Skin tone bias in online psoriasis imagery: Insights from an international study.

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 χ 2 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.