More than any other specialty, the field of dermatology has always required visual education aids to document pathology. Before the era of easily accessible high-resolution photographs, physicians relied on tediously crafted, illustrated descriptions to document the stories of visible illness.
Figure 1: Purpura simplex and hemorrhagic purupra
Figure 2: Eight orders of cutaneous diseases, Robert Willan
The first set of illustrated depictions of dermatologic diseases was compiled by Dr. Robert Willan in the 1790s. These illustrations and accompanying text were published from 1798 to 1808 as “On Cutaneous Diseases,” the first official dermatologic text (Figure 1).
This collection of 30 elaborately hand-drawn colored prints depicted categories of disease grouped by their appearance, a technique derived from botanical grouping methods. These eight categories included papulae, squamae, exanthemata, bullae, pustulae, vesiculae, tubercula, and maculae (Figure 2).
Figure 3: Impetigo, hand on book, from Thomas Bateman’s ‘Delineations of Cutaneous Diseases’
Figure 4: Lichen Syphiliticum, from Sir Erasmus Wilson’s ‘Portraits of Diseases of the Skin’
In the 19th century, these “skin atlases,” as they were called, became highly demand by members of upper-class society who collected them for their libraries. The photographs of this time expanded on the prior categorization but also included cutaneous manifestations of infections common at the time including syphilis, lupus, and impetigo (Figure 3).
The illustrations were painted onto large, meter-wide canvases, allowing an inclusion of a great amount of detail. This detail was not only used to depict the characteristics of the dermatologic illnesses, but also characteristics of the patients themselves, including their clothing, hair, and surroundings (Figure 4).
As with criteria used to derive categories of dermatologic conditions, artists of the time once again drew inspiration from botany in their illustrations. Dermatologic conditions were often compared to elements in flora and fauna, and artistic liberties were taken to depict skin pathologies like plant tendrils or fungus (Figure 5). It should be noted that these early photographs predominantly documented White patients, and there is a significant lack of skin of color illustrations from this time period.
In the modern world, it is astounding to see how dermatology visual aids have evolved over centuries. Once reliant on basic illustrations and heavy textbooks to document dermatologic illnesses, clinicians now have access to handheld libraries of high-resolution clinical images through resources like VisualDx (Figures 6A and 6B). The extensive detail in these photographs not only helps educate learners on dermatological differentials, but importantly also documents the many variations of presentation in different skin types and colors.
In appreciating advances in dermatology education, we acknowledge the early physicians who helped shape the field as we continue to learn from VisualDx— our own virtual skin atlas.
Sources:
- CRISSEY JT. Early dermatologic illustration. AMA Arch Derm Syphilol. 1951;64(4):417-424. doi:10.1001/archderm.1951.01570100034004
- Patalay, Rakesh & Leslie, K & Levell, Nick. (2005). The origins of Robert Willan’s on cutaneous disease. P35-P35.
- Painstaking Portraits of 19th-Century Dermatology Patients (https://hyperallergic.com/290168/painstaking-portraits-of-19th-century-dermatology-patients/)
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