Silent Hill creature designer Masahiro Ito has clashed with Madonna fans after clarifying that his 1999 comments about the singer's music video misinterpreted his design inspirations. Ito, known for creating monsters such as the Bubble Head Nurses and Pyramid Head, had long credited the Butoh-style dance movements seen in Madonna's "Nothing Really Matters" video as one influence on the nurses' unsettling animations, but stressed this referred to the dancers' choreography rather than Madonna or her music itself.

The dispute flared up in May 2026 when a fan claimed Madonna was "literally the inspiration" for Silent Hill 2's atmosphere, prompting Ito to clarify that he meant the white-painted, Butoh-inspired dancers rather than the singer personally. This drew criticism from some Madonna fans who accused him of being dismissive, and the backlash has continued into August 2026, with Ito posting screenshots of ongoing harassment and dismissing some critics as trolls seeking a reaction.