Representation of diverse skin tones in Nelson's Textbook of Pediatrics.
Dermatology
Diversity, equity, inclusion
Pediatricians
Skin pigmentation
Textbooks as topic
Journal
Archives of dermatological research
ISSN: 1432-069X
Titre abrégé: Arch Dermatol Res
Pays: Germany
ID NLM: 8000462
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
received:
30
09
2024
accepted:
16
10
2024
revised:
30
09
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
Physicians are trained to visually recognize disease using images. Many pediatric dermatologic conditions are initially identified and treated by pediatricians, who need to diagnose on varied skin tones. The objective was to evaluate if figures depicting cutaneous disease in the preeminent pediatrics textbook reflect diverse skin tones. Figures depicting dermatologic findings in Nelson's Textbook of Pediatrics were assessed using the Fitzpatrick, Massey-Martin, and Color Bar scales. The distribution was compared to the US population using American National Election Survey 2012 data. The three scales were compared for concordance. Statistical analysis included chi square with P < 0.05 significant. Of 515 figures, 484 were classifiable. Light skin tones were depicted in 453 (93.6%) by Fitzpatrick, 364 (75.2%) by Massey-Martin, and 406 (83.9%) by Color Bar, moderate tones in 92 (19.0%) by Massey-Martin and 53 (11.0%) by Color Bar, and dark tones in 31 (6.4%) by Fitzpatrick, 28 (5.8%) by Massey-Martin, and 25 (5.2%) by Color Bar. The textbook skin tone distribution did not reflect the US population: light 75.2% vs. 63.3%, moderate 19.0% vs. 25.8%, dark 5.8% vs. 11.0%, respectively (P < 0.00001). The three scales yielded consistent proportions for light/moderate vs. dark tones (P = 0.71). Certain conditions were mostly depicted on dark (burns, leprosy, urticaria pigmentosa) or light skin (psoriasis, acne, hemangioma, molluscum, herpes, keloid). Figures demonstrating dermatologic manifestations are predominantly depicted on light skin tones, and are not representative of the US population. Certain conditions were more commonly shown on dark or light skin tones, unrelated to epidemiology.
Identifiants
pubmed: 39485519
doi: 10.1007/s00403-024-03460-9
pii: 10.1007/s00403-024-03460-9
doi:
Types de publication
Journal Article
Historical Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
733Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Adelekun A, Onyekaba G, Lipoff JB (2021) Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol 84(1):194–196. https://doi.org/10.1016/j.jaad.2020.04.084
doi: 10.1016/j.jaad.2020.04.084
pubmed: 32335181
Kaundinya T, Kundu RV (2021) Diversity of skin images in medical texts: recommendations for student advocacy in medical education. J Med Educ Curric Dev 8. https://doi.org/10.1177/23821205211025855
Lovett L (2021) Dermatology data sets lack ethnicity, skin type information. In: Mobi Health News. https://www.mobihealthnews.com/news/dermatology-data-sets-lack-ethnicity-skin-type-information . Accessed 29 Nov 2024
Prichep D (2019) Diagnostic gaps: Skin comes in many shades and so do rashes. In: NPR. https://www.npr.org/sections/health-shots/2019/11/04/774910915/diagnostic-gaps-skin-comes-in-many-shades-and-so-do-rashes . Accessed 29 Nov 2024
Reuter E (2021) Study shows skewed dermatological datasets result in less accurate models. In: MedCityNews. https://medcitynews.com/2021/07/study-shows-skewed-dermatological-datasets-result-in-less-accurate-models/ . Accessed 29 Nov 2024
Gupta V, Sharma VK (2019) Skin typing: Fitzpatrick grading and others. Clin Dermatol 37(5):430–436. https://doi.org/10.1016/j.clindermatol.2019.07.010
doi: 10.1016/j.clindermatol.2019.07.010
pubmed: 31896400
