Warning: The following article may induce nausea and nightmares!

Fake Skin Diseases Online: a Review of Dermatological Hoaxes

Keith D. Wagner, M.S.
Department of Dermatology
University of Texas Medical Branch

Julie A. Croley, M.D
Department of Dermatology
University of Texas Medical Branch

Corresponding Author:
Keith D. Wagner
Department of Dermatology
301 University Bvld
Galveston, TX 77555-0783
kedwagne@utmb.edu>

Abstract
The internet has become a fixture of modern times. However, not all the information it holds is accurate. For more than a decade, users have shared images intended to shock. Some have even gone so far as to create fake skin conditions using photo-editing programs or other means.  We present six “skin conditions” that were fabricated by internet users and have been spread across the internet message boards, social media, and in chain E-mails. Many of the images take advantage of the discomforts found in trypophobia and acarophobia. It is important for dermatologists to recognize how these fake conditions may be influencing their patients’ opinions about skin disease and further stigmatizing dermatological illnesses.

Tags
Internet, Hoax, Skin disease, trypophobia, acarophobia, stigma, parasites, skin infections, cellulitis

Introduction
Hoaxes are nothing new to medicine, with records extending back as far as 1585.¹ However, with the advent of the internet, hoaxes have a new and improved means by which to circulate. The internet provides a visual medium on which pranksters can self-publish and reach a massive worldwide audience. Concurrently, photo editing programs have become more powerful, user-friendly and ubiquitous. With these new tools, hoaxers have created fake images, stories, and websites designed to shock and scare. As the skin is the largest and most visible organ, it is little surprise it has become a target. Commonly, these images exploit the discomfort found in trypophobia, the fear of small holes or bumps clustered together in objects, or acarophobia, the fear of insects burrowing into or infesting the skin. These images can be especially disturbing to people who suffer from actual skin diseases.²

The word “Trypophobia” is derived from the Greek: τρύπα, trýpa, meaning “hole” and φόβος, phóbos, meaning “fear”.

Review of Hoaxes
One of the oldest online skin disease hoaxes is the “lotus breast” (Figure 1) . The image circulated widely on message boards as early as 2003 and can still be found on the web today. The image is created by photo editing a lotus plant onto the breast, creating the appearance of myiasis. The repeated application of this pattern has given rise to “lotus disease,” and it is one of the most popular among the online skin disease hoax patterns, with variants on the forearms, hands, face, mucosa, and other parts of the body. The stories that accompany the images usually implicate exotic foreign parasites, popular shampoos, and encourage users to boil their undergarments, lest they be the next unfortunate host of this fictitious condition.³

Like the lotus breast, Figure 2 is part of a larger family of “trypophobia patterns.” It can be found under several names and can be searched using the term “trypophobia foot.” The pattern has been said to be related to various insects like “jiggers” (Tunga penetrans). However, it is likely that the image comes from an edited photo pattern made of Mehron spirit gum and scar wax, or some other unknown pattern.⁴ This produces artificial skin effects that are then digitally edited to decrease resolution and create an erythematous pattern. Due to the nature of these images and how they are used online, it can be difficult to discover their origin or the source material for photo-editing. The trypophobia patterns have become so popular that video tutorials about producing them have been created. One of these has over 14 million views.⁵

Another common skin disease hoax is known as “Lamprey Disease.” This condition involves photo-editing lamprey eel mouths onto various parts of the body, orifices, and amputated limbs, giving the appearance of tissues that have eroded through to bone. The earliest example of this is likely the “Lamprey fingers” (Figure 3). This image is said to be connected to an exotic parasite or excessive computer use. It has been circulated online since at least 2007.⁶

Figure 4 is known as the ham face girl, which circulated as early as 2016, and asks for Facebook post likes and shares, or claims that the post is raising money for the girl. The image is said to be of a girl with an incurable skin condition. While many internet users could tell that this was a hoax, many appeared to have fallen for it. The image has spawned several variants and parodies involving animals, like the ham face dog.⁷

These “conditions” do not always involve erosions or ulcerations in the skin; they can also involve malformations and discolorations. Figure 5 depicts an image of what is alleged to be a hand associated with the “blue waffle disease,” a fabricated gynecologic condition that has made rounds on the internet since at least 2013. Now, the “disease” has gained a cutaneous manifestation. The supinated hand is blue, calloused, and completely malformed. While the image is clearly fake to the medical professional, it still manages to shock and captivate audiences that have less experience in medicine or skin disease (loud volume warning).⁸

