2019 Skinnies Awards

Congratulations to all the winners! Here’s wishing you (and them) a year’s worth of healthy skin!

Selfless Skin Sharer: Ariana Grande and Her Tattoo Fail

We all make mistakes.  Yet when celebrities err, their flubs go viral.   Credit singer Ariana Grande with the willingness to mess up online.  She had good intentions when she decided get yet another patch of body art.  She had been working with a Japanese tutor and had a new album to promote.  Why not get a tatt that would overlap these two events?  What could go wrong?
When you are a beginner in a language, a LOT can go wrong.  Grande was shooting for the translated version of "7 Rings,'' the name of her new album.  These are the correct characters for "7 Rings" in Japanese.  The plan was to inscribe these characters on her palm.  FYI, tatts on the palms are extremely rare, due to the intense pain sustained on that location.  In this case, celebrities are NOT just like us!
Unfortunately, her artist left out some of the necessary characters.  Instagram fans quickly pointed out that the intended "7 Rings" instead reads "BBQ Grill."  With this knowledge, she joked that she likes tasty barbecue too.
She also revealed how painful the original process was.  Though she made light of the mistake, she opted to add characters to make a fix.   For round #2,  she enlisted a doctor to inject anesthetic.
Turns out, since the character was added below, rather than in between, the previous art, it now reads: "Japanese BBQ Finger."  Major sigh!  The good news is that Grande can start entirely anew if she wants.  Lasers can clear tattoo pigment without scarring, and black dye responds the best.  She would do well to call the doctor back for more numbing.  Relatively fresh tattoos clear faster than pigment that is longstanding.
Or she can follow her ex-fiance's lead.  Pete Davidson and Grande both had this French phrase instilled on their necks in solidarity.
Rather than spend time and cash for laser treatments, Davidson just had "Cursed" tattooed over it.  When celebs share troubles online, regular folks can empathize. Thanks for sharing!
Runner up: Selfless Skin Sharer: Chrissy Tiegen's Post Pregnancy Skin Issues
Supermodel and Influencer Chrissy Teigen is shown here with her husband, musician John Legend.  She has proved refreshingly open, sharing potentially embarrassing stories and images from her life as a young mother.
In early 2019, she posted images of her post-preggers stretch marks.  Stretch marks are likely less common than many think.  Not every pregnant belly results in these pink strands of altered collagen.  At Teigen's stage, when the stretch marks are still red, topical creams with Vitamin A, such as Retin-A can provide improvement.  Pausing if one has irritation, the creams can reduce the marks and improve the texture.  Vitamin A should not be applied during pregnancy.
If one waits several months, and the stretch marks are white, rather than red, the cream won't be as effective.
During the same post, Teigen showed she had developed hives.  These red blotches come and go like regretted tweets.  Due to a release of histamine, these lesions are typically itchy.  Triggers include medicines, insect bites, internal health issues and stress. Most hives resolve over time and antihistamine pills can help.  We'll be on the lookout to see if Ariana Grande develops hives from her next tattoo drama!

Scar-y Villain: Michael B. Jordan in "Black Panther"

The cinematic comic book epic, "Black Panther," continues to break ground, receiving Oscar nominations in 2019.  Less impressive is the film's adoption of an old school cliché, the scarred villain.  As Erik Killmonger, Michael B. Jordan is covered with raised, flesh-toned firm scars.  Known as keloids, these lesions are thought to be more common in those of African descent.
A result of skin trauma, keloids represent a mass of abnormal proteins called collagen, a component of normal skin.  With keloids, the collagen is thickened and raises above the skin. Often they can be itchy or tender.  Shoulders, upper chest and back are common areas.  The stretched lesions on his central chest appear fairly realistic.
Many movie villains are involuntarily scarred, and shift to evil as part of that transformation.  Think Darth Vader (Star Wars), Freddy Krueger (Nightmare on Elm Street), or Two-Face (Batman). Killmonger's scars are from self-inflicted cuts, a record of the numbers of murders he has committed. If he had just grown up with a different name.  If his last name were "Donut-monger" instead, he could have applied a scar for every donut.  Unlikely he would appear so fit.
The uniform nature of Jordan's scars is also not realistic.  The producers opt for exact symmetric and show every scar to be the exact dimension, shape and color as the rest.  The image shows the computer rendering the film makers used to create Jordan's scarred style.
In reality, keloids don't tend to follow the rules.  They can develop randomly after surgery and can develop from pimples.  British reality show contestant Bianca Lewis revealed her keloids online. These developed from acne cysts.  Note the variety of shapes and sizes.  Keloids can also be itchy and painful.  Any scenes showing Killmonger scratching his scars were left out of the film.
Finally, keloids are usually shiny and red with dilated superficial blood vessels. Padma Lakshmi is a model/author/television host with a large keloidal scar on her arm. This was caused by a car accident when she was a teen. For those seeking treatments for keloids, cortisone injections can be used to soften & flatten the lesions.  Lasers can reduce the redness.  Like blockbuster movie sequels, keloids can recur after treatment.  2018 popularized the phrase "Wakanda Forever."  Keloids can sometimes seem to last that long...
Runner up, Scar-y Villain: Rachel Weisz in "The Favourite"

