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September 2014

The Dark History of White Spots

Author Affiliations
  • 1Miller School of Medicine, University of Miami, Miami, Florida
JAMA Dermatol. 2014;150(9):936. doi:10.1001/jamadermatol.2014.155

The stigmatization of patients with “white spots” on their skin dates back several millennia. For much of this time, a clear distinction was not made among the various disorders of hypopigmentation. In the Hebrew Bible, Leviticus 13 described a number of such disorders under the broad term Zoraat, denoting white spots.1 Zoraat was a sign of sin and punishment from God, and the afflicted were considered “unclean” and decreed to live alone.2 Around 250 bce, Ptolemy II ordered the translation of the Hebrew Bible to Greek and the term Zoraat was translated as lepra. This paved the way for many years of associating white spots with leprosy, and leprosy with mortal sin. It is clear that at least some of the disorders described in Leviticus 13 do not fit our understanding of leprosy and may refer to other disorders such as vitiligo, postinflammatory leukoderma, psoriasis, or granulomas.

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