GD10 Diversity to the forefront: representation of skin types across British Association of Dermatologists medical journal covers

Abstract The British Association of Dermatologists (BAD) publishes three widely read and cited dermatology-focused medical journals: (i) the British Journal of Dermatology (BJD), (ii) Clinical and Experimental Dermatology (CED) and (iii) Skin Health and Disease (SHD). It has been well established that skin, hair and nail pathologies in skin of colour can be under-recognized by physicians secondary to lack of knowledge of varying presentations, and the BAD has highlighted the importance of integrating minority ethnic group skin types into all BAD workstreams. The front page of a medical journal is the most widely seen component of a publication. Our study endeavoured to review the representation of skin of colour on the front covers of the BAD’s leading journals. A qualitative analysis was conducted on finalized published covers of journals of the BJD, CED and SHD across 5 years (January 2020 to November 2024) archived in the BAD website. Covers with patient images were categorized based on Fitzpatrick skin type (I–VI). The results were cross-tabulated to identify the proportions of representation of patients with skin types V and VI. In total, 104 published journal front-page covers over a 5-year period were reviewed. During this period the BJD had 59 covers, CED 51 covers and SHD four covers. Overall, 57% (n = 59) of the journal issues featured human participants on the cover, including 34% (n = 20) of BJD covers, 71% (n = 36) of CED covers and 75% (n = 3) of SHD covers. Covers with human participants were reviewed and categorized based on the Fitzpatrick skin type of the participant. The results were as follows: type I: 31% (n = 18), type II: 41% (n = 24), type III: 14% (n = 8), type IV: 3% (n = 2), type V: 5% (n = 3), type VI: 7% (n = 4). In total, 69% of patients featured on the front cover had skin type I or II, vs. 12% of cover participants with skin types V or VI. Front-page illustrations of skin conditions offer a novel opportunity to raise awareness of skin presentations in darker skin tones. The 12% of covers representing patients with skin types V or VI may represent a missed opportunity to promote the pathology of darker skin tones to a wider audience. The UK government highlights that 18% of UK residents belong to a Black, Asian, mixed or other ethnic group. This highlights disproportionate representation on the front covers of these journals. While a front cover illustration is not representative of the entire contents of a journal, our study appeals to editors to consider a front-page illustration as an effective way of highlighting conditions affecting patients with darker skin tones by ensuring all skin types are adequately represented on journal covers.