2025-10-29 08:38:49
Presenters: Zieneldien T,1 Busot D,2 Ma S,1 Cohen BA3
Affiliations: 1Johns Hopkins University School of Medicine, Baltimore, MD; 2University of South Florida, College of Public Health, Tampa, FL; 3Department of Dermatology, The Johns Hopkins Hospital, Baltimore, MD
Background: Google Images (GI) is widely accessible and has become a popular tool for patients seeking to identify or understand their skin conditions. However, concerns have emerged regarding the limited diversity reflected in image results. The objective of this study was to assess the representation of skin tones and anatomical locations in Google Image search results for common inflammatory and eczematous skin conditions.
Methods: A newly installed, unused Firefox browser was used to eliminate the influence of previous search history or cookies. GI was accessed to search five dermatologic terms: contact dermatitis, allergic rash, skin reaction, atopic dermatitis, and eczema. For each term, the first 50 images were collected in chronological order of appearance. Images that included multiple individuals or were cartoons were excluded. Each image was independently evaluated by two reviewers, who classified the skin tone as either "light" or "dark" and noted the anatomic location of the rash. When disagreements occurred regarding skin tone classification, a third reviewer served as the tiebreaker. Percentages of light versus dark skin tones, along with anatomic location distributions, were calculated for each search term.
Results: A search for “contact dermatitis” yielded 49 photos or 98% lighter skin, “allergic rash” yielded 50 photos or 100% lighter skin, skin reaction yielded 48 photos or 96% lighter skin, atopic dermatitis yielded 45 photos or 90% lighter skin, and eczema yielded 48 photos or 96% lighter skin images. Eczema images were concentrated on the hands at (58%), while contact dermatitis also frequently involved the hands (24%). Skin reaction was most often observed on the face (28%), whereas allergic rash was concentrated on the back (22%). Atopic dermatitis showed a broader spread, most notably on the arms (26%) and legs (12%).
Conclusion: Our analysis revealed a lack of diversity in GI search results for common inflammatory and eczematous skin conditions, with over 90% of images across all search terms depicting lighter skin tones. Since nearly all dermatologic disease manifest distinctly across different skin tones and anatomical locations, this lack of diversity could perpetuate diagnostic disparities, especially since the results do not reflect the prevalence observed in epidemiologic data.
Disclosures: The authors declare no conflicts of interest.
Funding: This study received no external funding.
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