Dermatology in Media: More than Meets the Eye

Dermatologic conditions frequently portrayed in visual art forms are of considerable significance due its influence on public perception of the field. Skin conditions are utilized in television and film to quickly portray character traits to the audience. Most often, these conditions carry negative connotations when attached to characters, being used as visual cues to symbolize immorality, evilness, and unattractiveness. The misrepresentation of dermatologic conditions in film can cause trivialization of skin disease in society. Affected patients, as well as the general public, can suffer as a result of this misinformation. Key words: Dermatology; media; movie; television; film; society

Dermatologic depictions are prevalent in visual broadcast media, including television, movies, and social media, pervading virtually all genres.¹ In turn, film plays an influential role on community sentiment and the perception of dermatology.In film, skin conditions are often depicted realistically (i.e., occurs on an actor without a role in the film) or symbolically. Cinematic plots involving skin may be attractive to film makers due to the perceived ease of conveying symbolic messages and creating memorable impressions in the eyes of the audience.² Many films develop character traits through speech, behavior, and interactions with other characters. However, through symbolic depiction, directors can employ a variety of cutaneous conditions to easily influence viewers and illustrate characters with psychological and psychiatric conditions limited by production constraints.²Most often, symbolic depictions are used to induce sympathy or convey immorality or evilness. In a review performed by Croley et al¹, the dichotomous dermatologic depictions between heroes and villains in film visually illustrate the contrasting morality between these character types. A variety of dermatological conditions are used for this purpose. Classic dermatologic features of villains include facial scars, alopecia, deep rhytides, periorbital hyperpigmentation, rhinophyma, verruca vulgaris, extensive tattoos, large facial nevi, poliosis, and albinism or gray-hued complexions.¹ These foretelling marks are commonly used to represent the villainous character’s inward corruption and troubled past, which in turn serves the purpose of easily instilling fear and apprehension in the audience.Croley et al¹ went on to evaluate the hero-villain skin dichotomy in film by comparing dermatologic findings of the all-time top 10 American film heroes to the all-time top 10 American film villains. The results showed that 0 percent of the heroes and 60 percent of the villainous characters display dermatologic conditions. Most commonly, villains had alopecia (30%), periorbital hyperpigmentation (30%), deep rhytides on the face (20%), multiple scars on the face (20%), verruca vulgaris on the face (20%), and rhinophyma (10%). Darth Vader from "Star Wars" is noted as the ultimate example. When unmasked, he displays gray pallor, periorbital hyperpigmentation, alopecia, and facial scars to externally signify his internal evilness.¹Comedies also employ dermatologic findings as a means to enhance character development. However, instead of symbolizing immorality, comedies more often encourage viewers to laugh about social problems and psychological distress stemming from skin disease.² "Austin Powers in Goldmember" is a striking example, in which the protagonist Austin Powers repeatedly jokes about a minor character with a nevus before having an outburst alluding to his repulsion towards the character’s nevus.Another popular platform which often employs skin disease to represent unattractiveness are television series. Throughout its 10 seasons, the series "Friends" had 199 references to dermatology.⁴ The three dermatologic categories with highest frequencies were hair (91/199, 45.7%), skin growths/pigmented lesions (19/199, 9.6%), and cosmetic products (15/199, 7.5%).⁴ Hair is related to attractiveness numerous times throughout the series. For example, one episode portrays a neighbor who is feared and called a yeti for having long hair and then becomes attractive once he cuts it short. Skin growths and pigmented lesions are the mentioned second most frequently. This group includes references to supernumerary nipples, freckles, moles, and an unknown skin growth. Unattractiveness of this category is displayed by a main character who loses a date due to his supernumerary nipple. Another important dermatologic topic touched on is sunburn and tanning. Ten references made were about tanning throughout the series and each reference portrayed tanning as positive and attractive.⁴