Letter to the Editor: Regarding “Integrating the Integumentary System with the Arts”

Dear Editor:

The article “Integrating the Integumentary System with the Arts,” by Om and Om and published in the October issue of JCAD,1 is interesting for pointing out artistic representations of dermatologic disease. The authors have taken on a large range of topics, which is risky since several significant references appear to be unknown to the authors.

Petrus Gonsalvus and his hypertrichosis are described. The authors seem unaware that Gerald P. Hodge and I described him and his family in a cover story in JAMA.2 Gonsalvus’s daughter was the cover illustration.

Om and Om1 also describe a member of the family of the Spanish King Charles IV from a famous Goya painting, and indicate cutaneous melanoma is the most likely diagnosis. Hodge and I described her in another JAMA cover story and offered a different diagnosis.3 Spanish women at the time commonly put beauty marks on their faces composed of a dark waxy substance. Om and Om cite LP White’s comments on this painting in West J Med and he concurred with the melanoma diagnosis. I rebutted this in the same journal.4

I hope readers of the journal find these comments of help.

With regard,

James G. Ravin, MD

Dr. Ravin is with the University of Toledo College of Medicine, Department of Surgery, Toledo, Ohio

Correspondence. James G. Ravin, MD; Email: jamesravin@bex.net


  1. Om A, Om A. Integrating the integumentary system with the arts. J Clin Aesthet Dermatol. 2018;11(10):21–27. 
  2. Ravin JG, Hodge, GF. Hypertrichosis portrayed in art. JAMA. 1968;207:533–535.
  3. Hodge GP, Ravin JG. Spanish art— a contribution to medicine. JAMA. 1969;207:1693–1696.
  4. Ravin JG. Melanoma? or make up? West J Med. 1996;164(2):182.

Author Response

We thank Dr. Ravin for his insightful comments regarding our recently published article. Indeed, Drs. Ravin and Hodge did publish an article about Peter Gonzales and his condition of hypertrichosis universals congenital, or Ambras syndrome.1 When conducting the research for our review article, we did not come across this article, but we believe it obviously would have only bolstered our review. With regard to the possible melanoma seen in Goya’s painting of King Charles IV and his family—we feel the jury is still out on the answer and is open to interpretation by the individual reader. In our opinion, we agree with Dr. White, given the irregularity of the lesion and the death of subject shortly after completion of the painting.2  

With regard,

Amit Om, MD

Dr. Om is with the Division of Dermatology at Florida State University in Tallahassee, Florida.

Correspondence. Amit Om, MD; Email: amitom4@gmail.com


  1. Ravin JG, Hodge, GF. Hypertrichosis portrayed in art. JAMA. 1968;207:533–535.
  2. White LP. What the artist sees and paints. West J Med. 1995;163:83–84.