Dermatologists want
to find out why 

Among the few telltale signs of a movie villain: a sadistic laugh, a penchant toward explaining evil plans and a skin disease.

Dermatologists are taking notice with a critical eye.

As outlined in a recently published study in JAMA Dermatology, movie villains are often afflicted with various skin conditions, such as alopecia (hair loss), facial scars and periorbital hyperpigmentation (a condition leading to dark circles around the eyes).

“Symbolic dermatologic depictions are prevalent in film,” the study said. ” … its most prominent use in film is to illustrate underlying immoral depravity.”

Some advocacy groups have long attacked Hollywood for these portrayals. When “The Da Vinci Code” was released in 2006, for example, its villain was a monk-assassin with albinism named Silas. Michael McGown, executive director of the National Organization for Albinism and Hypopigmentation, noted it was the 68th movie since 1960 to feature an albino villain.

“Silas is just the latest in a long string,” McGowan told the Associated Press. “The problem is there has been no balance. There are no realistic, sympathetic or heroic characters with albinism that you can find in movies or popular culture.”

In the study, researchers looked at the top 10 villains from the American Film Institute’s “100 greatest heroes and villains” list. Villains were defined as “a character(s) whose wickedness of mind, selfishness of character and will to power are sometimes masked by beauty and nobility, while others may rage unmasked.”

Granted, that’s a small sample size, but the conclusion was clear as a damsel in distress’s skin.

Six of the 10 villains, or 60 percent, featured visible, diagnosable dermatologic conditions —  all of which are generally considered cosmetically unpleasant.

Among those characters were Dr. Hannibal Lecter, the cannibalistic serial killer from “Silence of the Lambs,” the Wicked Witch of the West, the green-faced cackler from “The Wizard of Oz”, and Regan MacNeil, a young girl possessed by the devil in “The Exorcist.”

The most obvious is Star Wars’s Darth Vader, a man so hideously deformed, he wore a mask to hide his visage.

“The unmasked Darth Vader epitomizes the use of facial dermatologic findings in combination to project evil,” the study stated. “With his bald scalp, unnatural fair gray skin, periorbital hyperpigmentation, facial scars, and deep rhytides, Vader manifests sheer evil and incites apprehension and fear of the unfamiliar.”

Some villains featured less severe conditions. Mr. Potter, the “greedy businessman” from “It’s a Wonderful Life,” for example, suffered from stage 7 androgenic alopecia. That might not seem particularly notable, until one realizes how the camera hovers on his bright scalp.

“Mr. Potter is often filmed with his glaring alopecic scalp, clenched fist, and Scrooge-like scowl behind a grand wooden desk,” the study said. “A whitecollar villain, Mr. Potter’s androgenic alopecia gives him an air of moral corruption.”

A glance down the rest of the list found many more villains with dermotological conditions, such as “Freddy Krueger’s severe scarring in ‘A Nightmare on Elm Street’ (1984), Mrs. Danvers’ large facial nevus in ‘Rebecca’ (1940), and Cruella de Vil’s poliosis and deep rhytides in ‘101 Dalmatians’ (1996).”

Using dermatological conditions to symbolize evil was even starker when the top 10 villains were contrasted with the top 10 heroes.

Of these, only four showed any sort of cosmetic facial damage – Indiana Jones, Rocky Balboa, Rick Blaine (“Casablanca”) and Will Kane (“High Noon”). The former two had small facial scars, while the latter sported lacerations inflicted while they were defending some form of “good.”

Meanwhile, the appearances of heroes’ scars were different than those of villains. Via the study:

The facial scars of the heroes are much subtler and shorter in length than those of the villains. Unlike the scars of the villains, those of the heroes are neither created with prosthetic makeup nor commented on during the narrative. In addition, villains each have multiple facial scars whereas heroes each have a single facial scar.

Implications beyond theater

While the study might seem anecdotal, its authors warned that “the implications … extend beyond the theater.”

“Specifically, unfairly targeting dermatologic minorities may contribute to a tendency toward prejudice in our culture and facilitate misunderstanding of particular disease entities among the general public,” the study said.

 Vail Reese, a dermatologist, keeps an entire blog — fittingly named Skinema —dedicated to exploring skin conditions in film.

“The majority of films use skin disease to convey a character’s devious motivations. Finally, very few films depict characters with skin disease sympathetically,” Reese wrote on his blog. “We must remember that the attitude towards skin disease in movies to some extent both reflects and informs the perceptions of our society. Even today, individuals with non-infectious diseases such as psoriasis and vitiligo are treated as if they have the plague.”

Added Reese, “Skin disease does not represent inherent evil, but rather a difficult and at times disabling condition.”

But some recent shows portray skin disease as a disabling condition, rather than shorthand for evil. HBO’s acclaimed drama “The Night Of,” featured a kindhearted character who so suffers from psoriasis that Slate called the show “a star vehicle for eczema.” One dermatologist told Slate the show “really resonated” with one of her patients.

It’s too early to know if “The Night Of” signals a new trend, of course, but it’s important to note most of the villains and heroes listed above are from movies that are decades old.

Robert Englund (Freddy Krueger ) in “A Nightmare on Elm Street.” MUST CREDIT: Zade Rosenthal-New Line Home Entertainment

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