The bigger picture

By Megan Bennett, Staff Writer, February 1, 2026

The appearance of several common skin conditions and diseases vary depending on patients’ skin color. However, overwhelmingly, clinical images in dermatologic literature and other professional educational resources represent white patients, leading to disparities in diagnostics and care.

Bridging this gap will be increasingly relevant in the coming years. Census projections indicate that between 2040-2050, people of color will make up a majority of the U.S. population.

“That makes it even more relevant for all our physicians and non-physician health care providers to feel really comfortable taking care of patients that have all different skin tones,” said Nada Elbuluk, MD, MSc, FAAD, professor of clinical dermatology at the University of Southern California and president of the Skin of Color Society (SOCS).

“It’s not just for urban locations or diverse locations, it’s really everywhere,” she added. “That pressing need will only increase with time.”

To broaden physicians’ access to images across skin colors, the AAD launched its Clinical Image Collection in January 2025. In addition to other factors like age, sex, and area of the body, users can search the online database by light, medium, and dark skin.

“The AAD has been a leader in developing the basic dermatology curriculum and so many other educational resources,” said Vinod Nambudiri, MD, MBA, MPH, EdM, FAAD, director of Harvard Medical School’s dermatology residency program and co-chair of the AAD working group that formed the collection. “But one thing that has been apparent for several years is that many of our sources, particularly dermatology textbooks, have been under-representative of clinical images across a diversity of skin tones and a spectrum of disease. So, the collection really came from a member-driven recognition of this obstacle and the idea that we don’t have as centralized a resource as we could for our membership and their patients.”

One year in, the collection has more than 1,700 AAD member-sourced images of approximately 200 conditions. About half of those images are of medium or dark skin tones. The collection has more than 51,000 views, and Academy members can download the images to use for educational purposes, presentations, or to show patients images of conditions on a variety of skin tones.

“That’s remarkable for something so new, and I expect it to keep growing,” said Naiara Barbosa, MD, FAAD, FACMS, dermatologist at the Mayo Clinic in Jacksonville, Florida. Dr. Barbosa headed the SOCS collaboration with AAD on the collection, which has also been made available to its members. Founded in 2004 by Academy President Susan Taylor, MD, FAAD, SOCS’s mission is to improve skin of color dermatology by furthering research, advocacy, and education for the public and physicians, and providing mentorship programs.

Origins of the issue

A 2021 analysis published in JAAD of nearly 15,500 images across eight popular dermatologist resources — six print and two online — found that 19.5% were of dark skin (Fitzpatrick types V or VI), with online databases offering more diversity on average than textbooks (doi: 10.1016/j.jaad.2020.06.041). A 2023 JAAD study analyzing two decades of skin of color publications in JAAD showed that while there was an upward trajectory, the highest percentage of SOC articles published within a year was in 2022 at just 7.1%. (doi: 10.1016/j.jaad.2023.05.036).

Additionally, a 2020 survey in the Journal of Drugs in Dermatology looking at the available images on AAD’s public education website showed a significant lack of images of darker skin, except for the conditions that commonly affect people with darker skin tones like vitiligo and keloids.

This underrepresentation can translate to missed diagnosis, delay in diagnosis, or undertreatment, explained Dr. Elbuluk. Concerns about misdiagnosis due to a lack of knowledge about conditions in darker skin tones have also been reflected in AAD member surveys prior to the creation of the collection.

“There are so many things that happen that lead to increased disease burden and, in some cases, even increased morbidity and mortality depending on the diagnosis,” said Dr. Elbuluk. For example, patients of color have a lower survival rate of melanoma, particularly men, because it is diagnosed in later stages, according to the Melanoma Research Foundation.

A lack of diverse clinical images can also add barriers to connecting with patients. “If you are a clinician trying to show an example of disease to a Black patient, but you’re teaching them about shingles with a picture on white skin, you may have lost their trust,” explained Art Papier, MD, FAAD, dermatologist and CEO and cofounder of VisualDx, a clinical decision support software that includes more than 50,000 medical images and the largest set of images with all skin tones, per the 2021 JAAD analysis. “There is also a trust factor that’s part of this — not only regarding education but with the shared decision-making aspect.”

