History of Limited Research and Education in Skin of Color Dermatology
Historically, dermatology has developed as a visually driven specialty largely based on observations in lighter skin populations, resulting in a longstanding imbalance in both research and educational resources related to skin of color (SoC). For decades, dermatologic textbooks, atlases, and training materials have disproportionately featured lighter skin tones, limiting exposure of trainees to disease presentations in darker skin types [1], [2]. This imbalance has persisted despite the growing diversity of global populations and the increasing recognition that many dermatologic conditions manifest differently across varying levels of pigmentation.
Early analyses of dermatologic literature revealed that SoC representation in research was limited, both in terms of patient inclusion and visual documentation. Even in recent decades, underrepresentation of darker skin types has remained significant in clinical trials, academic publications, and case-based teaching materials [3]–[5]. For example, studies evaluating dermatology trials have consistently demonstrated that Black and other minority populations are underrepresented relative to disease prevalence, restricting the generalizability of findings and contributing to gaps in clinical knowledge [3], [6]. Similarly, analyses of dermatology journals and educational resources have shown a predominance of lighter skin images, which can directly impact diagnostic accuracy and clinical training [2], [7].
Comparison of skin tone scales that can be used for skin cancer detection utilizing AI. Recreation of Fitzpatrick Skin Type
References
[1] S. Narla et al., “Racial disparities in dermatology,” J. Am. Acad. Dermatol., 2022.
[2] “Lack of darker skin representation in dermatology textbooks and journals,” STAT News, 2020.
[3] J. Mineroff et al., “Racial and ethnic underrepresentation in dermatology clinical trials,” J. Am. Acad. Dermatol., 2023.
[4] N. El-Kashlan et al., “Disparities in dermatology: A reflection,” Dermatology Reports, 2022.
[5] L. N. Guo et al., “Underreporting and underrepresentation of diverse skin types,” J. Am. Acad. Dermatol., 2022.
[6] “Racial and ethnic underrepresentation in dermatology trials,” 2025.
[7] N. A. Marroquin et al., “Skin of color representation in dermatology literature,” JMIR Dermatology, 2023.
[8] G. Ongoro et al., “Gaps in dermatological education for melanin-rich skin,” Clin. Cosmet. Investig. Dermatol., 2023.
[9] N. C. Syder et al., “Gaps in medical education curricula on skin of color dermatology,” J. Am. Acad. Dermatol., 2023.
[10] International Expert Consensus on Skin of Color Dermatology, 2024.
[11] G. Kleinberg et al., “Bias in dermatological machine learning datasets,” 2022.
[12] Stanford HAI, “Dermatology educational materials lack darker skin tones,” 2023.
Parallel to these research gaps, deficiencies in medical education have been widely documented. Traditional curricula in dermatology have historically provided limited structured content focused on SoC, resulting in reduced confidence among trainees in diagnosing and managing dermatologic conditions in diverse populations [8], [9]. Surveys of dermatology residents and medical students have repeatedly highlighted inadequate training in recognizing conditions in darker skin tones, with many reporting insufficient exposure during their formal education [8]. These educational limitations have been linked to delayed diagnoses, misdiagnoses, and disparities in treatment outcomes among patients with SoC [8], [10].
The emergence of digital health technologies and artificial intelligence has further exposed these disparities. Dermatologic datasets used for algorithm development have often lacked sufficient diversity, leading to biased model performance and reduced diagnostic accuracy in darker skin types [11]. This issue underscores how historical limitations in research representation extend into modern computational approaches, reinforcing inequities unless explicitly addressed.
In response to these longstanding gaps, the field of dermatology has increasingly recognized the need for dedicated SoC education and research. Initiatives such as specialized curricula, targeted educational platforms, and consensus guidelines have begun to address these deficiencies, aiming to improve diagnostic accuracy, clinical confidence, and equity in care delivery [9], [12]. However, despite recent progress, the historical lack of research and education in SoC dermatology continues to influence current clinical practice and underscores the importance of sustained efforts toward inclusivity in both training and scientific investigation.