Dark Skin Representation in Mobile Applications for Dermatology Education: A Scoping Review

There is increasing recognition regarding the need to represent ethnic diversity within dermatology education. Past evaluation of dermatology textbooks has demonstrated that depiction of dark skin makes up to 4.5%-19.9% of total photographs. The present study reviewed the representation of dark skin photography and diseases in dermatologic educational resources provided through mobile application technology. Of the 518 mobile applications reviewed, 18 were included in this analysis. A total of 6,645 in-app photographs were categorized in Fitzpatrick skin types I-IV (5,975 photographs, 89.9%), Fitzpatrick skin types V and VI (459 photographs, 6.9%), or uncertain (211 photographs, 3.2%). The degree of photographs depicting Fitzpatrick skin types V and VI ranged from 0.0% to 17.7% between different mobile applications. This was significantly different from past results derived from photographic depictions in dermatology textbooks-suggestive of fewer depictions within applications (P < 0.001). In addition, the number of mobile applications presenting educational information regarding four conditions that affect people with darker skin tones varied considerably: central centrifugal cicatricial alopecia (3 applications, 16.7%), melasma (9 applications, 50.0%), acral lentiginous melanoma (8 applications, 44.4%), and keloid scarring (11 applications, 61.1%). Overall, there is a limited depiction of darker skin tones and conditions that affect those with darker skin tones within educational mobile applications aimed at students and professionals in dermatology.