Adapting pediatric dermatology textbooks in South America: enhancing visual representation for skin of color patients

Abstract

Skin diseases have different visual characteristics in skin of color, making recognition a challenge. Pictures and illustrations of darker skin tones in the literature are scarce. In American pediatric dermatology books, less than 40% of photographs depict skin of color. No similar studies have been conducted for South American pediatric dermatology books. This study evaluates the frequency of photographs of skin of color in pediatric dermatology textbooks and atlases. A prospective documentary study was conducted on the skin color of clinical photographs from 5 pediatric dermatology books (4 Brazilian, 1 Argentinian). All photographs were evaluated by three researchers and classified using the Massey-Martin scale (white 1–2, light brown 3–5, dark brown 6–8, black 9–10). Out of 3,471 photographs, 1,000 were excluded, and skin color was determined in 2,471 photographs. White was identified in 1,403 (56%), light brown in 1,044 (42%), dark brown in 24 (1%), and 0 (0%) in black. Atopic dermatitis, contact dermatitis, and psoriasis were the most common diagnoses; however, no dark brown or black skin was represented. In conclusion, photographs of skin of color were less frequent, despite most of the Brazilian population (55.5%) identifying as Black, and in Argentina, 0.7%, though hindered by the lack of self-identification questions before the 2022 census. This disparity undermines education, highlighting the need to increase representation of skin of color in educational materials to improve healthcare for these populations.