Crazy in Love.

Abstract

Every February brings with it St Valentine's Day, and while expressions of loveaboundduring thismonth, onanygivenday throughout theyear there are ample romantic descriptions to be found in dermatology. Drawing on classical mythology, the hypopigmented macules of syphilis are known as the necklace of Venus, and the vermillion border of the upper lip is referred to as Cupid's bow. Infectiousmononucleosis is knownas “kissingdisease,” “kissing” lesionshavebeendescribed inZoonbalanitis andelectrical burns, and the ideal apposition ofwound edges has been described as that of a “social kiss.” Ecchymoses on the neck are known as “love bites,” and, somewhat less desirably, those with excess abdominal adiposity are said to have “love handles.” Part of the tradition of Valentine's Day is the exchange of gifts, and plentyof inspirationcanbedrawn fromthedermatological realm.While the rose is perhaps themost popular gift, it is also a popular descriptor of cutaneous lesions, suchas “dewdropsona rosepetal” for thevesicles of varicella, roseola infantum, and the “rose spots” of Salmonella typhi infection. The rosette is a widely used dermatology descriptor; clinically as in linear IgA disease, dermoscopically as in keratinizing tumors and histologically as in cyclindromas. Chocolates are always a favorite, and chocolate agar is also the desiredmediumforgrowthofMycobacteriumchelonae. Champagne is liberally consumed on Valentine’s Day, and once the bottle is overturned, it resembles the legofapatientwithadvanced lipodermatosclerosis.Oysters and caviarmay feature on the romantic dinnermenu, conjuring images of rupioid psoriatic plaques and “caviar tongues” (sublingual varicosities). For dessert, strawberries, as in the “strawberry tongue” of Kawasaki disease, are often coupled with cream, the ubiquitous medium for delivery of topical medicaments. Followed by port of course, as in port-wine stains (best referred to as capillary malformations). The luckiest among us will receive jewelry, be it silver, as in the scale of psoriasis, or gold, as in lichen aureus or Staphylococcus aureus infection (with special mention of the Panton-Valentine leucocidin strain). Pearls for some, hopefully rarer types than the common “pearly” surface of nodular basal cell carcinomas, and diamonds for others, such as the rhomboid structures seen dermoscopically in lentigo maligna. While skin remains the loveof all dermatologists, theuniversal symbol of St Valentine's Day is of course the heart, and a wide range of cutaneous abnormalities with heart-shaped morphologic characteristics have been reported. So this February, let us all remember that dermatology ismore than skin deep and that caring for patients with cutaneous disease remains at the heart of dermatology.