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Background: There is increasing international concern that dermatology teaching materials insufficiently represent conditions as they present in individuals with darker skin tones (“Skin of Colour”, SoC), potentially contributing to diagnostic uncertainty and health inequities. While this issue has been described in Anglo-American contexts [1], empirical data from Swiss medical curricula are lacking. This study aimed to systematically assess the representation of SoC in the undergraduate dermatology curriculum at the University of Bern and to develop an action plan to address identified gaps.

Methods: A cross-sectional analysis of dermatology teaching materials was conducted. All images contained in 24 dermatology lecture podcasts from a total of 16 lecturers, supplemented by the clinical skills training script and supplementary video materials, were included. In total, 1,821 images were analysed. Images were independently classified by two raters as Skin of Colour [2] (phototypes V-VI), non-Skin of Colour (phototypes I-IV), or indeterminate; disagreements were resolved by a third rater. Images were further categorized by underlying pathology (inflammatory, infectious, neoplastic, other, unclear). Absolute and relative frequencies were calculated.

Results: Of 1,821 images, 72 (3.95%) depicted Skin of Colour, 1,695 (93.08%) depicted non-Skin of Colour, and 54 images (2.97%) were classified as indeterminate. Regarding underlying pathology, 43% of images were inflammatory, 22% infectious, 21% neoplastic, 7% other, and 7% unclear. Skin of Colour images were most common in the “infectious” category. In the absence of population-based prevalence data for the construct “Skin of Colour” in Switzerland, the identified proportion of Skin of Colour images (3.95%) remains substantially lower than estimates derived from commonly used demographic surrogates [3], [4].

Discussion: This analysis demonstrates a marked underrepresentation of Skin of Colour in the undergraduate dermatology curriculum at a Swiss medical faculty. In response, an action plan is being formulated, including structured feedback to teaching staff, access to a curated image databases with higher proportions of Skin of Colour, and the development of a written syllabus addressing dermatologic assessment in Skin of Colour. Pending implementation, explicit communication of identified gaps to students is planned to promote critical awareness.

Competing interests: The authors declare that they have no competing interests.

References

[1] Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatol. 2006;55(4):687-690. DOI: 10.1016/j.jaad.2005.10.068
[2] Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6): 869-871. DOI: 10.1001/archderm.124.6.869
[3] Schweizerische Eidgenossenschaft, Staatssekretariat für Migration. Foreign Population and Asylum Statistics 2024. Bern: Schweizerische Eidgenossenschaft, Staatssekretariat für Migration; 2025. Zugänglich unter/available from: https://www.sem.admin.ch/dam/sem/en/data/publiservice/statistik/bestellung/auslaender-asylstatistik-2024.pdf.download.pdf/auslaender-asylstatistik-2024-e.pdf
[4] Schweizerische Eidgenossenschaft, Bundesamt für Statistik. Contacts with people of another nationality, religion or skin colour. Bern: Schweizerische Eidgenossenschaft, Bundesamt für Statistik; 2025. Zugänglich unter/available from: https://www.bfs.admin.ch/asset/en/34047294