Massey DS, Martin JA (2003) The NIS skin color scale. In: The New Immigrant Survey. Princeton. https://nis.princeton.edu/ . Accessed 29 Nov 2024
Ho BK, Robinson JK (2015) Color Bar tool for skin type self-identification: a cross-sectional study. J Am Acad Dermatol 73(2):312. https://doi.org/10.1016/j.jaad.2015.05.024 . 3.e1
doi: 10.1016/j.jaad.2015.05.024
pubmed: 26183973
pmcid: 4506490
Kliegman RM, St Geme JW III et al (eds) (2020) Nelson Textbook of Pediatrics, 21st edn. Elsevier Inc, Philadelphia
Alvarado SM, Feng H (2021) Representation of dark skin images of common dermatologic conditions in educational resources: a cross-sectional analysis. J Am Acad Dermatol 84(5):1427–1431. https://doi.org/10.1016/j.jaad.2020.06.041
doi: 10.1016/j.jaad.2020.06.041
pubmed: 32565205
Barve A, Shah M, Sheth P (2021) Skin of color images in pediatric dermatology textbooks. Pediatr Dermatol 38(S2):144–145. https://doi.org/10.1111/pde.14760
doi: 10.1111/pde.14760
pubmed: 34402099
Chang MJ, Lipner SR (2020) Analysis of skin color on the American Academy of Dermatology public education website. J Drugs Dermatol 19(12). https://doi.org/10.36849/jdd.2020.5545
Ebede T, Papier A (2006) Disparities in dermatology educational resources. J Am Acad Dermatol 55(4):687–690. https://doi.org/10.1016/j.jaad.2005.10.068
doi: 10.1016/j.jaad.2005.10.068
pubmed: 17010750
Lester JC, Taylor SC, Chren MM (2019) Under-representation of skin of colour in dermatology images: not just an educational issue. Br J Dermatol 180(6):1521–1522. https://doi.org/10.1111/bjd.17608
doi: 10.1111/bjd.17608
pubmed: 31157429
Louie P, Wilkes R (2018) Representations of race and skin tone in medical textbook imagery. Soc Sci Med 202:38–42. https://doi.org/10.1016/j.socscimed.2018.02.023
doi: 10.1016/j.socscimed.2018.02.023
pubmed: 29501717
Reilley-Luther J, Cline A, Zimmerly A, Azinge S, Moy J (2020) Representation of Fitzpatrick skin type in dermatology textbooks compared with national percentiles. Dermatol Online J 26(12). https://doi.org/10.5070/D32612051349
Van Beek MJ, Swerlick RA, Mathes B, Fitzgerald M, Etkin CD, Jacobs JP (2021) The 2021 annual report of DataDerm: The database of the American Academy of Dermatology 86(5):1058–1062. https://doi.org/10.1016/j.jaad.2021.11.029
Wen D, Khan SM, Ji Xu A, Ibrahim H, Smith L, Caballero J, Zepeda L, de Blas Perez C, Denniston AK, Liu X, Matin RN (2022) Characteristics of publicly available skin cancer image datasets: a systematic review. Lancet Digit Health 4(1):e64–e74. https://doi.org/10.1016/S2589-7500(21)00252-1
doi: 10.1016/S2589-7500(21)00252-1
pubmed: 34772649
The American National Election Studies (ANES) (2016) ANES 2012 Time Series Study. Inter-university Consortium Political Social Res [distributor]. https://doi.org/10.3886/ICPSR35157.v1 . Accessed 29 Nov 2024
doi: 10.3886/ICPSR35157.v1
Halder RM, Nootheti PK (2003) Ethnic skin disorders overview. J Am Acad Dermatol 48(6 Suppl):S143–S148. https://doi.org/10.1067/mjd.2003.274
doi: 10.1067/mjd.2003.274
pubmed: 12789168
Maymone MBC, Watchmaker JD, Dubiel M, Wirya SA, Shen LY, Vashi NA (2019) Common skin disorders in pediatric skin of color. J Pediatr Health Care 33(6):727–737. https://doi.org/10.1016/j.pedhc.2019.04.019
doi: 10.1016/j.pedhc.2019.04.019
pubmed: 31655787
Glass DA 2nd (2017) Current understanding of the genetic causes of keloid formation. J Investig Dermatol Symp Proc 18(2):S50–S53. https://doi.org/10.1016/j.jisp.2016.10.024
Velez Edwards DR, Tsosie KS, Williams SM, Edwards TL, Russell SB (2014) Admixture mapping identifies a locus at 15q21.2-22.3 associated with keloid formation in African americans. Hum Genet 133(12):1513–1523. https://doi.org/10.1007/s00439-014-1490-9
doi: 10.1007/s00439-014-1490-9
pubmed: 25280642
pmcid: 4334317