Emma Stone's rival in "The Favourite," is thrown from her horse and dragged, resulting in a facial scar. Unlike comic book adaptations, her scar is presented not as a simple case of good and evil.
In fact, both she and Stone are ruthless in their attempts to woo the Queen's attention.  And since Stone drugged her, causing her fall, Stone is actually responsible for her scarring.  In recent years, this same pattern, protagonists disfiguring their own frenemies, was seen in both Star Wars and James Bond flicks. This #trend could go viral as #HeroesCauseVillainsScars.

Royal Rash: Gout in "The Favourite"

Oscar-nominated period piece "The Favourite" features Emma Stone and Rachel Weisz as rivals vying for the attention of Olivia Colman (center) as 18th Century British Queen Anne.
Central to the tale is The Queen's merciless malady, the caustic condition known as gout. Gout is an extremely painful condition with flares of arthritis (joint inflammation), redness and swelling, usually of the feet and lower legs. Though the science behind gout was not yet determined in Queen Anne's day, certain triggers were known. Gout not shown in image.
Rich foods, especially meats, seafood, alcohol such as beer and drinks high in fructose can increase amino acids called purines in the blood.  For those that are genetically at risk, small crystals can lodge in the joints, hastening a world of harrowing hurt.
Note this image from the 18th Century, showing gout as a demon biting into the swollen joint. Gout has long been known as the "Disease of Kings" because the affluent had access to rich foods and alcohol.
It is now clear that not just the ruling class, but anyone can develop gout.  Recent reports show an increasing cases of gout in the UK.  Rates of metabolic syndrome, associated with obesity and diabetes are risk factors. Shakespeare's ale-swilling rogue, Falstaff, states: "... A pox of this gout! or, a gout of this pox! for the one or the other plays the rogue with my great toe." Gout not shown in image. Falstaff not seen in "The Favourite."
Studies have shown that Tyrannosaurs, the kings of the dinosaur world, likely suffered from gout.  Dinosaur gout not shown in image. Dinosaurs not seen in "The Favourite."
As a newly appointed servant to the court, Emma Stone applies herbal salves and wraps to the Queen's legs,  increasing Stone's status. While this is a reasonable plot device, in practice, topical treatments are of little benefit for flares. Flares can be treated these days with anti-inflammatory pills and changing the diet.
Important disclaimer:  Though this is a site about Dermatology in Movies, dermatologists do not, in general, treat gout.  If one has a painful swollen joint after imbibing excess shellfish and alcohol, make haste and get thee to an internist or rheumatologist who can assist with this agonizing ailment. Skin doctors can help fade any discoloration once the ache has been eradicated.

Runner up, Royal Rash: Smallpox in "Mary Queen of Scots"

Oscar-nominated period piece "Mary Queen of Scots" features Margot Robbie and Saoirse Ronan  as rival queens vying for control of 16th Century Britain.
In the film, as in real life, Queen Elizabeth contracts the insidious and scar-inducing virus smallpox.
Important disclaimer:  Though this is a site about Dermatology in Movies, dermatologists do not, in general, treat smallpox.  Fortunately for all, this egregious germ was eradicated from planet Earth in the late 1970's. If one has been exposed to stock of the virus in some creepy laboratory, make haste and get thee to an emergency public health official who can assist with quarantine. Skin doctors can help address scarring if the patient survives.
In the film, Elizabeth survives and is left with scarring.  The implication is that Elizabeth then turns to heavy white makeup and wigs to conceal her less than regal complexion and hair loss. She is also portrayed as threatened by the unscarred beauty of Ronan's Mary.
It turns out that the makeup of that era was corrosive and likely resulted in further damage to her skin. In this age of easy access to aesthetic treatments, side effects and an unnatural plastic appearance can occur. Sometimes the cure is worse than the condition!

