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You can usually tell if someone's a bad guy in a movie if they're bald, pale or badly scarred.

"It's basically movie shorthand for the evil character," San Francisco dermatologist Vail Reese told As It Happens host Carol Off. 

And it's a trope that he says is both ​cliché and dangerous.

Reese, who runs the safe-for-work blog Skinema, has published a study in JAMA Dermatology, in which he looked at the top 10 films from the American Film Institute's 100 greatest heroes and villains list and found that 60 per cent of the villains had a skin condition.

A scarred face means a scarred soul

The biggest signifier of evil was, by far, scarring.

"Typically, if you see a scar in a film, usually done with prosthetic makeup, that's gonna be the bad guy," Reese said. 

Take Darth Vader, the Star Wars villain whose iconic helmet covers severe facial burns.

Or the titular mobster in 1983's Scarface, portrayed by Al Pacino. 

"Even children's movies," Reese said. "The Lion King, the character's name is actually Scar."

Heroes, on the other hand, tend to have smooth skin to go along with their smooth moves. 

Only two of the movie heroes had facial scars — Indiana Jones in Raiders of the Lost Ark and Humphrey Bogart as Rick Blaine in Casablanca. But in those cases, it was the actors, not the characters, who sported the marks.

"Very different from the movie villains, these two scars are never really discussed in the plot, they're never really focused on and they weren't applied with makeup," he said. "They're more incidental."

Bald, pale and up to no good

Other tell-tale signs of fictional villainy include alopecia, the technical term for hair loss, and the extremely pale skin of albinism. 

He points to Silence of the Lambs as a prime example. "Hannibal Lector has a receding hairline that they specifically focus the camera on to really accentuate," he said. 

Often you get a combination of scars, baldness and albinism. Harry Potter's Voldemort is both hairless and pale.  

Dr. Evil, a parody of the villain archetype from the Austin Powers franchise, has what Reese calls the "tripple whammy" of bald, scarred and pale. 

And female characters? Sometimes they fit into the above categories, like the possessed little girl in The Exorcist, but more often they have their own epidermal criteria. 

"Women, perhaps, may play a witch. So often the witch have skin lesions too, warts, wrinkles, bags under their eyes — all signs in Hollywood that this is a character to be feared or avoided," Reese said, citing The Wizard of Oz' Wicked Witch of the West and Snow White's  Evil Queen Grimhilde.

Reese says the study is about more than an "interesting concept or cliché." It can have dire repercussions in real life.

"There are people with large facial birthmarks, much as The Phantom of the Opera had, who have to deal with potential stigma and prejudice," he said.

"People with extensive skin conditions such as psoriasis or eczema, there are many studies documenting higher levels of depression, problems with career moving forward, other just emotional problems associated with stigma and being outcast."

He said he's had patients who were hesitant to get medically necessary surgery for fear of facial scarring.

"Patients, even they they don't realize necessarily that I have this interest in dermatology in movies, may say to me, 'Look doctor, you're gonna do this incision on my cheek. I don't wanna look like that monster from Frankenstein,'" he said. 

"And what they're saying is not just that they want to stay looking good, that scars aren't attractive, I think there's a subconscious understanding that in films, scars also identify evil characters."

Things are getting better

But Reese believes change is possible — and we're already starting to see it.

He noted a decline in "evil albino" characters since the National Organization for Albinism and Hypopigmentation started raising concerns about the stereotype in 2006.

And he sings the praises of Marvel's Deadpool, in which Canada's Ryan Reynolds portrays a hero who has full facial and body hair loss and scarring, which he called "'a very powerful and authentic . . . representation of what it's like to have a severe skin condition and how society can really undermine one's confidence."

"People in Hollywood are extremely creative and I would just encourage them to use that creativity in ways that basically still allow for interesting stories with complex good and bad characters, but not to always just fall to the default scarred, albino, bald stereotypes," Reese said.