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August 2016

Greyscale—A Mystery Dermatologic Disease on HBO’s Game of Thrones

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2016;152(8):904. doi:10.1001/jamadermatol.2015.5793

Game of Thrones is a popular television show based on a series of ongoing fantasy novels involving a world of warring dynasties and creatures (eg, dragons, the living dead called “white walkers”). In Westeros, one disease is known as a plague feared by all and marked by classic skin manifestations: greyscale.

Through 5 seasons on HBO, greyscale has been depicted on-screen in only 3 different places. Most prominent is the case of a 9-year-old girl, Shireen Baratheon, the daughter of the leader of one faction, Stannis Baratheon. Her eruption is depicted as ichthyotic plaques in a somewhat Blaschkoid pattern limited to the left side of the face and body. We are told that this disease afflicted her years before, apparently transmitted by a contaminated doll, but she has recovered with the lingering skin changes an unfortunate permanent mark of what she survived. One other set of cases are “the Stonemen,” beings with disseminated skin changes and psychiatric instability with aggressive behavior who were exiled and isolated into the land of Valyria. This quarantine has effectively stopped most new cases of disease. The last and most recent case, presented at the end of the last season, was the brave warrior, Jorah Mormont, who developed a skin lesion within a day of skin-to-skin contact with a Stoneman.

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