Before jumping to conclusions, carefully read this article. Its content has been formulated based on Dermatology and History. At no time does it justify or excuse the crimes or purges committed by the protagonists. We are not responsible for other interpretations. If in doubt, consult your trusted historian.
"Stalin could change the world, but he couldn't stop scratching. What's the point of being all-powerful and feared if every night your bones ache and your skin itches?" These words, written by Sergio del Molino in his book La piel, are over six years old, but they serve retired Dermatology professor José Carlos Moreno to introduce some of his talks about skin diseases in different historical figures. "Del Molino acknowledges that he is a psoriatic patient and he portrays his life and experiences in this book and compares it with the lives of other characters who have suffered from psoriasis. It is the one that has truly served me as a starting point to get to know the lives of many patients who suffered from this disease," confesses Moreno.
From there, the specialist has searched for numerous references and has studied many other characters - some of them present in Del Molino's book - not only patients with psoriasis but also with other skin conditions since the beginning of time. Moreno, who was head of the Dermatology Department at the Reina Sofía Hospital in Córdoba, belongs to the Spanish Group of History and Humanities of the Spanish Academy of Dermatology and Venereology (AEDV), where they are true lovers of their medical specialty related to literature, art, and history. Moreno's work demonstrates that the history of humanity has also been written based on complexes, intense scratching, and clothes stained with blood. Characters wrapped in stigma and misunderstandings by the science and society of their time.
Ancient Greece, Egypt, even Mesopotamia left evidence of dermatopathies. Even in the Bible, leprosy was described as anything that caused the skin to scale or stain with that initial idea of stigma: the skin becomes ill as a divine punishment, which demands social exclusion. The Book of Job says that he was struck by Satan "with a malignant sore from the sole of his foot to the crown of his head." It describes a blackened skin that falls off and hurts, and to soothe the itching, he used a piece of broken pottery to scrape off the scabs. Although it was considered leprosy - in ancient iconography it is depicted as a pattern of lepers - it is very likely that he suffered from "an autoimmune blistering disease, specifically dermatitis herpetiformis," indicates Moreno.
In the Middle Ages, the term leprosy continued to be attributed to a wide range of problems, from a simple ringworm or vitiligo to severe psoriasis. The famous leprous king Robert I of Scotland actually suffered from severe psoriasis, according to current historical analyses. Jumping to the France of the guillotine, we find the doctor, journalist, and Jacobin politician Jean-Paul Marat. One of the most radical and ruthless ideologues of the French Revolution began to suffer from sores at the age of 45 that covered his entire body, especially his scalp. He was convinced that he had contracted it in the sewers of Paris when he had to take refuge there to escape his political enemies. He felt intense itching and burning and emitted an unpleasant odor that he mitigated with constant immersion baths (where he took the opportunity to sign death sentences by guillotine, up to 1,200, proving that multitasking is not exclusive to the 21st century).
Precisely in the bathtub, death found him after being stabbed by the Girondin Charlotte de Corday in 1793. The blood splattered the newspaper he was reading (L'Ami du peuple, of which he was the founder and director), which was kept as a memento by his sister and after passing through private collectors ended up in the National Library of France, where it is preserved as the only opportunity to study his DNA - his remains were removed from the Pantheon of Paris in 1795, and his trail was lost. The geneticist from the Higher Council for Scientific Research (CSIC) Carlos Lalueza-Fox led an international team to study those blood remains and the work ruled out diseases attributed to the revolutionary such as leprosy, syphilis, tuberculosis, candidiasis, scabies, atopic eczema, or gluten allergy. But it did find traces of DNA from viruses, bacteria, and fungi, such as Malassezia restricta, which causes seborrheic dermatitis. The study suggests that Marat may have suffered from this type of dermatitis superinfected with opportunistic bacterial pathogens.
If he had not been assassinated, would he have died from his illness? At that time, there were no treatments available for many dermatological diseases, herbal ointments were used, bloodletting which were even counterproductive and weakened the patient more, or medicinal baths. He resorted to hours in the bathtub for the relief it provided for itching and pain (even to clean open wounds from scratching). "Current authors speak more of an autoimmune blistering disease, possibly dermatitis herpetiformis," Moreno also leans towards.
Marx, the ordeal of furuncles
A few decades later, in 19th-century England, Karl Marx wrote Das Kapital in certain isolation. He had liver and bile problems, exacerbated by a very inappropriate lifestyle. According to his biographer Werner Blumenberg, "he would get up between eight and nine in the morning, have a black coffee, read the newspaper, and then go to his study, where he worked until two or three in the morning. During the day, he sometimes slept for an hour or two on the sofa." Prolonged insomnia, night work, and poor diet: he liked highly seasoned food, smoked fish, pickled cucumbers - "not good for liver patients," indicates Moreno. He also liked wine, spirits, and smoked poor-quality cigars. He began to suffer from furuncles, with abscesses so severe that he could not sit or work upright.
So the bible of communism was written hunched over and perhaps at times standing or lying down. This emphasized traits of his character: he argued harshly, could be rude and cruel in his expressions, and even criticized his friends, like Friedrich Engels. He suffered from hidradenitis suppurativa, known as furuncles, which is the "inflammation of the gland mainly axillary, inguinal, and in the sacral area, around the anus. It produces abscesses with pus constantly," explains Moreno. It is not exactly known what causes the disease, but at that time there were no treatments that currently alleviate especially the most severe forms. In addition to the ordeal, the odor emitted by the lesions was another reason for isolation, in addition to various family tragedies such as the death of his wife and one of his daughters (another committed suicide, and a third was found dead next to her husband after both injected themselves with cyanide).