Teen Skin Stressor: Acne in "My Brilliant Friend" and "Eighth Grade"

The HBO series "My Brilliant Friend" Brilliantly captures the drama of two girls enduring adolescence in Southern Italy in the 1950's.  The production gets the smallest details right, even down to the troubled complexion of the narrator, Elena "Lenù" Greco (played by Margherita Mazzucco).
With her ongoing rivalry with her friend and her growing interest in boys, the last thing Lenù needs is pimples.  Not to mention the periodic murders and beatings that go on in town.  This is an HBO series, after all.  These images display her congested pores and inflamed cystic lesions.
Though acne is common in adolescents, it occurs at a particularly delicate stage of emotional and physical development.  Some families shrug off the condition as normal, but treatment can boost self esteem and prevent acne scarring.  In the 1950's, especially among the disenfranchised, treatment options were few.
Maintaining realism, Lenù's acne evaporates during the summer she spends tanning at a beach resort island.  Sunlight improves acne because the ultraviolet radiation (UV) zaps the inflammatory cells in the skin and reduces the swollen cysts.  Today, UV light treatments called phototherapy or some forms of laser can be used sporadically to reduce acne flares.  In general, dietary changes have less impact, so Lenù may as well finish that yummy gelato.
The film "Eighth Grade" follows the trials of Kayla (Elsie Fisher) as she suffers through her final week of, you guessed it, eighth grade.  Though swimming in a outdoor pool may minimize Kayla's pimples, sunlight these days is not considered a safe option to control acne. Anyone as fair skinned and freckly as Kayla would do better to wear sunscreen and turn to the large number of over-the-counter and prescription options to improve pores and clear blemishes.
A novel option is Seysara (sarecycline), an antibiotic pill that was approved by the US FDA in Autumn 2018 for treatment of acne.The logic of using antibiotics is to both clear bacteria, but also reduce inflammation.  There are a few advantages to Seysara over existing anti-inflammatory tetracycline family antibiotics.  The dosing is once a day, so easy to fit in before home room.  Disclaimer:  Dr. Reese and this website have no financial ties to the makers of Seysara.  Nor to movie studios or makers of Multiplex grade popcorn.
There should be no stomach upset, unlike doxycycline.  So while it can be downed in the cafeteria with food, it can also work on an empty stomach.  Unlike minocycline, Seysara should not cause headache or dizziness to get in the way of extracurricular activities. In general, antibiotics should be used in conjunction with topical creams that improve the pores.
With treatment, Kayla, Lenù, or any teen may look forward to an adolescence with adol-less-stress. Finally, props to the directors for hiring actresses with acne rather than attempting faux CGI zits.  Like actress Saoirse Ronan in last year's film "Lady Bird," these young women may have been cast in part because of they were prone to pimples.  Not only does this trend result in a more authentic production, it proves that one doesn't always need good skin to make it in Hollywood!
Runner up, Teen Skin Stressor: Sunburn on a Cloudy Day in "Roma"
In "Roma," a stressed 70's era family decides on an impromptu beach trip.  The day is overcast, the visit spontaneous, it's a simpler time, so...sunscreen not applied, and voila!  The next day, blistering sunburns are peeled off of the children's backs and shoulders. Thanks, independent film for teaching a valuable lesson.  Ultraviolet let still streams through clouds, so keep up the sun protection.  And teach that nanny how to swim!

Bold Birthmark: Zazie Beetz as Domino in "Deadpool 2"

