The Art of Skin: Portraits in Pathology
Authors: Janmesh D. Patel, BS,1 Vail Reese, MD2
Key Points
- Artists across time and cultures have recorded cutaneous detail with diagnostic clarity, with portraits and historical manuscripts preserving inflammatory, infectious, and neoplastic features that can be read as inadvertent medical records.
- Artists have long used visible skin lesions to signal moral or social traits, and these portrayals have reinforced stigma and shaped public attitudes toward people with skin disease.
- The transformation of visible lesions into aesthetic devices such as beauty marks shows how medical phenomena and cultural ideals of youth and attractiveness have co-evolved and continue to influence popular culture today.
How does this work highlight an innovative perspective in dermatology?
This paper reframes art as a visual archive that preserves both clinical detail and cultural meaning, inviting dermatologists to see portraits as sources of diagnostic and social insight. By encouraging clinicians to notice cutaneous signs in historical images, the work sharpens observational skill while revealing how visual culture has long shaped stigma and standards of beauty. Understanding visual cues in art and film highlights deep, persistent patterns in how societies represent and judge skin, insights that can improve clinical empathy and public communication.
Introduction: Skin as a Story
In Domenico Ghirlandaio’s Old Man with His Grandson (1490), the viewer’s eye is irresistibly drawn to the grandfather’s weathered countenance. In this portrait, furrowed wrinkles give way to discrete papules and erythema that suggest underlying disease as much as age (Figure 1). A bulbous prominence at the nasal tip suggests end stage rhinophyma in an era before antibiotics tempered the inflammation of rosacea. A flesh-toned papule near his temple could be read as anything from an innocuous intradermal nevus to a worrying basal cell carcinoma. Shifting focus to the child, the lower eyelid fold displays the thickening and lichenification of atopic dermatitis (Dennie-Morgan lines). Here, portrait becomes a clinical canvas, each brushstroke a subtle medical record, reminding us that art has long captured not only beauty but also disease. In this paper, we first examine clinical realism in portraiture, then consider how artists harnessed skin to signify moral failing and finally trace the aesthetics of beauty marks and their cultural meaning. We close by considering how these art-historical methods can be applied to analyze film.
Clinical Realism: Dermatologic Conditions in Canvas
Beyond Ghirlandaio’s iconic portrayal, Renaissance artists frequently recorded cutaneous details with remarkable fidelity. In Lorenzo Lotto’s Portrait of a Young Man with a Lamp (1506), the sitter’s forehead bears a few firm cysts and clusters of open comedones, an authentic depiction of acne amid the era’s push for hyperrealism (Figure 2A). Francisco Goya’s La Boda (1792) depicts an impoverished youth. His scalp reveals a sharply demarcated patch of alopecia. Once attributed to alopecia areata, this is more likely tinea capitis, reflecting the poor hygiene and endemic fungal infections of 18th‑century Spain (Figure 2B). Even outside Europe, the Ancient Maya rendered skin disease in ritual iconography. The deity “God S,” shown with dark, crusted plaques, likely represents impetigo (or possibly Chagas disease), illustrating how tropical dermatoses found expression in non‑photorealistic yet clinically suggestive art (Figure 2C). Together, these examples underscore how artists have long served as inadvertent dermatologic recorders, immortalizing both endemic and emerging skin conditions.
Figure 1. Domenico Ghirlandaio’s Old Man with His Grandson (1490).3 Detail of the old man’s face shows a bulbous, erythematous nasal tip consistent with end stage rhinophyma. The child’s lower eyelid fold displays lichenification consistent with atopic dermatitis.
Figure 2. Artwork as cutaneous illustration. (A) Lorenzo Lotto’s Portrait of a Young Man with a Lamp (1506),4 hyperrealistic depiction of adolescent acne, forehead comedones and cystic lesions. (B) Francisco Goya’s La Boda (1792),5 scalp alopecia consistent with tinea capitis. (C) Mayan God S6, stylized crusted plaques likely represent impetigo or another tropical dermatosis.
The Dermatology of Sin: Markers of “Evil” in Art
Over the centuries, artists have also used skin pathology to signal moral failings or spiritual corruption. An anonymous 15th-century Passion of Christ painting features men torturing Christ, one of whom is depicted with a genital ulcer; an allegory that equates the tormenters’ sins with the contagion of disease. In Andrea Mantegna’s Saint Sebastian (1480), the archer at the saint’s side bears patchy beard alopecia and dental erosion, signs of untreated syphilis in the pre-antibiotic era (Figure 3A). Sebastian himself remains unblemished, however, contrasting sanctity with sin. Otto Dix’s Lust (detail from Seven Mortal Sins, 1933) similarly stigmatizes moral transgression. The seductive figure’s lip chancre, consistent with primary syphilitic infection, symbolizes a condemnation of carnal desire (Figure 3C). In Juan O’Gorman’s El Feudalismo Porfirista (1973), facial scars brand the criminal subject, extending this tradition of dermatologic stigma into modern social critique (Figure 3B). Together, these works reveal how cutaneous signs have been used to portray evil intent across centuries and cultures.
