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This icon is "considered a variation of the Virgin of Tenderness (Glykophilousa)," adding that "The infant Christ hugging his mother with his back turned to the viewer characterizes this type, a gesture that boosts the drama of the mother worried for her frightened child who is threatened with martyrdom.
This image, conveying the heightened emotions of the mother and the child, is also related to another iconographic type, the Holy Virgin of Sorrows (Passion). It is believed that the image and the topographic epithet were created, following older Slavic traditions, in monasteries in the Pelagonia region of Macedonia, most probably during the time of the mid-ninth-century Slavic missionaries Cyril and Methodios. This iconographic type, regardless of the appellation, appears on fresco icons.
Other well-known older icons of the Holy Virgin Pelagonitissa are found at Veroia, Hilandar, Decani, and Priuzren, and one early example of Macedonian origin from the fifteenth century is in the collection of the Monastery of Saint Catherine, Sinai.Other works by Makariya are found in the vicinity of Prilep and in Serbia. In the history of medieval art in Macedonia, the icon of the Holy Virgin Pelagonitissa has been considered one of the last outstanding achievements of icon painting, a representative of the then still-living tradition of Byzantine iconography."