We arrive at the 20th century and the Soviet dictator Joseph Stalin, who also had a litany of problems throughout his life: he suffered from smallpox as a child, which left terrible scars on his face; also in his childhood, he was run over by a horse-drawn cart in his native Georgia, shattering his left arm (it remained shorter, a complex the dictator camouflaged by ordering custom-made military jackets with asymmetrical sleeves). Presumably, all these insecurities forged a very particular character, in addition to suffering from appendicitis, tuberculosis, gallstones, and mental disorders. Despite this (or perhaps precisely because of it), he was a vain man—or perhaps terribly self-conscious—who wouldn't allow any photos to be taken unless they were retouched to hide the smallpox scars.
But then came a vicious bout of psoriasis, which obviously didn't help matters. She sought relief at her dacha (country house) in Sochi, on the shores of the Black Sea, where she immersed herself in a private seawater pool, hoping the sun and salt air would soothe her skin. Her indulgence in lavish dinners washed down with alcohol and copious amounts of tobacco—two factors that exacerbated her illness (as did the lithium she took for her psychiatric disorders, which is an accelerator)—only worsened her condition.
In her despair, she encountered Dr. Ignaty Nikolayevich Kazakov, director of the State Research Institute of Metabolism and Endocrine Disorders of the USSR People's Commissariat of Health, who had invented lysate therapy to rejuvenate the body. This technique was met with outrage by the medical community due to the deaths it caused, which were subsequently covered up. It involves hydrolyzing products from various organs using enzymes in an acidic medium under high pressure. Initially, he had good results with Stalin, which earned him gifts and appointments, but when his psoriasis flared up with greater intensity... Kazakov was arrested, accused of high treason, and sentenced to death.
The drug trafficker Pablo Escobar shares a bloodthirsty nature with Marat and Stalin, and with the Soviet leader, he also suffers from psoriasis, in his case on his face. Although he imposed his law with "silver or lead," the stress of being the most wanted man on the planet contributed to the psoriasis outbreaks that, paradoxically, helped the Search Bloc of the Colombian National Police and Army to identify him when the drug lord used doubles to evade the authorities.
The temptation arises to wonder to what extent this skin torture conditioned the bloodthirsty nature of some of these figures. Without psoriasis, would Stalin have been so despotic and sinister? (The same applies to Marat, who spared no one.) "It's hard to know. It doesn't seem like he started out in very good shape. But it influenced his confident character. In the end, it just adds insult to injury," Moreno points out, adding, "It's what you call making life miserable and often paying the price through others." The retired professor believes that these dermatological diseases "reduce quality of life tremendously." "Having to scratch the itching is, I think, the worst symptom there is, even worse than the pain. The classics say that you scratch to remove the skin and exchange the sensation of itching for the sensation of pain, which is much more tolerable," Moreno reflects.
But skin ailments haven't always led to diabolical figures. Some preferred to chase butterflies, like the writer Vladimir Nabokov. The author of Lolita also suffered from psoriasis and described the torment of the itching to his wife, Vera, in the letters he wrote to her. "Everything would be wonderful, if it weren't for this damned skin," he told her. He was "so tormented" by his "Greek," as he called the disease (psoriasis comes from the Greek word psora, meaning scabies or itching), that he contemplated suicide. Nabokov's torment was compounded by guilt: he loved his wife, but she was unfaithful, and this aggravated his psoriasis scales. Although it was already known at that time that the sun could be harmful, Moreno maintains that the writer didn't care and spent time exclusively sunbathing. "He was very bitter about his illness, and it had to be treated. In fact, he said he felt good when his skin was peeling."
The Power of Biological Treatments
Singer Cyndi Lauper probably wanted girls to have a good time because she had a very difficult time herself. She was on tour when psoriasis appeared on her scalp, a disease with very aggressive flare-ups in her case. The artist spoke openly about her condition. "I see a clear difference there between men and women. Women make it visible and use the disease to help other patients. Men complain a lot, but that's it. And women, in general, have participated in associations and are active in patient networks; that is, they make very good use of the disease in the sense of helping others. That has really caught my attention," explains Moreno. Model Cara Delevingne and businesswoman and influencer Kim Kardashian are also examples of this, having shown their psoriasis flare-ups on the runway or to millions of followers on social media.
These characters have been lucky enough to experience the revolution that marked the arrival of biological treatments in the early years of the 2000s (in Spain, the Health Ministry approved its financing between 2007 and 2008). In psoriasis, the immune system begins to produce cytokines (inflammatory proteins) that instruct the skin to produce cells at a rapid rate, causing scales and scabs (basically too much skin). Biological drugs neutralize these cytokines so that they do not give any more orders, the excessive production of skin is stopped and they do not harm the rest of the body. "Going from suffering to using today's biological treatments, where maybe you get an injection every 15 days and you are free of disease, that is wonderful, it is a miracle. You can't imagine how these people's character changes, their smile changes, their way of being changes," Moreno emphasizes.
If these treatments had been available in the dacha of Sochi or in the bathtub of revolutionary Paris, perhaps the pages of the history books would have been written with less blood.