The "Deadpool" franchise is notable for its sympathetic depiction of skin issues.  As the titular anti-hero, Ryan Reynolds rocks the red carpet touting total body scars and lacking hunk-associated hair. Yet he is not the straight-out-of-central-casting disfigured evil doer, but rather the pop-culture-referencing protagonist. This surprises because flicks based on comics usually use skin defects to identify bad guys.
New to the series is Domino, a mutant played by actress Zazie Beets. Domino has plenty of hair and no scars.  This is consistent with her power: Luck.  Though Reynold's Deadpool argues whether luck can be considered a power, it works very well for her.  She's lucky enough not to have sustained a scarring injury.  She has luckily maintained her natural hair curls rather than straitening her hair or using tight braids. She therefore avoids styles that can cause hair recession & loss for races with tight curls. But heroic Domino shares Deadpool's dermatological drive. Note the white patch of skin surrounding her eye.
This patch is entirely flat with a sharp border.  The skin is as free of color as Deadpool is bereft of basic manners. The iris is also lighter in color.  The appearance fits with a rare birthmark: Nevus depigmentosus (ND for short, natch).  This means "birthmark without color" as does the lesion's alternative name: Nevus achromicus. Much like mutants have powers that lack scientific explanation, it remains unclear why birthmarks form.
ND lesions can occur anywhere on the body. They can be small like a coffee bean ground in a Sunset Boulevard cafe or as large as a Hollywood budget. The cells within the border of the mark do not produce pigment.  Domino remains lucky: Some birthmarks have cells that can convert to forms of skin cancer.  This lesion is not in that franchise universe.  The individual cells are otherwise no different than other skin cells. ND patches can grow as the person develops, retaining the same shape. Unlike vitiligo, the pale patch doesn't spread other epidermal areas.
But since the area lacks the protective pigmentation of the rest of her skin, Domino will need to work to maintain her lucky streak. Exposure to the sun could cause burns and skin cancer years later. So like her fellow mutants in the announced "Deadpool" sequel, "X-Force," Domino will need to rely on team mates for help.  In this case, sunscreen, wide-brimmed hats and sunglasses should be members of her four leaf clover crew.
Domino also has the distinction of being one of the only superheroes with a birthmark on their action figure. For those born with birthmarks, this type of toy may help to reduce feelings of stigma.  Good luck indeed!
Runner up, Bold Birthmark: Olivia Cooke as Art3mis / Samantha in "Ready Player One"
Like Domino, Art3mis / Samantha, the kickass video-playing rebel, has a facial birthmark. Note the large red blotch over her forehead, temple and eye visible under her bangs.  Because of the purple-red color, this is called a Port Wine Stain (PWS) birthmark. Cue "Deadpool"-style sarcastic comment about the dermatologically dorky name.
Here the PWS is seen on Samantha videogame avatar, Art3mis. The PWS is a patch of skin that over-expresses small superficial blood vessels, hence the red to purple color.  Over a lifetime, raised nodules can form in the area, but this mark is also free of eventual skin cancer risk.
Of note, early in the film, Samantha’s avatar does not show the PWS.  After her lesion is accepted in real life, she then wears it proudly as Art3mis. Birthmarks such as these are not contagious or dangerous.  By removing the mystique, society may recognize that birthmarks may be chic and unique, not a streak that needs to be critiqued and tweaked.
Unlike Domino's doll, the Artemis action figure is modeled after her avatar in the early part of the film, before her character is "woke" enough to display it proudly.  Maybe the toy company and studio will step up for the sequel...

Skin in the (Political) Game: Beto O'Rourke's Sweating

Political campaigns are endurance tests. Any kind of exercise generates sweat to cool the body's core temperature. Yet some develop sweat above and beyond normal.  Texas politician Beto O'Rourke appears to have that condition known as hyperhidrosis.  Increased perspiration can result from heat, but also stress triggers.  Some are affected under the arms, but the face, chest and back can also be involved.

There are many options for treatment.  Topical aluminum chloride is a safe option, available in over-the-counter antiperspirants.  Prescription forms also exist, though some cause irritation.  The ingredient establishes microscopic plugs to reduce the sweat release. A novel option, approved by the US FDA in 2018, is Qbrexza (glycopyrronium) cloths. Qbrexza, supplied as a disposable wipe, doesn't block the pores, but inhibits the sweat gland itself.
In 1963, one of the first televised US presidential debates featured candidates John Kennedy and Richard Nixon.  Nixon, who appeared stiff and sweaty onscreen, went on to lose the election.  Qbrexza would not have helped him.  It can only be used under the arms because if used on the face or lips, it can cause symptoms such as dry mouth, dilated pupils, headache, blurred vision, urinary problems, dry skin and constipation.  Coincidentally, these are symptoms many voters feel during the debate season...
If none of these options work for O'Rourke, he can at least consider the option singer Willie Nelson took at this concert:  Wearing dark fabric goes a long way to obscure the drenched appearance of hyperhidrosis.  And since Nelson is famous for promoting the recreational use of cannabis, folks who toke probably won't care as much. Disclaimer:  Dr. Reese and this website have no financial ties to the makers of Qbrexza.  Nor to maker of laundry detergents or dark colored clothing.
Runner up, Skin in the (Political) Game: Judicial Rosacea
Rosacea is a common form of facial inflammation. Symptoms include red flushed cheeks, small inflamed pimples and dilated facial blood vessels.
Rosacea can affect the eyes.  Triggers include sun exposure, certain spicy foods and emotional outbursts.
Alcohol use is a long established trigger for rosacea.
Alcohol use is still a long established trigger for rosacea.

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