When most people think about the field of medicine, art and drawings may not come to mind. Yet, the medical illustration field (which now includes digital media and animation) is a thriving and necessary part of helping both medical students and doctors understand the body.
Medical illustrations help students become familiar with how certain conditions may look and can help doctors understand how to diagnose them. Unfortunately, a lack of diversity in illustrations has led to a smaller number of pictures that showcase skin of color.
According to several recent studies, textbooks feature Black skin at a much lower rate (about 4%) than lighter skin. A recent social media post went viral when Nigerian medical student Chidiebere Ibe illustrated a pregnant woman of color carrying a Black fetus. He’s posted other illustrations, too.
This opened a larger conversation about a lack of diversity in medical texts. For many, this was the first time they had ever seen an image of this type. With research showing that more than 65% of medical students learn visually, the importance of medical illustrations as a training tool is clear.
While some conditions are more commonly found in certain ethnic groups than others, many diseases also look different on skin tones that can range from very pale to dark.
Imagine a medical student learning about a condition like eczema, which is often described and pictured as scaly skin with reddish patches. If you are a person of color, however, eczema may look dark brown instead of red, according to the National Eczema Foundation.
“It is critically important for there to be medical resources that include and feature patients with various skin tones, including darker skin,” says Susan Taylor, MD, vice chair for Diversity, Equity and Inclusion at the University of Pennsylvania’s Dermatology Department. “They support an accurate diagnosis of skin diseases in patients with darker skin hues, which ultimately improves patient care and reduces health disparities.”
Some of the earliest forms of medical illustration come from what’s now called Egypt. Sheets of papyrus (paper) showing surgery, obstetrics, and natural plant remedies have been found from as early as the 3rd century BC. As medicine and science progressed in Africa and other parts of the world, so did the illustrations explaining them.
You probably know of Leonardo da Vinci, who painted the Mona Lisa (and many other works). A genius of the Italian Renaissance, da Vinci also drew hundreds of complex pictures of the human body. While these drawings helped propel the medical field forward, they were all of white men.
But history does not have to be the future. While most illustrations used in medical schools have pictures of mostly white males with no physical disabilities, organizations like the Association of Medical Illustrators (with more than 900 members) are working to change this reality.
“I wish our industry was paying attention to this 50 years ago, but they weren’t,” says Nicholas Woolridge, president of AMI and associate professor of medical illustrations at the University of Toronto. “We have a legacy of medical illustrations that feature mostly slender, white males. We are now intentional about featuring different body shapes, sizes, and colors. We are trying to address that disparity now.”
Efforts include recruiting more people of color to the field of medical illustration along with existing programs to promote STEM education. Illustrators, publishers, and medical companies are exploring ways to keep this topic front and center and assist with training and diagnosis.
Diagnosis is not the only reason to have diversity in medical illustrations. “Seeing a diversity of people in their text is important for medical students when it comes to empathy,” says Ni-ka Ford, a New York-based medical illustrator and the diversity chair of the Association of Medical Illustrators (AMI). “Without that diversity, it can lead to stereotyping certain groups and a lack of empathy. All patients want to feel seen.”
Here are five examples of conditions that look different on darker skin tones.
Eczema: a condition that involves dry, itchy skin, often with scaly, leather-like patches
- On light skin: scaly skin with red patches
- On dark skin: scaly skin that is dark, violet, or ashen gray in color; and small bumps often found on the chest and legs, more common around the hairline and eyes
Psoriasis: a condition where the body makes too many skin cells at once
- On light skin: pink or red patches with silvery-white scales
- On dark skin: patches that appear more violet or brown with gray scales
Lupus: a condition that causes the body to attack its own immune system
- On light skin: depending on the type could be a red, scaly rash with ring-like sores or a reddish, purple butterfly-like patch on the face over the nose and cheeks
- On dark skin: abnormal skin color more around the scalp and ear
Women of color are three times more likely to have lupus compared with white women, yet they are often diagnosed later. Left untreated, lupus can lead to issues with other internal organs like your heart, liver, or kidney.
Lyme disease: a condition caused by a tick bite that leaves a circular bulls-eye patch
- On light skin: bulls-eye patch could be pink or red
- On dark skin: bulls-eye patch can be dark brown or purple and can be hidden due to darker skin tone, often delaying diagnosis
Research shows that 1 in 3 Black patients had advanced symptoms by the time they were diagnosed with Lyme disease compared with 1 in 10 white patients.
Scleroderma: a hardening and tightening of the skin that may impact blood vessels, internal organs, and the digestive system
- On light skin: small, red spots on hands and face, may impact the fingers (Raynaud’s phenomenon) causing them to turn white, blue, or red
- On dark skin: darkening of the hands, arms, or feet; pale fingers for Raynaud’s phenomenon
Understanding how certain conditions show up on various skin colors can also help dispel myths. Some still believe that having more melanin in your skin means you can’t get skin cancer. But that’s false. The fact is, people of any skin color can get skin cancer. In people with darker skin, it’s often diagnosed at a later stage. And skin cancer may look different among people of different racial or ethnic backgrounds.
Health professionals recommend that everyone wear sunscreen daily, with an SPF of at least 30. And the American Academy of Dermatology recommends that people who have skin of color check their entire body, including areas that don’t see the sun much, for the following:
- Dark spot, growth, or darker patch of skin that grows, bleeds, or changes
- Sore that won’t heal, or is slow to heal, or comes back after healing
- Patch of skin that feels rough and dry
- Dark line underneath or around a fingernail or toenail
Being able to recognize symptoms for these conditions and how they vary from one skin tone to the next is critical.
“Medical illustrators play such a vital role in health that diversity should be a focus in the curriculum when illustrators are learning,” Ford says. “I’m conscious of the bias when I create work and recognize that reversing systemic racism in the medical field needs to be intentional and proactive.”
When doctors and medical students know the ways some conditions will appear on dark skin, it can lead to an earlier diagnosis and can also save lives.