Michael Jackson with Jane Fonda in 1983. The red “butterfly” rash associated with lupus is clearly visible on Michael’s cheeks.

On July 8, 2009, Michael Jackson’s dermatologist of 25 years, Dr. Arnie Klein, appeared on Larry King Live. Among the topics of discussion included Michael’s affliction with vitiligo, lupus erythematosus, and chronic pain; as well as the subjects of plastic surgery and body dysmorphic disorder.

A full transcript of the program can be found here. I have chosen to directly excerpt the passages specifically relating to Michael’s health.

CNN LARRY KING LIVE
Interview with Michael Jackson’s Doctor
Aired July 8, 2009 – 21:00 ET

LARRY KING, HOST: The saga the death of Michael Jackson continues. And we welcome a very special guest tonight. Dr. Arnie Klein, they call him the dermatologist to the stars, easily the best known dermatologist in Southern California, maybe elsewhere, too. He’s Michael Jackson’s long-term dermatologist, friend and he’s a professor of medicine and dermatology at UCLA.

Doctor, how did you first meet Michael?

DR. ARNIE KLEIN, MICHAEL JACKSON’S DERMATOLOGIST: I met Michael because someone had brought him into my office. And they walked into the room with Michael. And I looked one — took one look at him and I said you have lupus erythematosus. Now, this was a long word.

KING: Lupus?

KLEIN: Lupus, yes. I mean, because he had red — a butterfly rash and he also had severe crusting you could see on the anterior portion of his scalp. I mean I always am very visual. I’m a person who would look at the lips of Mona Lisa and not see her smile. I would see the lips.

KING: Was he there because of that condition?

KLEIN: He was there only because a very close friend of his had told him to come see me about the problems he had with his skin. Because he was — he had severe acne, which many people made fun of him [for]. He used to remember trying to clean it off and he’d gone to these doctors that really hurt him very much. And he was exquisitely sensitive to pain.

So he walked into my office. He had several things wrong with his skin. So I said — and you have thick crusting of your scalp and you have some hair loss.

He says, well, how do you know this?

I said, because it’s the natural course of lupus. So I then did a biopsy. I diagnosed lupus. And then our relationship went from there.

KING: Grew from there.

You — let’s fast forward. You saw him the Monday before he died.

KLEIN: Absolutely. Yes, sir.

KING: What was the purpose of the visit?

KLEIN: He came to me because, basically, I was sort of rebuilding his face, because he had severe acne and scarring. He had scarring from having a lot of cosmetic surgery. And my expertise is — like it is with every one of my patients. My patients are my treasures. And I was rebuilding his face so he looked much more normal. And contrary to what people said, he could not take off his nose. His nose was attached. But it looked too small. And I just was trying to get him ready to do the concert, because in the way he looked in his face, he wanted it to be absolutely as perfect as it could be.

KING: Did he consult you when he was doing his plastic surgery?

KLEIN: No. I mean I came onto the scene long after he’d begun plastic surgery. In fact, what I wanted to do is, you know, stop it, because I felt that, you know, we were losing body parts in the situation…

KING: Do you know why — he was such a good-looking young man — why he even started the plastic surgery?

KLEIN: I don’t know because I can’t definitively say. But I know that people made fun — or family members — of the size of his nose. He was very sensitive to that. And so he doing cosmetic surgery. [...] The thing is there’s — plastic surgery, it’s unfortunate. If you want it done, there’s someone who will do it.

KING: [...] How would you describe Michael’s mental, physical condition on that Monday?

KLEIN: He was dancing in the office, so it’s hard to say. So he was in very good physical condition. He was dancing for my patients. He was very mentally aware when we saw him and he was in a very good mood, because he was very happy and…

KING: Was it good?

KLEIN: It was a very, very happy mood.

KING: So, therefore, you had to be shocked when he died.

KLEIN: Oh, I sat and — I remember when I found out. I sat at my desk. For about five hours, I couldn’t move, because I was very close to him. And it’s not just because he’s Michael Jackson, probably the most talented actor — or, excuse me, performer of our age. I mean when I lose anyone that I know I go — having lost my brother and my father when I was in medical school, I don’t do well with death. [...] Anyone I’ve taken care of many of your friends. And I have to tell you one thing, I give my life to my work. I have nothing else.

KING: Was — was Michael in any kind of pain when you saw him?

KLEIN: Not whatsoever.

KING: Yes. Now, there are reports, doctor, that his body was riddled — I want to get this right — with needle marks when he died.

Did you see any evidence of needle marks on this visit?

KLEIN: Well, I didn’t examine his entire body.

KING: Had you seen any in prior exams?

