions were probably indistinguishable at that time in history). In fictional films, there is a depiction of skin disease sometimes to add to a character’s persona through visual representation. Visual depictions of skin disease in villains are often used to portray inward corruption and degeneracy. Most of us can recall the visual decline of Anakin Skywalker in Star Wars to Darth Vader. The main concern is of course that films depicting these diseases may have an impact on the patients who genuinely suffer with these skin problems in real life. The negative portrayal of these conditions on the screen can affect the patient’s self-image in real life.
When viewing many action and thriller movies which usually are a fight between good and evil it is interesting to note how many of the villains have visual skin problems – Voldemort from Harry Potter, Scar from the Lion King, Blofeld from James Bond, for example. As television and films move towards high definition and ultra-high definition dermatological symptoms may only become more evident.
In fact, a paper on this topic was published last year in JAMA Dermatology (Full Article - click here) . In the paper, the authors carried out an analysis of the top ten villains and heroes taken from the American Film Institutes own list of 100 top villains and heroes. In this work they discovered that 60% of the top ten villains had a visible diagnosable skin condition compared with none of the heroes. Popular dermatoses included facial scars, alopecia, deep wrinkles, periorbital hyperpigmentation, rhinophyma, verruca vulgaris, extensive tattoos, large facial nevi and albinism or grey-hued complexions (1). Taking this further, Ryan and colleagues, preformed a similar study on characters of “good” and “bad” nature in animated movies. Their work concluded that 76% of villains had dermatological disease compared with just 25% of heroes (2).
The idea of skin disease representing or portraying immorality in films is also demonstrated in another study which specifically examined characters in films where they underwent a transformation from good to evil. Characters undergoing this moral transformation were examined for dermatological finding before and after their turn to the "dark" side. The average number of skin features was just 1.3 per person but increased to 3.5 after they became evil (3).
Whilst this tends to propagate the negative side of dermatological disease, this work has been challenged recently on the basis that the films included in this list were all from the last century. Consequently, the Japanese authors of this new work ran a similar methodology on American films published so far in the 21st century drawing on a list drawn from the Metacritic Movie database. In their analysis they discovered no significant differences in the dermatological conditions between villains and heroes suggesting a shift in the industry away from the older ideas of the earlier movies (4). Only time will tell - but keep watching!
1. Croley JA, Reese V, Wagner RF, Jr. Dermatologic Features of Classic Movie Villains: The Face of Evil. JAMA Dermatol. 2017;153(6):559-64.
2. Ryan MP, Reese V, Wagner RF. Dermatologic Depictions in Animated Movies. Br J Dermatol. Early view;0(ja).
3. Tyler M, Reese V, Wagner R. Dermatologic features in good film characters who turn evil: the transformation. Dermatol Online J.24(6).
4. Ishida Y, Lin E, Otsuka A, Kabashima K. Skin findings of 21st-century movie characters. J Eur Acad Dermatol Venereol. 2017.