Earliest Depiction of Port wine stains, Eye Signs and Ear Deformity in the Portrait of Edward Grimston (c. 1399–1478) by Petrus Christus

Background: The portrait of Edward Grimston (c. 1446) by Petrus Christus represents one of the earliest known artistic depictions of a port-wine stain (PWS) and associated craniofacial anomalies. This study examines the clinical features observed in the painting and explores possible underlying neurocutaneous syndromes.Methods: A detailed clinical assessment of Grimston’s portrait was conducted, focusing on facial vascular malformations, ocular findings, and auricular anomalies. Differential diagnoses were considered based on contemporary medical understanding.Results: The subject exhibits a PWS distributed in the ophthalmic (V1) and maxillary (V2) trigeminal regions, external ear deformity, strabismus, and possible hemifacial weakness. These findings are suggestive of Sturge-Weber syndrome, though other differential diagnoses, including PHACE syndrome, neurofibromatosis type 1, and Goldenhar syndrome, were considered.Conclusion: This historical case provides a unique insight into the earliest artistic representation of PWS and potential neurocutaneous syndromes. The anatomical accuracy of Netherlandish portraiture allows for retrospective medical analysis, offering perspectives on historical figures’ health conditions and the persistence and impact of dermatopathy on mankind.