KLEIN: No, I never saw needle marks on his body. I mean I never saw them. But I could tell you— but I didn’t see a riddling of anything. People sound like he looked like he was made of, you know, there were holes in him. And there weren’t anything like that.

KING: Reports he was emaciated.

KLEIN: He wasn’t emaciated. I mean, I know dancers because I’ve worked with dancers many times and dancers are very concerned about their weight. And so I knew that he always wanted to be thin. And I talked to him about eating enough and making sure he didn’t over exercise, as some dancers, in order to remain thin, will over dance, in order to keep their weight down.

KING: [...] Well, what about pain killing medications? Did you prescribe any?

KLEIN: I mean I’ve some sedatives for, you know, when he had surgical procedures that were immense, because, don’t forget, he had a lot of — he had the burn — the serious burn when he was burnt on the Pepsi commercial and the severe hair loss when he, you know, contracted lupus, also.

So when you have to fix all these areas, you have to sedate him a little bit.

But if you took all the pills I had given him in the last year at once, it wouldn’t do anything to you.

KING: What was the strongest medication you gave him?

KLEIN: I once — you know, I, on occasion, gave him Demerol to sedate him. And that was about the strongest medicine I ever used.

[...]

KING: What is vitiligo?

KLEIN: It’s a loss of pigment cells. And the pigment cells, you — for every 36 normal cells in your body, you have one pigment cell pumping pigment into them. Unfortunately, it’s an autoimmune disease and lupus is an autoimmune disease. And they tend to go together, because you make antibodies against your pigment cells.

KING: Did Michael have it?

KLEIN: Absolutely. We biopsied (INAUDIBLE).

KING: What causes it?

KLEIN: It’s caused by your immune system and your immune system destroying your pigment cells.

KING: Do black people have it more than white people?

KLEIN: No. But it’s just more visible on black people, because they have a dark skin. The other thing is, it certainly occurs with a family history. And I believe one of Michael’s relatives did, in fact, have vitiligo.

KING: How bad was his?

KLEIN: Oh, his was bad because he began to get a totally speckled look over his body. And he could…

KING: All over his body?

KLEIN: All over his body, but on his face significantly; on his hands, which were very difficult to treat.

KING: So let’s clear up something.

He was not someone desirous of being white?

KLEIN: No. Michael was black. He was very proud of his black heritage. He changed the world for black people. We now have a black president.

KING: So how do you treat vitiligo?

KLEIN: Well, I mean there’s certain treatments. You have one choice where you can use certain drugs called (INAUDIBLE) and ultraviolet light treatments to try to make the white spots turn dark or — his became so severe, that the easier way is to use certain creams that will make the dark spots turn light so you can even out the pigments totally.

KING: So your decision there was he would go light?

KLEIN: Well, yes, that’s ultimately what the decision had to be, because there was too much vitiligo to deal with and…

KING: Otherwise, he would have looked ridiculous?

KLEIN: Well, you can’t — he would have to wear heavy, heavy makeup on stage, which would be ridiculous. And he couldn’t really go out in public without looking terribly peculiar.

KING: [...] How did you treat the vitiligo?

KLEIN: Well, we basically used creams that would even out the same color and we destroyed the remaining pigment cells.

KING: And did his color change a lot over the years?

KLEIN: No, because once we got — we got it more uniform, it remained stable. But you still had to treat it because once in a while — and he had to also be extraordinary careful with sun exposure because of a lot of things. And that’s why he had the umbrellas all the time (INAUDIBLE) skin now.

KING: So when you have vitiligo, you have it all your life?

KLEIN: Usually. Almost uniformly. You don’t just have a little bit of it. And it’s most disconcerting not in white people, but in black people because you begin to look like a leopard.

KING: You can see it. Yes.

Did he have blotches?

KLEIN: He had blotches but we evened out almost all of them. And he was very, very devoted to treating it. I mean he wanted to look well. He wanted to look well for one group of people, his fans. He wanted to embrace and love his fans more than any performer I’ve ever known.

KING: Did he have hair?

KLEIN: He had lost a great deal of it. You forget this first fire…

KING: That was the Pepsi fire, right?

KLEIN: Yes. But then what happened is he used a great deal of what are called tissue expanders in his scalp, which are balloons that grow up — blow up the scalp. And then what they do is they try to cut out the scar.

Well, because he had lupus, what happened is every time they would do it, the bald spot would keep enlarging.

So, I mean, he went through a lot of painful procedures with these tissue expanders until I put a stop to it. I said no more tissue expanders, because he had to wear a hat all the time and it was really painful for him.

KING: So what would his — without the hat, what would he look like?

KLEIN: Well, he had a big raised ball on the top of his head because of this device. It would expand the tissue, which you cut out.

But (INAUDIBLE) would you — (INAUDIBLE) too much stretch back in the scar, you understand?

