Skin of Color Representation on Wikipedia: Cross-sectional Analysis

Background: Wikipedia is one of the most popular websites and may be a go-to source of health and dermatology education for the general population. Prior research indicates poor skin of color (SOC) photo representation in printed dermatology textbooks and online medical websites, but there has been no such assessment performed to determine whether this discrepancy also exists for Wikipedia. Objective: The aim of this study was to investigate the number and quality of SOC photos included in Wikipedia’s skin disease pages and to explore the possible ramifications of these findings. Methods: Photos of skin diseases from Wikipedia’s “List of Skin Conditions” were assigned by three independent raters as SOC or non-SOC according to the Fitzpatrick system, and were given a quality rating (1-3) based on sharpness, size/resolution, and lighting/exposure. Results: We identified 421 skin disease Wikipedia pages and 949 images that met our inclusion criteria. Within these pages, 20.7% of images of skin diseases (196 of 949 images) were SOC and 79.3% (753 of 949 images) were non-SOC (P<.001). There was no difference in the average quality for SOC (2.05) and non-SOC (2.03) images (P=.81). However, the photo quality criteria utilized (sharpness, size/resolution, and lighting/exposure) did not capture all aspects of photo quality. Another limitation of this analysis is that the Fitzpatrick skin typing system is prone to subjectivity and was not originally intended to be utilized as a non-self SOC metric. Conclusions: There is SOC underrepresentation in the gross number of SOC images for dermatologic conditions on Wikipedia. Wikipedia pages should be updated to include more SOC photos to mend this divide to ameliorate access to accurate dermatology information for the general public and improve health equity within dermatology.