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Dark Skin Representation within Mobile Applications for Dermatology Education: an Observational Analysis (Preprint)


 BACKGROUND
 Ethnic diversity in dermatology has previously been neglected within educational curricula. This has previously been demonstrated within many established dermatology textbooks. Many urban populations find their communities becoming increasingly diverse and medical education must match these changes. The increasing use and modernisation of mobile technology in health education may represent an avenue to provide increasingly diverse knowledge related to dermatology in dark skin populations.
 
 
 OBJECTIVE
 To review the representation of dark skin photography and diseases in dermatological educational resources provided via mobile application technology.
 
 
 METHODS
 Mobile applications related to ‘dermatology’ were reviewed within the Google Play Store. Only original mobile applications made for education of medical students or health professionals were analysed. Photographic depictions of dermatological conditions were categorised according to Fitzpatrick type 1-4, Fitzpatrick type 5-6, or uncertain. Additionally, mobile applications were reviewed for information regarding four conditions more common in people with darker skin: central centrifugal cicatricial alopecia, melasma, acral lentiginous melanoma, and keloid scarring.
 
 
 RESULTS
 Of 200 mobile applications reviewed, 12 were included within the analysis. In total 3755 in-app photographs were categorised into Fitzpatrick type 1-4 (3398 photographs, 90.5%), Fitzpatrick type 5-6 (245 photographs, 6.5%), or uncertain (112 photographs, 3.0%). The degree of photographs showing Fitzpatrick 5-6 ranged from 0.7% to 17.6% between the different mobile applications. This was not significantly different from results previously gained from photographic depictions in dermatology textbooks. Furthermore, the number of mobile applications presenting overt educational information regarding the four conditions reviewed varied considerably; central centrifugal cicatricial alopecia (1 application, 8.3%), melasma (5 applications, 41.7%), acral lentiginous melanoma (4 applications, 33.3%), and keloid scarring (6 applications, 50%). No mobile applications contained information for all four conditions.
 
 
 CONCLUSIONS
 There is limited depiction of dermatological conditions in darker skin tones within mobile applications aimed at educational students and professionals in dermatology.
