Pattern recognition is at the heart of clinical dermatology and dermatopathology. Yet, while every practitioner of the art of dermatological diagnosis recognizes the supreme value of diagnostic cues provided by defined patterns of 'efflorescences', few contemplate on the biological basis of pattern formation in and of skin lesions. Vice versa, developmental and theoretical biologists, who would be best prepared to study skin lesion patterns, are lamentably slow to discover this field as a uniquely instructive testing ground for probing theoretical concepts on pattern generation in the human system. As a result, we have at best scraped the surface of understanding the biological basis of pattern formation of skin lesions, and widely open questions dominate over definitive answer. As a symmetry-breaking force, pattern formation represents one of the most fundamental principles that nature enlists for system organization. Thus, the peculiar and often characteristic arrangements that skin lesions display provide a unique opportunity to reflect upon -and to experimentally dissect -the powerful organizing principles at the crossroads of developmental, skin and theoretical biology, genetics, and clinical dermatology that underlie these -increasingly less enigmatic -phenomena. The current 'Controversies' feature offers a range of different perspectives on how pattern formation of skin lesions can be approached. With this, we hope to encourage more systematic interdisciplinary research efforts geared at unraveling the many unsolved, yet utterly fascinating mysteries of dermatological pattern formation. In short: never a dull pattern!
Prelude 1: Tracing skin patternsPattern recognition is the quintessential skill of a dermatologist. His ability to recognize the target lesions of erythema multiforme, the Wickham's striae of lichen planus and the geometric picture of factitial dermatitis affords him an advantageous position in therapy. Furthermore, the pattern of fingerprints provides a means of identifying every single one of the 6 000 000 000 people on our planet. It even distinguishes between identical twins. In addition, the distinctive palmar lines have spawned the thousands of spurious predictions of palmistry.Some patterns are indicative of ageing, such as wrinkles and the similar ridging of the fingernail plate. Onychogryphosis and pincer nail also reflect ageing keratin synthesis. The shoreline nail pattern and Beau's lines hark back to prior illness. Leukonychia is the sign of prior local injury to the nascent nail plate. The cutaneous horn stands as a dramatic sculpture of sun damage.