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

Sep 28, 2026

Psoriasis is often recognized first through online image searches, yet search engines may produce results dominated by lighter skin tones influenced by geographic location. This observational study evaluated whether search algorithms tailor regional psoriasis imagery by skin color. Sixty-six participants from 18 countries searched “psoriasis” across web browsers, reporting skin-tone representation in the first three result rows. Findings showed a strong global bias toward light skin, with limited medium or darker representation, affecting early visibility for people of color.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Aim

Methods

Results

Conclusion

Core Tip

Introduction

| W | J | C | C | World Journal of
Clinical Cases | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 116656 DOI: 10.12998/wjcc.v13.i36.116656 ISSN 2307-8960 (online) ORIGINAL ARTICLE Observational Study Skin tone bias in online psoriasis imagery: Insights from an international study Aman Sandhu, Sanya Ailani, Smitesh Padte, Priyal Mehta, Neha Deo, Salim Surani, Rahul Kashyap Specialty type: Medicine, research and experimental Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade C Novelty: Grade C Creativity or Innovation: Grade C Scientific Significance: Grade C P-Reviewer: Georgakopoulou VE, MD, Greece Received: November 17, 2025 Revised: December 3, 2025 Accepted: December 12, 2025 Published online: December 26, 2025 Processing time: 38 Days and 14.9 Hours 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 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](srsurani@hotmail.com) 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 WJCC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025 Volume 13 Issue 36 Sandhu A et al. Skin tone bias and psoriasis imagery 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. Key Words: Psoriasis; Internet; Skin tone bias; Image search; Global ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. 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

FAQs

Why might people of color receive delayed recognition of psoriasis from online searches?

Because online psoriasis image results may be dominated by lighter skin tones, limiting early visual matching for people of color and potentially delaying care.

How was the skin tone bias assessed in the study?

Sixty-six participants from 18 countries performed image searches for “psoriasis” across web browsers and recorded the skin-tone diversity in the first three rows of results using reference Fitzpatrick types.

What were the main findings about the representation of skin tones?

A global bias toward lighter skin tones was found: 94% of participants reported light skin predominance in the first row, with minimal representation of medium or darker tones in subsequent rows verified by χ2 analysis.

Sep 28, 2026

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