Medical Illustration of Skin Conditions on Different Skin Tones

Infantile haemangiomas may appear bright red when superficial or bluish-purple when located deeper in the skin, with their appearance and contrast varying depending on skin tone.

When we think of medical illustration, we often think of anatomy hidden beneath the skin: muscles, bones, organs or surgical procedures. But when illustrating dermatological conditions and other diseases with visible symptoms on the skin, the skin itself becomes an important part of the medical information.

For a long time, medical textbooks, patient information and online health resources have predominantly shown skin conditions on light skin. This can become a problem because many conditions do not look exactly the same on every skin tone.

Redness is probably one of the most obvious examples. In medical descriptions we frequently read terms such as red, reddened or erythematous. On very light skin these changes may indeed appear distinctly red or pink. On darker skin, however, the same process may appear more subtle, darker, purplish, brownish or simply as a change in tone compared with the surrounding skin.

This dermal melanocytic naevus typically appears as a blue-grey to brownish area of pigmentation, with its visual contrast varying across different skin tones.

The condition is the same, but its visual appearance can be different.

Showing the same disease on different skin tones

Over the years I have created medical illustrations of a variety of diseases and conditions that are visible on the skin. These include Lyme disease (borreliosis), erysipelas, cellulitis (in german; Phlegmone), venous insufficiency, neurodermatitis, pityriasis versicolor, genital warts, nail fungus and different types of moles and birthmarks.

When creating these illustrations, it is important not to simply take an illustration made for light skin and change the base colour of the skin.

The appearance of the actual symptom has to be considered as well.

The skin reaction around a tick bite may appear red or pink on lighter skin, while on darker skin tones the affected area can appear more subtle, greyish, purple or darker than the surrounding skin.

Changes in pigmentation, inflammation, swelling, lesions, borders and colour contrasts interact differently with the surrounding skin tone. In some conditions these differences are quite noticeable, while in others the appearance remains relatively similar. Both are important to show accurately.

The same applies to more localised skin findings and changes such as different types of naevi, Mongolian spots (congenital dermal melanocytosis), haemangiomas or visible cholesterol deposits around the eyes.

Xanthelasma typically appears as yellowish plaques around the eyelids, with the contrast and visibility varying depending on the surrounding skin tone.

Why diverse medical illustrations matter

The primary purpose of medical illustration is to communicate medical information as clearly and accurately as possible.

If a patient, student or healthcare professional is learning what a particular condition looks like, the illustration should provide useful visual information for more than just one skin tone.

This is particularly important for patient education. A beautifully illustrated symptom is of limited use when a large proportion of the people looking at it cannot easily relate what they see in the illustration to an actual symptom on their own skin.

Atopic dermatitis often appears red or pink on lighter skin but may look brown, purple, greyish or subtly darker on more deeply pigmented skin.

There is also another aspect that shouldn’t be overlooked: representation.

People with darker skin tones should be able to recognise themselves in medical and health communication. Not every illustration needs to show every possible skin tone, of course. But across a larger publication, website, patient information platform or educational project, diversity can be incorporated naturally rather than treating light skin as the automatic default.

This comparison illustrates how the characteristic skin changes associated with chronic venous insufficiency can appear different on light and dark skin tones.

 Genital warts can be skin-coloured, pink, brownish or more deeply pigmented, making their appearance variable across different skin tones.

Onychomycosis (Nail fungus) can cause thickening and white, yellow or brown discolouration of the nail, with surrounding skin tone influencing the overall visual appearance.

Creating medical illustrations for different skin tones

For me, this is an interesting combination of medical accuracy and visual communication. The goal isn’t simply to make an existing illustration more diverse. It is to think about what information the illustration is supposed to communicate and how that information needs to be represented visually on the chosen skin tone.

Medical illustration has the advantage that it can show exactly what needs to be communicated. Unlike finding suitable clinical photographs, an illustration can be created specifically for a condition, a particular stage of disease, a certain body area and different skin tones while maintaining a consistent visual style across an entire project.

Pityriasis versicolor causes patches that may appear lighter or darker than the surrounding skin, often making the condition particularly visible on more deeply pigmented skin.

This makes illustration particularly useful for patient information, medical websites, textbooks, educational material, scientific communication and larger collections of health information.

If you are working on a medical publication, patient information project, educational platform or other healthcare communication that would benefit from accurate illustrations of diseases and symptoms on different skin tones, I’d be happy to help.

Please feel free to ⁠contact me to discuss your project.