ArticleGMS journal for medical education2026
Representation of different skin colors in German nursing textbooks.
Article in GMS journal for medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The accurate assessment of skin lesions is one of the core tasks of professional nursing practice. Cutaneous signs depend on the skin color due to the melanin content. Nursing students must therefore learn how skin lesions look in different skin colors. Aim: The aim of this short report is to describe the current state of representation of different skin colors in German nursing textbooks. The research question was: To what extent are different skin colors represented in German nursing textbooks? Methods: A systematic analysis of ten German nursing textbooks was conducted. The included images were divided into the ten skin colors according to the Monk Skin Tone Scale. Categories A to D were classified as light, E to G as medium and H to J as dark skin. Results: Ten textbooks were included and 475 images analyzed. One hundred images (21.1%) showed skin color A, 118 (24.8%) B, 128 (26.9%) C, 94 (19.8%) D, 29 (6.1%) E, five (1.1%) F, one (0.2%) G and none each of H, I and J. In total, 92.6% (n=441) show light skin tones and 7.4% (n=35) medium skin colors. Conclusions: There is a significant underrepresentation of darker skin colors in images depicting clinical signs and dermatological diseases. This gap in education may lead to delayed symptom recognition, delayed interventions, and possibly wrong diagnoses. Textbooks should be revised to include a broader representation of skin colors, and darker skin colors should be integrated into nursing education to compensate for this limitation.
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