School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Arch Dermatol Res. 2024 Nov 1;316(10):733. doi: 10.1007/s00403-024-03460-9.
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.
医生接受过通过图像识别疾病的培训。许多儿科皮肤科疾病最初由儿科医生识别并治疗，他们需要在不同肤色的基础上进行诊断。本研究旨在评估卓越的儿科学教科书内描述皮肤疾病的图像是否反映了不同的肤色。
使用 Fitzpatrick、Massey-Martin 和 Color Bar 量表评估 Nelson 儿科学教科书内描述皮肤科发现的图像。使用 2012 年美国全国选举调查数据，将分布情况与美国人口进行比较。比较三种量表的一致性。采用卡方检验，P 值<0.05 为差异有统计学意义。
在 515 幅图像中，484 幅可分类。Fitzpatrick 量表显示浅色肤色 453 幅（93.6%），Massey-Martin 量表显示浅色肤色 364 幅（75.2%），Color Bar 量表显示浅色肤色 406 幅（83.9%）；Massey-Martin 量表显示中色肤色 92 幅（19.0%），Color Bar 量表显示中色肤色 53 幅（11.0%）；Fitzpatrick 量表显示深色肤色 31 幅（6.4%），Massey-Martin 量表显示深色肤色 28 幅（5.8%），Color Bar 量表显示深色肤色 25 幅（5.2%）。教科书的肤色分布与美国人口分布不同：浅色肤色分别为 75.2%和 63.3%，中色肤色分别为 19.0%和 25.8%，深色肤色分别为 5.8%和 11.0%（P<0.00001）。三种量表对浅色/中色与深色的比例一致（P=0.71）。某些疾病主要出现在深色（烧伤、麻风病、色素性荨麻疹）或浅色（银屑病、痤疮、血管瘤、传染性软疣、疱疹、瘢痕疙瘩）皮肤。
展示皮肤科表现的图像主要描绘浅色肤色，且与美国人口分布不相符。某些疾病更多见于深色或浅色皮肤，与流行病学无关。
