Representation of Skin Color, Disease Severity, and Anatomic Location in Hidradenitis Suppurativa Images

SKIN The Journal of Cutaneous Medicine Pub Date : 2024-07-23 DOI:10.25251/skin.8.4.8

D. De, Sarah Park, T. Shih, Vivian Y Shi, J. Hsiao

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Abstract

Introduction: Hidradenitis suppurativa (HS) is an inflammatory dermatosis disproportionately affecting patients of color. We evaluated characteristics of HS images in dermatology online image resources and textbooks. Methods: Images of HS were collected in December 2021 from online and textbook sources. Data regarding anatomic region, Hurley stage, and Fitzpatrick skin tone (FST) were collected and analyzed. Results: 318 images remained after exclusion criteria. VisualDx contained the highest number of dark skin (FST V-VI) images (59%, 47/79), followed by Google (4%, 2/52) and DermNetNZ (4%, 4/100). In textbook sources, dark skin represented 25% (4/16) of images. Across sources, 47% (151/318) of images represented Hurley stage 2, followed by 32% (101/318) stage 3, and 21% (66/318) stage 1. The axilla (49%, 156/318) was the most common anatomic location featured, followed by the groin (18%, 58/318) and breast/chest (9%, 28/318). Involvement of non-classic locations was represented in 3% (8/318) of images. There was a positive correlation between higher Hurley stage and darker skin (r=0.26, p<0.05). Discussion/Conclusion: Overall there is underrepresentation of dark skin tones, “non-classic” anatomic locations, and mild HS which may lead to missed opportunities for patient education and dermatology training. Dermatologists should take the lead to improve image diversity across educational resources.

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皮肤颜色、疾病严重程度和解剖位置在扁平湿疹图像中的体现

导言：化脓性扁平湿疹（HS）是一种炎症性皮肤病，对有色人种患者的影响尤为严重。我们评估了皮肤病学在线图像资源和教科书中 HS 图像的特征。方法：2021 年 12 月，我们从网络和教科书中收集了有关 HS 的图片。收集并分析有关解剖区域、赫里分期和菲茨帕特里克肤色（FST）的数据。结果排除标准后，剩余 318 张图片。VisualDx包含的深色皮肤（FST V-VI）图片数量最多（59%，47/79），其次是谷歌（4%，2/52）和DermNetNZ（4%，4/100）。在教科书来源中，深色皮肤占图片的 25%（4/16）。在所有图片来源中，47%（151/318）的图片代表 Hurley 第 2 阶段，其次是 32%（101/318）的第 3 阶段和 21%（66/318）的第 1 阶段。腋窝（49%，156/318）是最常见的解剖位置，其次是腹股沟（18%，58/318）和乳房/胸部（9%，28/318）。3%（8/318）的图像涉及非经典部位。较高的赫利分期与较黑的皮肤呈正相关（r=0.26，p<0.05）。讨论/结论：总体而言，深肤色、"非经典 "解剖位置和轻度 HS 的代表性不足，这可能会导致错过患者教育和皮肤科培训的机会。皮肤科医生应率先改善教育资源中的图像多样性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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SKIN The Journal of Cutaneous Medicine

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