Sandhu A, Ailani S, Padte S, Mehta P, Deo N, Surani S, Kashyap R. Skin tone bias in online psoriasis imagery: Insights from an international study. World J Clin Cases 2025; 13(36): 116656 [DOI: 10.12998/wjcc.v13.i36.116656]
Corresponding Author of This Article
Salim Surani, MD, FACP, FCCP, Professor, Department of Medicine, University of Houston, 4302 University Drive, Houston, TX 77004, United States. srsurani@hotmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 26, 2025 (publication date) through Dec 25, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Sandhu A, Ailani S, Padte S, Mehta P, Deo N, Surani S, Kashyap R. Skin tone bias in online psoriasis imagery: Insights from an international study. World J Clin Cases 2025; 13(36): 116656 [DOI: 10.12998/wjcc.v13.i36.116656]
Aman Sandhu, Sanya Ailani, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19104, United States
Smitesh Padte, Department of Medicine, WellSpan York Hospital, York, PA 17403, United States
Priyal Mehta, Department of Medicine, St. Vincent Hospital, Worcester, MA 01608, United States
Neha Deo, Department of Dermatology, University of Colorado, Boulder, CO 80309, United States
Salim Surani, Department of Medicine, University of Houston, Houston, TX 77004, United States
Rahul Kashyap, Department of Research, WellSpan York Hospital, York, PA 17403, United States
Author contributions: Sandhu A wrote the original draft; Sandhu A and Ailani S designed the research study and conducted the formal analysis; Sandhu A, Ailani S, Padte S, Mehta P, Deo N, Surani S, and Kashyap R performed the investigation; Sandhu A, Ailani S, and Kashyap R developed the methodology and curated the data; Sandhu A and Kashyap R generated the visualizations; Kashyap R supervised the research. All authors reviewed and edited the manuscript.
Institutional review board statement: This study is considered Institutional Review Board exempt because no patient-identifying health information was sought or recorded.
Informed consent statement: All participants were informed of the nature of the study and provided with the option to participate voluntarily. Informed consent has been waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All the data are presented in the article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, MD, FACP, FCCP, Professor, Department of Medicine, University of Houston, 4302 University Drive, Houston, TX 77004, United States. srsurani@hotmail.com
Received: November 17, 2025 Revised: December 3, 2025 Accepted: December 12, 2025 Published online: December 26, 2025 Processing time: 38 Days and 13.4 Hours
Abstract
BACKGROUND
Psoriasis is often first recognized by patients through online image searches. However, search engine algorithms influenced by geographic location may still produce results that predominantly feature lighter skin tones, regardless of the region’s majority skin type. This underrepresentation may limit recognition and delay care for people of color.
AIM
To examine whether search algorithms tailor region-specific results in terms of skin color for psoriasis imagery.
METHODS
This observational study recruited 66 participants from 18 countries who conducted image searches for “psoriasis” across various web browsers. During the meeting, a Google form was posted to record observations, and participants reported the diversity of skin tones in the first three rows of search results using a reference image depicting Fitzpatrick types.
RESULTS
Results showed a global bias toward lighter skin tones, with 94% of participants identifying light skin predominance in the first row and minimal representation of medium or darker skin tones in subsequent results, verified via χ2 analysis. Participants who observed darker or mixed skin tones typically found them further down their results.
CONCLUSION
There remains a significant gap in global representation of psoriasis imagery. This paper deepens the current understanding of bias in online media and pushes for further exploration of more inclusive dermatologic imagery.
Core Tip: In this global observational study, online psoriasis image search results across major web browsers were systematically analyzed to assess the representation of skin tone. Lighter skin tones overwhelmingly predominated early search results, while darker skin tones were consistently ranked lower in visibility, limiting early exposure for patients of color. These findings reinforce a lack of diverse dermatologic imagery worldwide and underscore the need for more equitable medical resources.