Fleshing out the collection

The working group, which developed the platform over the course of a year, was comprised of dermatologists with professional interests in health equity, medical education, and their intersection with technology, said Dr. Nambudiri. To crowdsource the images, the working group promoted the collection to Academy members — particularly those working within education — and through events like the Art of Skin gala.

Though the collection accepts images of all dermatologic conditions, the working group identified 20 priority conditions for its focus. Those conditions, Dr. Nambudiri explained, represent the overall most-common dermatologic conditions as well as conditions that are easy to miss in darker skin tones — like rosacea, pityriasis rosea, and other pigmentary disorders — and those that have higher incidence in darker skin tones, like acne keloidalis, sarcoidosis, and central centrifugal cicatricial alopecia.

More than 100 individuals and institutions have contributed to the collection. The contributors come from around the world, “which is a testament to this sort of pent-up demand for having something like this available and accessible,” Dr. Nambudiri said.

Drs. Nambudiri and Barbosa hope to not only see more contributions to the collection, both of images and other skin conditions, but that a growing number of physicians use it to diversify presentations or with patients.

“When I lack examples of dark skin tones, I use the Clinical Image Collection to make my lectures more representative,” said Dr. Barbosa.

She added, “Some people may think, ‘Why change? I have used the same photos for years.’ However, even if it doesn’t seem relevant or useful to you, this small action can still have a big impact.”

Better access to diverse clinical images will also lead to a more confident workforce, predicts SOCS President-Elect Rebecca Vasquez, MD, FAAD, chair of AAD’s Diversity Committee and associate professor of dermatology at UT Southwestern Medical Center.

“There’s going to be a higher level of confidence that dermatologists didn’t have before,” said Dr. Vasquez. “They may not say it, but maybe they’re not comfortable when a patient comes in who has a darker skin type because they’re kind of unsure. The goal here is that physicians always feel that they’re capable of providing that quality dermatologic care.”

Beyond images

The Clinical Image Collection is one of several equity initiatives within dermatology that have been launched in recent years. In 2023, the Academy launched the series, Medicine Without Barriers: Overcoming Unintended Bias in Practice. Hundreds of members have also completed AAD’s Skin of Color Curriculum, which was made available in 2022.

“Have we reached the point where there’s a cultural change happening? I think it comes in waves,” said Dr. Vasquez. “I do think that there’s enough interest in really becoming more comfortable. But I think that will become especially important when these patients actually have more access to us. Right now, though, unfortunately — probably disproportionately — a lot of these patients don’t have access to specialized care.”

“But I do think as we start to see, over the years, more and more of these patients, there will be a sense of urgency,” Dr. Vasquez continued. “This is no longer a niche.”

In recent years, the American Board of Dermatology (ABD) has also taken action to diversify its exams.

“In 2020, ABD started the process by assessing our item bank and developing a system to tag questions that feature deeper skin tones or issues particularly relevant to patients with all skin tones,” said Julie Schaffer, MD, ABD’s Associate Executive Director for Exam Development. Using U.S. Census data, the ABD set a goal that more than 20-25% of images in ABD assessments would include skin with darker pigmentation. “To fill gaps and augment coverage of darker skin tones across the entire spectrum of dermatologic disease, we have invited dermatologists with expertise in all skin tones to join each of our subspecialty question-writing committees, encouraged development of items featuring darker skin tones in our question-writing assignments, and enlisted the help of groups and individuals with rich experience caring for diverse patient populations to submit high-quality images of the breadth of dermatologic conditions in patients with all skin tones.”

The ABD also created a committee in 2024 that selects papers for CertLink questions related to darker skin tones. “Looking ahead, ABD plans to further track the performance of test items depicting darker skin tones and to partner with AAD, the Skin of Color Society, Project IMPACT, and other groups to reduce knowledge gaps and improve dermatologic care for patients with all skin tones,” Dr. Schaffer continued. “We hope that our endeavors enhance crucial visual recognition skills and promote learning in trainees and practicing clinicians alike, thereby optimizing dermatologic care across the full range of skin tones.”

Additional DermWorld Resources