Diverse Canadian derm image library under development
New database is collecting images of dermatologic conditions in diverse skin tones to improve equity in outcomes for all Canadians (1,200 words, 6 minutes)
The Dermatology Industry Taskforce on Diversity, Inclusiveness & Equity (DiTiDE) is developing an image library of dermatologic conditions that will focus on the diversity of skin tones across Canada.
DiTiDE is a volunteer committee of Canadian physicians, life sciences managers and executives, and allied parties.
The mission statement for the image library is to create an educational resource database of photos through voluntary user contributions to raise the standard of care for patients of all skin types
The DiTiDE website notes: “Skin disorders and diseases are known to present differently across the six Fitzpatrick Scale skin types. However, many teaching and diagnostic clinical image collections depict only Caucasian skin or under-represent more richly pigmented skin types.”
Features in development for the image library include:
Each image will list detailed diagnostic notes on the patient and clinical presentation
The library will be searchable by Fitzpatrick skin type, dermatologic condition, and body region
The library will permit combined search parameters to filter for images of a skin condition in a specific body region and skin type
The library will continue to grow as Canadian physicians submit photos
Physicians can contribute images by filling out a patient consent form and submitting their photos to the DiTiDE Image Library.
More information on DiTiDE is available at www.ditide.ga
From the literature on dermatology imaging and education
Representation in medical illustration: The impact of model bias in a dermatology pilot study
This study was conducted to evaluate the impact of a diverse range of model images on identification rates of melanin-dependent dermatological symptoms in a quantifiable, though non-statistically significant manner.
Participants, including individuals with a range of education levels and backgrounds, were split into two groups and asked to review four different skin conditions. One group received illustrations of homogeneous pale skin tones, and another received illustrations depicting diverse skin tones, and then both groups were asked to identify clinical photographs.
The group with a diverse reference pool performed marginally better overall and was more able to identify specific conditions where melanin levels impact the appearance of the condition.
Skin tone representation in dermatology textbooks: Approximating the gap
The authors of this paper set out to investigate the current trends of skin of colour representation in the surgical and cosmetic sections of current dermatology textbooks.
They assessed Dermatology 4th Edition, Andrews’ Diseases of the Skin: Clinical Dermatology 13th Edition, and its corresponding Clinical Atlas to find the skin tones represented in each photograph or anatomical schematic.
The images represented among the three dermatology textbooks were 79.9% skin tones I-III and 20.1% skin tones IV-VI. Similar outcomes were found when evaluating the procedural categories. Skin tones I-III represented 97.2% of surgical images and 95.3% of cosmetic images; 100% of anatomical schematics were represented as skin tones I-III.
Photodocumentation in skin of colour
The authors of this paper note
that there is an under-representation of images of dark skin in dermatology textbooks and other educational resources. Because of this, they say it is essential for dermatologists to work toward increasing the availability of images of dermatologic disease in dark skin by improving their ability to successfully photograph dark-skinned patients.
In this article, the authors describe their approach to photographing skin of colour regarding the ideal background type, lighting, and camera settings.
Skin tone representation in dermatologist social media accounts
This study was conducted to explore the representation of skin tones within dermatology social media posts in 2019.
Researchers reviewed posts on Instagram, YouTube, and Twitter by the top 2019 dermatology social media influencers. Twenty-one accounts were included. Eight posts were randomly chosen per account and graded by the Fitzpatrick scale (I-VI).
Overall, Fitzpatrick Type II was the most represented skin type (53%), while Fitzpatrick Type VI was the least represented (0%). On Instagram, 79.7% of posts represented light skin tones (Fitzpatrick Types I-III) and 20.3% represented dark skin tones (Fitzpatrick Types IV-VI). On YouTube, 93.75% of posts represented light skin tones and 6.25% represented dark skin tones. On Twitter, 73.2% of posts represented light skin tones and 26.8% represented dark skin tones.
VIDEO: Presentation on Clinical Photography in Dermatology
At the intersection of skin and society
The First Nations Health Authority (FNHA) marked the second anniversary of the In Plain Sight Report on Wednesday, Nov. 30, 2022, by publicly announcing the completion of work on a first-of-its-kind Cultural Safety and Humility Standard (CSHS) for First Nations in British Columbia (BC), according to an FNHA press release.
In Plain Sight is a review of Indigenous-specific racism in the provincial healthcare system commissioned by the BC Health Minister. One of the recommendations in that report was that BC should adopt an accreditation standard for achieving Cultural Safety and Humility (CSH).
The new standard was developed by a First Nations-led technical committee, supported by the FNHA and with input from Métis Nation BC and partnership with Health Standards Organization (HSO).
According to the release, the new CSHS “is a significant milestone event along the path toward ending systemic racism in BC's healthcare system.”
Work on the CSHS began in October 2018, two years before the release of In Plain Sight.
During the public consultation phase of developing the CSHS, a technical committee co-chaired by the FNHA's Deputy Chief Medical Officer Dr. Nel Wieman and St'at'imc Nation Elder Gerry Oleman received and reviewed more than 1,100 comments from First Nations people, other Indigenous groups, health organizations, and health professionals.
The existence of Indigenous-specific racism in BC's healthcare system is long-standing and pervasive and its ongoing presence continues to have harmful impacts on the overall health and well-being of BC First Nations people today, according to the release. For this reason, the CSHS developers said it was important that First Nations health professionals, with input from community Chiefs, health leaders, and First Nations people across the province were involved in creating the new standard.
“What motivates me in this work is knowing that somewhere today in BC, a First Nations person is seeking medical attention and is being treated in a racist, discriminatory manner,” said Dr. Wieman, FNHA Deputy Chief Medical Officer and co-Chair of the CSHS Technical Committee. “This CSH standard is signalling to the BC health system that racism is no longer acceptable and there is a way forward to making the system safer for First Nations and other Indigenous people. We can be justifiably proud of the work that went into creating the CSH standard and know that we at FNHA are leading systemic change across the country.”
This week is National Hand Washing Awareness Week in the U.S.
Dec. 9 is International Day of Commemoration and Dignity of the Victims of the Crime of Genocide and of the Prevention of this Crime
Dec. 10 is International Human Rights Day
Something to think about in the week ahead…
Wayne Dyer, American psychologist, 1940-2015
Dec. 12 will be the last edition of Skin Spectrum Weekly for 2022, and we will cover a presentation by Dr. Rachel Netahe Asiniwasis summarizing findings from a scoping review on atopic dermatitis in Canada’s Indigenous population. The newsletter will return on Jan. 13, 2023.
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