Dermatology undergraduate textbooks used in Scandinavia lack skin type diversity, according to study findings published in the Journal of the European Academy of Dermatology and Venereology.

Investigators sought to determine whether the content of dermatology textbooks used by medical students in Scandinavia reflects the ethnic diversity of the population. A total of 7 dermatology textbooks were recommended in medical programs in Scandinavian universities. In addition, 8 universities also recommended a non-Scandinavian book, and 1 university recommended only a non-Scandinavian book. Skin type diversity in the latest edition of each textbook was independently analyzed by 2 researchers.

A total of 2916 images of dermatologic disease were categorized as “lighter skin types,” “darker skin types” (which corresponded with Fitzpatrick skin types V to VI), and “indeterminate” when skin color could not be assessed. The study authors had 10 disagreements, which were discussed until a consensus was achieved.

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The researchers found that non-Scandinavian books had a higher proportion of images of darker skin types (4.2%-6.4%) compared with Scandinavian books (0.9%-3.1%). Indeterminate images in the books ranged from 0.3% to 2.2%.

“Notably, there were hardly any darker skin type images in any of the books of common conditions such as psoriasis, acne vulgaris and lichen planus,” the investigators commented. “Our findings indicate an inadequate reflection of the skin type diversity of Scandinavian populations in the dermatologic educational resources used by medical students in Scandinavia.”

The researchers noted limitations to their findings, as their categorization does not represent the true diversity of skin tone in the images evaluated and it omits minorities who have a lighter skin tone.

Authors of new editions of these textbooks should have an inclusive mindset and use a wide range of skin type images, especially for the more common diagnoses, advised the investigators.

“Skin of color images and cultural issues should be integrated throughout textbooks rather than being confined to a separate chapter,” the study authors stated. “The educational effectiveness of these approaches should be evaluated. Textbooks must evolve to meet changing needs: it is crucial to educate and prepare medical students to face the clinical reality they will encounter.”


Elyas A, Dalgard F, Svensson A. Dermatology textbooks in Scandinavia should prepare medical students for ethnic diversity. J Eur Acad Dermatol Venereol. Published May 29, 2021. doi: 10.1111/jdv.17418