KING: Did you see him one other time?

KLEIN: Of course I did. But he would have a stretch back on the scar. I mean the scar would get worse after they removed it. And I had to put a stop to it. So I told Michael, we have to stop this. And that’s when I fired this plastic surgeon altogether. And I said I can’t deal with this anymore. We’re going to deal with me as your doctor or you’re going to have to find another doctor if you want to work with him.

KING: What you can tell us about his changing face?

KLEIN: Well, I mean, I didn’t know a whole lot through the whole changing face schedule, because I’m telling you that when I met him, he had done a — a decent bit of surgery by then. I know…

KING: Was it done poorly?

KLEIN: Well, it’s not done poorly, but I think that there’s a time — the magic is not knowing when to begin the big game. The secret is knowing when to end it.

And I think that he believed that his face was a work of art, which is fine with me.

But I think at one point that I wanted to stop the doctors from continuing it. Because it wasn’t the doc — Michael, I think, that wanted all these things. It was the surgeon who kept doing it. So I got rid of the surgeon.

KING: The surgeon got him to do it?

KLEIN: No, he did some of it himself. But he didn’t know — the surgeon did not know when to stop doing it. The judgment call there was (INAUDIBLE).

KING: Did you ever say to Michael, we’re going too far?

KLEIN: I stopped him from going to the surgeon because I said this isn’t working anymore, you have to stop it. And what I spent the last part of the year doing is rebuilding a lot of things that I thought were done poorly. And to look at it, because I didn’t think he — he had a — OK, to him, his face was a work of art. You want to talk about Andy Warhol’s work of art. And there are women in Paris and elsewhere — and men — who do works of art. Some of them implant things under their skins through surgeries.

KING: But there are plastic surgeon addicts, right — people who keep going?

KLEIN: Yes. And there are also people who are — it’s called body dysmorphic disorder, that you don’t like the way you look, which represents 18 percent of patients that see a doctor.

KING: You can be beautiful, but look in the mirror and not think you’re beautiful.

KLEIN: Oh, absolutely.

[...]

KING: Why did he wear the mask?

KLEIN: He wore the mask because it sort of became like the white glove. He would…

KING: Oh, it was a — it was a gimmick.

KLEIN: A gimmick. He had no reason other than to wear the mask than gimmickry.

[...]

KLEIN: The subject is Michael Jackson — the changes to his nose.

Why did he do that? And is it true that he wanted to look like Peter Pan?

KLEIN: I don’t think he wanted to look like Peter Pan. I didn’t see him implanting wings on the back of his back or doing anything like that, right?

KING: All right, what about the nose?

KLEIN: The nose was a very special thing, because his father and his brothers supposedly, from what I’ve read, made fun of his nose all the time. So he was very sensitive to the nose. And…

KING: What was wrong with his nose?

KLEIN: I originally didn’t think there was much wrong with his nose. I thought he had a nice-looking nose. But in the beginning, it was never able to come off his body. But it got to the point where it was far too thin. It didn’t look natural to me.

KING: Now, you helped him rebuild it?

KLEIN: I rebuilt it, yes. Using fillers. I used Restylane. I used hydronic acids because — and they worked very well. And it’s not — it’s an arduous procedure, because you don’t want to put too much in. And you have to do it exactly, so you can flow the material so it’s perfectly smooth.

So we rebuilt them. And I’m telling you that he was beginning to look like the nose was normal again. And that’s all I wanted — and regain the breathing, you know, passages of his nose, because there was a total collapse of the cartilage.

KING: In the last photos that we’ve seen, his nose has been built up, right?

He’s looking better?

KLEIN: Yes.

KING: Was he still working at that?

KLEIN: No, because I think we got to the point where he was very happy with the way he looked and he filled in the cheeks a little bit and did a lot of little things.

But I mean what I do to an individual patient is what I do. And what I do is just restoration work, because I don’t think people should look, again, like anything has been altered.

[...]

KING: Was Michael happy with the way he looked?

KLEIN: Absolutely. Michael, they painted him as a very sad creature like Charlie Chaplin or something.

KING: He loved Chaplin.

KLEIN: Well, we once went to Disneyland and it was Disneyland Paris and at night, he brought Michael Jackson. What he did is, he loved way he walked because he just walked like Charlie Chaplin. So he took the cane and he starts imitating the way Michael Chaplin walks.

Every time Michael would turn around, Michael Jackson would hide the cane. So he’s very, very funny that way. And I spent Christmas Eve with him with Carrie Fisher and his kids wanted to meet Princess Leia, it’s all they wanted to meet. So I dragged Princess Leia over and he played with her and the kids were all on the floor because he was a person who was both a father and he loved them here dearly.