J Clin Aesthet Dermatol. 2022;15(6):46-47.
by Austinn Miller, MD; Susuana Adjei, MD; and Laurie A. Temiz, BA
All authors are with the Center for Clinical Studies in Webster, Texas. Dr. Temiz is also with Meharry Medical College in Nashville, Tennessee
FUNDING: No funding was provided for this article
DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article.
ABSTRACT: 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.
Keywords: 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.2
Most 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.1
Comedies 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
Given its relevance and popularity, the cultural impact of visual broadcast media and its high frequency of dermatology references should not be overlooked.4 It is important to be aware of the ideas that television and film are reinforcing and to analyze the potential influence of cinematic depiction of dermatologic conditions because its portrayal does not often equate to reality.4 The incorrect association of skin disease with moral degeneracy and unattractiveness creates negative assumptions about those truly affected and causes unfair stigmatization. Additionally, poking fun at the distress caused by skin disease negatively influences cultural empathy. Moreover, these negative connotations created through viewing films may diminish more than an individual’s self-image or empathy.2 For example, millions of “Friends” viewers might be influenced to pursue tanning behavior and avoid proper sun protection strategies.4 A feared outcome is this cultural influence could result in a higher incidence of skin cancer as a result of poor sun protection habits.4 Although dermatologists know of the considerable patient morbidity, distress, and cost of skin diseases, many healthcare decision-makers are unaware and still regard skin diseases as relatively unimportant.2 This is concerning, because if healthcare decision-makers perceive skin diseases as unimportant, decisions that adversely affect patient care in dermatologists’ clinical practice, public policy, and research funding for the prevention and treatment of skin diseases might be compromised.2
However, negative portrayals of skin disease have not gone unnoticed. Albinism and alopecia advocacy groups have attempted to diminish discrimination by discouraging the use of degrading stereotypes in film, although with limited success.2 Moreover, with the rise of numerous video sharing social media applications, body positive influencers are gaining traction, some of which include models with vitiligo, inflammatory acne, and albinism.
Despite backlash from advocacy groups and the rising popularity of cancel culture, many directors continue to use dermatologic traits to portray characters in a negative fashion.However, a handful of movies depicting skin disease realistically and sympathetically have also been created.5 If more film makers choose uplifting protagonists and heroes with cutaneous conditions, negative societal views will weaken.
Dermatologists can help promote a public paradigm shift and engender empathy through exposure to film and television by expanding their own “dermatology literacy” in the setting of shifting societal perceptions of skin disease.2 Being aware of current societal beliefs can help dermatologists dispel inaccuracies among patients and public alike.
Dermatology is frequently portrayed through visual media. Its use demonstrates the great symbolic nature of the skin disease. It is important to understand how these conditions are represented through these mediums because each is very influential on society. Therefore, dermatologists must be cognizant and act as the ultimate educator when skin disease is displayed in a degrading manner to prevent misrepresented beliefs among patients and healthcare decision makers.
- Croley JA, Reese V, Wagner RF. Dermatologic features of classic movie villains: The face of evil. JAMA Dermatology. 2017 Jun 1;153(6):559–564.
- Chan C, Wagner RF. Dermatology at the movies. Clin Dermatol. 2009 Jul 1;27(4): 419–421.
- Roach J, Goldmember [DVD]. New Line Home Entertainment. New York, NY. 2002
- White SM, Wagner Jr RF. Dermatology depictions in Friends. Revista de Medicina y Cine. 2017 Jun 1;13(2):69.
- Reese V. Dermatology in the cinema. J Am Acad Dermatol. 1995 Dec 1;33(6):1030–1035.