When most people think of medicine, they may not think of art and drawings. Yet the medical illustration field (which now includes digital media and animation) is a thriving and necessary part of helping both medical students and physicians understand the body.
Medical illustrations help students become familiar with what certain conditions may look like and can help doctors understand how to diagnose them. Unfortunately, a lack of diversity in artwork has led to a smaller number of images featuring skin color.
According to several recent studies, textbooks are much less likely to have black skin (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 has also posted other illustrations.
This opened a broader conversation about a lack of diversity in medical writing. For many, this was the first time they had ever seen an image of this type. Research shows that more than 65% of medical students are visual learners, and the importance of medical illustrations as a training tool is clear.
While some conditions are more common in certain ethnic groups than others, many diseases also look different on skin tones, which can range from very pale to dark.
Imagine a medical student learning about a condition like eczema, which is often described and depicted as flaky skin with reddish patches. However, if you are a person of color, eczema may look dark brown instead of red, according to the National Eczema Foundation.
“It is critical that there are medical devices that include and characterize patients with different skin tones, including darker skin tones,” said Susan Taylor, MD, vice chair of Diversity, Equity and Inclusion at the University of Pennsylvania Department of Dermatology . support accurate diagnosis of skin diseases in dark-skinned patients, ultimately improving patient care and reducing health disparities.”
Some of the earliest forms of medical illustration come from what is now Egypt. Sheets of papyrus (paper) depicting surgery, obstetrics and natural plant medicines have been found as early as the 3rd century BC. As medicine and science advanced in Africa and other parts of the world, so did the illustrations explaining them.
You probably know Leonardo da Vinci, who painted the Mona Lisa (and many other works). Da Vinci, a genius of the Italian Renaissance, also drew hundreds of complex images of the human body. Although these drawings helped advance the medical field, they were all white men.
But history does not have to be the future. Although most illustrations used in medical schools feature images of primarily white males without physical disabilities, organizations such as the Association of Medical Illustrators (with more than 900 members) are working to change this reality.
“I wish our industry would pay attention to this 50 years ago, but it didn’t,” says Nicholas Woolridge, president of AMI and associate professor of medical illustration at the University of Toronto. “We have a legacy of medical illustrations that mainly show slim, white men. We are now consciously working on representing different body shapes, sizes and colors. We are now trying to tackle that inequality.”
The efforts include recruiting more people of color into 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 help with training and diagnosis.
Diagnosis isn’t the only reason for diversity in medical illustration. “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 diversity chair of the Association of Medical Illustrators (AMI). “Without that diversity it can lead to stereotyping of 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 involving dry, itchy skin, often with scaly, leathery patches
- On fair skin: flaky skin with red spots
- On dark skin: flaky skin that is dark, violet, or ashen in color; and small bumps that often appear on the chest and legs, more common around the hairline and eyes
Psoriasis: a condition in which the body produces too many skin cells at the same time
- On fair skin: pink or red spots with silvery white scales
- On dark skin: spots that appear more violet or brown with gray scales
Lupus: a condition that causes the body to attack its own immune system
- On fair skin: depending on the type, there may be a red, scaly rash with ring-shaped sores or a reddish, purple butterfly-like spot 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 to white women, but the diagnosis is often delayed. Left untreated, lupus can lead to problems with other internal organs such as your heart, liver, or kidneys.
Lyme disease: a condition caused by a tick bite that leaves a round bullseye
- On fair skin: The bulls-eye patch can be pink or red
- On dark skin: The bulls-eye patch may be dark brown or purple and may be hidden by a darker skin color, often delaying diagnosis
Research shows that 1 in 3 black patients had advanced symptoms by the time they were diagnosed with Lyme disease, compared to 1 in 10 white patients.
Scleroderma: a hardening and tightening of the skin that can affect the blood vessels, internal organs and the digestive system
- On fair skin: small, red spots on hands and face, can affect 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 appear on different skin tones can also help dispel myths. Some still believe that if you have more melanin in your skin, you can’t get skin cancer. But that is not true. It is a fact that people of any skin color can get skin cancer. In people with darker skin, the diagnosis is often made at a later stage. And skin cancer can look different in people from 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 with skin of color check their entire body, including areas that don’t see much sun, for the following:
- Dark spot, growth, or darker area of skin that grows, bleeds, or changes
- Pain that does not want to heal, or heals slowly, or that returns after healing
- A patch of skin that feels rough and dry
- Dark line under or around a fingernail or toenail
It is crucial that you are able to recognize the symptoms of these conditions and see how they vary from one skin color to another.
“Medical illustrators play such a critical role in health that diversity should be a focus in the curriculum when illustrators are learning,” says Ford. “I am aware of bias when I create work and recognize that reversing systemic racism in the medical field must be intentional and proactive.”
If doctors and medical students know how some conditions can occur on dark skin, it could lead to earlier diagnosis and also save lives.
