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Skin conditions among 20th century politicians and world leaders

2021; Wiley; Volume: 35; Issue: 12 Linguagem: Inglês

10.1111/jdv.17545

1468-3083

Nicolas Kluger, Antonio Perciaccante, Philippe Charlier, P. Vabres,

Health and Medical Research Impacts

Dear Editor, The health of world leaders is a legitimate source of concern for the global population and for historians. Cognitive disorders may impact their mandate decisions, particularly when occurring early in office.1 Cancer and cardio-vascular diseases may lead to disability with impossibility to carry out expected duties or unexpected death with power vacuum.2 World history has repeatedly showed that politicians tended to keep their illnesses hidden from the public long before they became obvious.2 French presidents Georges Pompidou (1911–1974) and Francois Mitterrand (1916–1996) both concealed their cancer from the public for a long time.3 Cutaneous conditions are more difficult to hide, when they affect the face or hands or when systemic treatments have an impact on physical appearance. We reviewed typical skin conditions found in world leaders and politicians of the post-World War 2 period. This selection of the best-known cases was non-exhaustive and based on the authors’ own recollections and freely available sources on the Internet. We also aimed to classify such conditions. We excluded skin features associated with ageing (androgenic alopecia or wrinkles), ethnic features and presumed cosmetic treatments. The characteristics of 26 world leaders and politicians from the 20th century, all males except one, are summarized in Table 1. Vitiligo was the most frequent condition (n = 5) followed by rosacea (n = 4). We considered seven categories of cutaneous conditions that can apply for politicians (Table 2). (i) A ‘trademark’ skin lesion that is so characteristic that it allows an immediate identification of the politician: Gorbachev’s port-wine stain of the scalp. (ii) A malignant skin lesion that may have an impact: the end of office of Premier of Quebec Robert Bourrassa because of metastatic melanoma.3 (iii) Cutaneous symptoms that may reveal a systemic condition: Kennedy’s ‘healthy’ suntanned skin attributed to Addison’s disease, although in his case his skin tone may have played in his favour4 or unmissable swelling due to corticosteroid intake shed light on Georges Pompidou’s Waldenström’s disease and Jim Flaherty’s bullous pemphigoid.5 (iv) Visible skin conditions that have a negative impact on politicians’ image. Sir Edward Leigh has spoken out about being mocked for his red face on social media.6 The public may associate red face, rosacea and rhinophyma to alcoholism. Manuel Noriega’s nickname ‘pineapple face’ illustrates his acne facial scars. Facial vitiligo may be a source of mockery, from either political opponents or collaborators: Former French Prime Minister Edouard Philippe derogatively nicknamed ‘102nd Dalmatian’, ‘Kung Fu Panda’ or ‘Normandy Cow’ has raised concern from the French vitiligo support group.7 In contrast, we found at least three Indian politicians suffering with vitiligo, although the psychosocial burden of vitiligo in India is high. (v) ‘Disfiguring’ conditions may have a positive impact in terms of public perception. Showing in public a facial vitiligo without make-up, facial scars after acid attack or chloracne scars after an assassination attempt can be perceived as a sign of bravery and strength by the public. Justin Trudeau’s Haida tattoo may either contribute to his positive public image as a progressive First Nation admirer or be considered as ‘cultural appropriation and insensitivity’.8 (vi) Cutaneous lesions that may be related to physical aggression or poisoning attempts. (vii) Skin conditions may be the centre of media coverage and better recognition to the public when disclosed to the public (bullous pemphigoid, erysipelas,9 dermatoporosis10 or argyria). Corticosteroid induced Cushing syndrome Bullous pemphigoid 1.Trademark lesion 2.Impact on political life and decisions’ making 3.Skin symptoms revealing a systemic condition or a treatment 4.Negative impact on one’s image, mockery 5.Positive impact on one’s image, benefits 6.Aggression/assassination attempt 7.Media coverage and general public’s information shedding spotlight on a dermatologic condition Acknowledging the limits of our study, we could illustrate the spectrum of skin manifestations among politicians and their possible impact either during office or when in campaign. Further studies could evaluate coping mechanisms and outcome as well the impact of politicians’ skin conditions on general public and patients. None. None declared.