33824 Skin of color representation in Google image searches of common nail conditions

Abstract

Introduction: Online resources in dermatology lack sufficient diversity in skin tones, which has been documented for common skin conditions. Representation of skin of color in online images of nail conditions is not well characterized. Methods: Common nail conditions were searched on Google images. The first 50 photographs for each condition were visually analyzed, rated on the Fitzpatrick scale, and categorized as Fitzpatrick I-II, Fitzpatrick III-IV, Fitzpatrick V-VI, or indeterminate, when categorization was not possible. Results: 34 nail conditions were searched on Google images. A total of 1826 photographs were evaluated, with 55% displaying Fitzpatrick skin types I-II, 31% displaying Fitzpatrick skin types III-IV, 7% displaying Fitzpatrick skin types V-VI, and 7% categorized as indeterminate. 5.9% (2/34) of searches displayed no photographs with Fitzpatrick skin types V-VI (nail pitting and onychomycosis, specifically). The conditions with the highest proportion of images displaying Fitzpatrick skin types V-VI are as follows: anonychia (32.7%), Darier disease (19.6%), longitudinal melanonychia (18.3%), and onychomadesis (15.7%). The conditions with the lowest proportion of images displaying Fitzpatrick skin types V-VI are as follows: brittle nails (1.9%), green nail syndrome (1.9%), ingrown nail (1.9%), nail psoriasis (1.9%), and pincer nail (1.9%). Conclusion: Skin of color is underrepresented in online searches of common nail conditions. With the increased reliance on the internet, especially Google, by patients and physicians to acquire medical information, there is an urgent need to include images representative of all skin tones in online medical content.