LAUSR

Importance Dichotomous dermatologic depictions of heroes and villains in movies have been used since the silent film age. Objective To evaluate the hero-villain skin dichotomy in film by (1) identifying dermatologic findings of the all-time top 10 American film villains, (2) comparing these dermatologic findings to the all-time top 10 American film heroes quantitatively and qualitatively, and (3) analyzing dermatologic portrayals of film villains in depth. Design, Setting, and Participants In this cross-sectional study, dermatologic findings for film heroes and villains in mainstream media were identified and compared quantitatively using a &khgr;2 test with &agr; < .05, as well as qualitatively. The all-time top 10 American film villains and heroes were obtained from the American Film Institute 100 Greatest Heroes and Villains List. Main Outcomes and Measures Primary outcomes include identification and frequencies of dermatologic findings of the top 10 film villains and of the top 10 film heroes. Results Six (60%) of the all-time top 10 American film villains have dermatologic findings, including cosmetically significant alopecia (30%), periorbital hyperpigmentation (30%), deep rhytides on the face (20%), multiple facial scars (20%), verruca vulgaris on the face (20%), and rhinophyma (10%). The top 10 villains have a higher incidence of significant dermatologic findings than the top 10 heroes (60% vs 0%; P = .03). Conclusions and Relevance Dermatologic findings of the all-time top 10 American villains are used in film to highlight the dichotomy of good and evil, which may foster a tendency toward prejudice in our society directed at those with skin disease.