The Aesthetics of Skin: Birthmarks, Beauty Marks, and Cultural Ideals
Not all skin irregularities seen in art are considered unattractive. A recurring fashion trend is the pleasantly irregular “beauty spot.” Defined as a discrete unilateral facial nevus, societies have at times recast this benign collection of melanocytes into an emblem of allure. Francisco Goya’s Charles IV of Spain and His Family (1800) famously portrays a woman’s prominent temple plaque, at once a cosmetic accent worn in courtly fashion and a medical curiosity that may represent a seborrheic keratosis, melanoma, or congenital nevus (Figure 4A). His earlier Queen Maria Luisa (1789) similarly elevates a subtle raised mole on a woman’s left temple to a hallmark of aristocratic elegance (Figure 4B). Miguel Cabrera’s Maria de la Luz Padilla (1755) depicts multiple discrete dark facial lesions (Figure 4C). These were deliberately placed at the temple, beneath the lower lip, and near the eye, mirroring practices of the era. Women enhanced or even painted on these marks to convey youth and refinement. In more modern times, film icon Marilyn Monroe sported her signature left-cheek beauty mark (Figure 4D). These small, darkly pigmented lesions represent codified symbols of femininity. Since dark, flat junctional nevi tend to raise and form flesh-toned intradermal nevi with age, these deliberately placed dark spots have long served as enduring symbols of youth and beauty, shaping cultural ideals for centuries.
Figure 3. Artwork depicting representations of immorality. (A) Andrea Mantegna’s Saint Sebastian (1480),7 the archer displays patchy beard alopecia and abnormal dentition, suggestive of syphilis. The contrast with the clear complected Saint distinguishes immoral vs sacred. (B) Juan O’Gorman’s El Feudalismo Porfirista (1973),8 depicts a criminalized subject with facial scarring, continuing a visual tradition of dermatologic stigma. (C) Otto Dix’s Lust (from Seven Mortal Sins, 1933),9 shows a likely syphilitic lip chancre used as a visual shorthand for sexual immorality.
Figure 4. Images of beauty marks throughout the years. (A) Francisco Goya’s Charles IV of Spain and His Family (1800).10 (B) Francisco Goya’s Queen Maria Luisa (1789).11 (C) Miguel Cabrera’s Maria de la Luz Padilla (1755).12 (D) American actress Marilyn Monroe.13
From Canvas to Celluloid: How “Derm in Art” Informs Cinematic Storytelling
With the advent of motion pictures in the modern era, dermatologic depiction in fine art transition to conditions seen on the silver screen. Filmmakers capitalize on the narrative power of skin findings, using makeup, lighting, and now computer-generated images to evoke disease, fear, or empathy.1,2 Applying art historical analysis to cinematic images not only illuminates hidden diagnoses on screen but also forges a new, interdisciplinary path that unites dermatology, humanities, and film studies.1,2 Dermatology in art and film represents a universal language spanning from canvas to celluloid to streaming media.
Conclusion
Art, and by extension, film have served as a vivid chronicle of cutaneous pathology, capturing the historical context of disease while simultaneously shaping our perceptions of health, morality, and beauty. “Clinical Realism” examples demonstrate how artists functioned as careful observers, capturing in detail the inflammatory and neoplastic processes of the era. “Dermatology of Sin” cases show how skin signs were used to mark moral failing, shaping stigma and social responses to disease. “Aesthetics of Skin” material reveals how visible lesions were adopted, enhanced, or even manufactured as cultural symbols of youth and desirability. Analysis of dermatology in cinema reveals similar trends extend to the big screen and beyond.
Examining cutaneous findings in paintings and on screen sharpens clinical observation and enriches narrative understanding. It helps clinicians appreciate historical context and challenges dermatologists to consider how visual culture frames health and stigma. This interdisciplinary approach has practical value for medical education as a tool to teach observational skills and cultural competence. On a larger level, the study reveals how images influence societal perceptions of disease. As cutaneous physicians, we may venture beyond clinical texts, peering into museums and theaters with a diagnostician’s curiosity. In doing so, we broaden the dialogue between medicine and the arts.
References:
1. Reese V. (1995). Dermatology in the cinema. Journal of the American Academy of Dermatology, 33(6), 1030–1035. https://doi.org/10.1016/0190-9622(95)90297-x
2. Ryan, M. P., Reese, V., & Wagner, R. F., Jr (2018). Dermatological depictions in animated movies. The British journal of dermatology, 179(4), 982–983. https://doi.org/10.1111/bjd.16880
3. Ghirlandaio, Domenico. An Old Man and His Grandson. 1490, Musée du Louvre.
4. Lotto, Lorenzo. Portrait of a Young Man with a Lamp. 1506, Kunsthistorisches Museum.
5. La Boda. 1792, Museo del Prado.
6. MAZARIEGOS, OSWALDO. “Pus, Pustules, and Ancient Maya Gods: Notes on the Names of God S and Hunahpu.” The PARI Journal, vol. XXI, no. 1, 2020, pp. 1–13, www.precolumbia.org/pari/journal/archive/PARI2101.pdf.
7. Mantegna, Andrea. Saint Sebastian. 1480, Musée du Louvre.
8. O’Gorman, Juan. El Feudalismo Porfirista. 1973, Museum of History in the Chapultepec Castle.
9. Dix, Otto. Lust (from Seven Mortal Sins). 1933, Staatliche Kunsthalle Karlsruhe.
10. Goya, Francisco. Charles IV of Spain and His Family. 1800, Museo del Prado.
11. Goya, Francisco. Queen Maria Luisa. 1789, Museo del Prado.
12. Cabrera, Miguel. Maria de la Luz Padilla. 1755, Brooklyn Museum.
13. Powolny, Frank. Marilyn Monroe. 1953, Photoplay Magazine. en.wikipedia.org/wiki/Marilyn_Monroe#/media/File:Marilyn_Monroe,_Photoplay_1953.jpg.
Affiliations:
1. University of Wisconsin School of Medicine & Public Health, Madison, WI
2 Union Square Dermatology, San Francisco, CA
Conflicts of Interest:
All authors report no conflicts of interest.