The final hoax reviewed is the disappearing tick. The story is that a new kind of tick can burrow under the skin and crawl freely around the body. The hoax involves a before (figure 6) and an after photo (figure 7). Allegedly, the hoax began as a parent demonstrating to his children how untrue things can circulate on the internet. As of May 2017, the post had over 50,000 shares on Facebook.⁹

Discussion
The images presented are so striking that popular internet media companies frequently publish them, presenting them as real or possibly real conditions.¹⁰ These websites receive high volumes of traffic, facilitating the spread of the images and the fear that accompanies them. Some of the images are so widespread that fact-checking websites like snopes.com have published articles addressing them.^{3, 6}

The fear of disease has found a comfortable home on the internet, living in the photo- edited skin of these and many other images. Using trends.google.com to evaluate Google search terms, it can be observed that people are increasingly googling their skin diseases and symptoms.¹¹ In June 2013, there was a more than 1000% increase in the search queries for the term “breast worms,” along with a substantial increase in the search queries for “skin bugs.” When this is cross-referenced with a list of lotus breast sightings from snopes.com, it can be observed that there was a fake story in circulation in that time frame about how a popular shampoo was causing skin disease. The photo that went along with the story was the lotus pattern photo edited onto a shoulder.^{3, 12} This demonstrates when these images circulate, they elicit a notable response from the viewers and can spread misinformation across the web.

It is worthwhile for dermatologists to be aware of this phenomenon because it is possible that their patients have been exposed to these images and tall tales. Patients may have found them through message boards and emails, or they may have encountered them when attempting to search the web for explanations about their own cutaneous symptoms. These fake conditions may affect our patients’ perceptions about skin disease, its causes, and how it manifests. Additionally, these images may serve to stigmatize skin conditions or make those with skin diseases more uncomfortable. In light of these possible challenges, the authors have launched The Online Skin Disease Hoax Archive a non-monetized educational website. The purpose of this website is to archive skin disease hoaxes in one place, collect reports of new dermatologic hoaxes, to reassure concerned individuals, and to provide a public resource about this emergent phenomenon.¹³

Stay tuned, and visit the Skin Disease Hoax Archive for exciting new sightings!

References:

1. Jütte, R. (2007). The medical miracle revisited: the enlightenment debate on the miraculous golden tooth.  Medicine and religion in enlightenment Europe. pgs. 196-204.

2. Yamada Y, Sasaki K. (2017) Involuntary Protection Against Dermatosis: A Preliminary Observation on Trypophobia. BMC Res Notes. (10)1:658
3. Mikkelson, D. (2014). Breast Rash. Retrieved from http://www.snopes.com/photos/medical/breastrash.asp 1/15/18.
4. Anderoli, R. (2016, March 15). Do you have this strange disease and not even know it?. Retrieved from http://firsttoknow.com/what-is-trypophobia-hand-the-truth-revealed/.
5. Konig, C. (2015, June 19). TRYPOPHOBIA HAND TUTORIAL! (SFX)! | QUEEN KINGSFX. Retrieved from https://www.youtube.com/watch?v=gRBYY1QHjMs.
6. Mikkelson, D. (2015) Fingertips Damaged from Computer Use? Retrieved from https://www.snopes.com/photos/gruesome/fingers.asp
7. Christensen B. (2016) The Curious Case of Ham-Face Girl (And Poor Ted From Hoax Slayer). Retrieved from http://www.hoax-slayer.net/the-curious-case-of-ham-face-girl-and-poor-ted-from-hoax-slayer 1/15/18.
8. Blue Waffle. (2015, September 1). Blue Waffle Infection Pictures. Retrieved from https://www.youtube.com/watch?v=xAajSdYhWeY.
9. Palma B. (2017). Is There a New, Rare Tick That Burrows Under Your Skin Undetected? Retrieved from https://www.snopes.com/new-tick-burrows 1/15/18.
10. Donovan, F. Trypophobia Is The Terrifying Phobia You Didn’t Know You Had. Retrieved from https://www.unilad.co.uk/pics/these-photos-of-objects-with-holes-in-will-freak-you-out 1/15/18.
11. Corcimaru, A., Morrell, D., Burkhart, C. (2017). The Internet for patient education on atopic dermatitis: friend or foe? JAAD. 76(6):1197-1198.
12. google.com, Search terms: “Breast worms”, “Skin Bugs”. Search Settings: Worldwide. 2004-present, All categories. Web Search. 11/15/17
13. skinhoax.com

In case you want to see how pervasive Fake Photos are:
Here’s one from snopes.com of of the Obamas from a Photoshop contest for which contestants were tasked “to show us what the world would be like if it were ruled by pimps and players.”