JMIR Publications

ABSTRACT

Background:

In recent years, there has been evidence of inadequate representation of skin of color (SOC) in dermatology resources. This inadequate representation of SOC may lead to underdiagnosis or misdiagnosis by clinicians. In addition, there is anecdotal evidence of lack of SOC representation in patient oriented educational materials, leading to patient frustration and delayed or missed diagnoses.

Objective:

Analysis of SOC representation in images used for publicly available patient dermatology educational resources from four prominent dermatology organizations between April and November 2023: the American Academy of Dermatology (AAD), American Osteopathic College of Dermatology (AOCD), the Society for Pediatric Dermatology (SPD), and the Skin Cancer Foundation (SCF).

Methods:

To analyze available images on each organization’s website search terms such as "handouts," "pamphlets," "educational material," "educational brochure," and "patient educational material were searched. We determined whether images depicted clinicians and/or patients in stock photography, and/or images of clinical dermatoses. Each image was then identified in terms of Fitzpatrick skin type I-VI.

Results:

Only two (AAD and AOCD) out of the four organizations depicted an array of clinical dermatoses images (Table 1). Out of the 86 clinical dermatoses images from AAD, 64 (74%) represented Fitzpatrick skin types I-III, while 22 (26%) represented skin types IV-VI. Out of the 491 clinical dermatoses images from AOCD, 414 (84%) represented Fitzpatrick skin types I-III, while 77 (16%) represented skin types IV-VI. In addition, AAD's patient educational pamphlet cover pages included stock photography images of clinicians and patients. Among the 35 images analyzed, 7 (20%) featured patients, while 28 (80%) depicted clinicians. Among the 7 patients featured on the cover pages, 4 (57%) represented skin types I-III, while 3 (43%) represented skin types IV-VI. Of the 28 clinicians shown on the cover pages, 13 (46%) represented skin types I-III, while 15 (54%) represented skin types IV-VI.

Conclusions:

There is a lack of diverse representation of SOC in images of clinical dermatoses images used in patient educational materials from dermatologic organizations, including AAD and AOCD. However, there is greater diversity in SOC representation in stock photography of clinicians and patients in AAD patient educational pamphlets. It may be that clinical dermatoses images depicting a range of SOC may not be as readily commercially available for use in patient educational materials when compared to stock photography depicting diverse cast of clinicians and patients. A limitation of our study is that Fitzpatrick skin phototype may not adequately represent ethnic and racial skin diversity. Further effort is needed to ensure diverse SOC representation in patient education materials as this can empower patients to better understand their skin conditions.