INTRODUCTION

Academic publications aspire to be impartial and objective, yet studies indicate otherwise. Gender bias in authorship has been observed across various medical specialties, including pediatrics, dermatology, cardiology, and others [1–3]. The first authorship reflects the researcher, while the last is understood to represent leadership in the field positions, both often occupied by men [3,4]. It is essential to note that, despite an improvement in gender diversity in high-impact medical journals over time, female authors remain underrepresented in the hierarchy of academic medicine on a global scale. This gender disparity in authorship in high-impact journals carries far-reaching implications, given their significance in professional and academic advancement [1]. The objective of this study was to assess the participation of women in articles published in Mexican scientific journals related to dermatology over a period of four years.

MATERIALS AND METHODS

A retrospective, observational, and descriptive study was conducted on scientific publications from two Mexican dermatology journals during the period from January 2020 to December 2024. The focus was on the participation of women as authors in the first and last positions across six different types of publications: original articles, review articles, case reports, Medicine and Culture, letters to the editor, and systematic reviews.

Gender identification was done individually based on the first name of the author. When this was not possible, a Google search for biographies and/or images was performed to identify the gender. Inclusion criteria comprised journals from Mexican publishers related to the field of dermatology, available with open access on official websites. Two journals specifically dedicated to dermatology were included: Dermatología Revista Mexicana and Dermatología Cosmética, Médica y Quirúrgica.

Gender was categorized as male or female, and the total number of authors per article was counted for both the first and last authorship positions. Editorials, brief comments, tributes or biographies, and articles where the gender of the authors could not be identified were excluded. An Excel database was created to compile data from the mentioned two journals, recording the year of publication, gender, first or last authorship, and the type of article.

RESULTS

Based on the inclusion criteria, a total of 773 articles were identified, among which 613 (41.6%) authors were men and 858 (58.3%) were women, resulting in a female-to-male ratio of 1.4:1 (Table 1). The proportion of women in first and last authorship positions was 32% and 26%, respectively, while the proportion of men in these two positions was 20.6% and 21% (Fig. 1). Over the years, we have observed fluctuations in the percentage of female participation in scientific papers. In 2020, the percentage of female authors was 57%, increasing to 67% in 2021. However, in 2022 and 2023, there was a decrease to 59% and 56%, respectively. Despite these fluctuations, in 2024, a proportion of 61% was reported.

Table 1: General characteristics of variables and the proportion of women.

Figure 1: Proportion of men and women as first and last authors.

When analyzing female participation by article type (Fig. 2), the highest proportion was found in case reports at 60%, with 53% in first authorship and 46.7% in last authorship (Fig. 3); followed by original articles at 24.7% and review articles at 11%. The highest percentage of female first authorship was seen in Medicine and Culture articles at 62%, while the highest last authorship was observed in systematic reviews at 54%.

	Figure 2: Proportion of women in different types of articles.
	Figure 3: Proportion of female researchers as first and last authors.

The journal Dermatología Revista Mexicana published a total of 398 articles, with 461 (53%) female authors participating in first (29.2%) or last authorship (24.4%). Meanwhile, the journal Dermatología Cosmética, Médica y Quirúrgica published a total of 278 articles, with 290 (33.7%) female researchers in first (12.8%) and last (9.5%) authorship positions.

DISCUSSION

Leadership, power, and status positions in clinical and academic medicine are disproportionately occupied by men [1,3]. While women are more likely to engage in academic medicine, research indicates that they are less likely to hold leadership positions and reach promotions at a slower pace. Academic promotion is closely linked to research outcomes and participation in editorial boards [5,6]. Despite the increasing presence of women in the medical profession, they continue to face harassment, discrimination, and inequality compared to their male counterparts. There remains a significant gap in achieving gender parity, especially in key positions in medical societies or high-level management roles [1,3]. For example, in Brazil, although dermatology is the specialty with the highest proportion of women, with nearly 78% of dermatologists being female, this representation is not reflected in leadership roles. According to the Brazilian Society of Dermatology (SBD), approx. 80% of its members are women; however, since its founding in 1912, only 5 out of 58 known presidencies (8.62%) have been held by women, highlighting the persistent underrepresentation of women in influential positions [7].

Urrutia et al. conducted a study demonstrating that, despite an increase in cardiovascular research publications involving women over the last decade, female researchers are cited less frequently than their male counterparts [5]. Gender disparities exist in the authorship of international cardiology guidelines, being lower in the European Society of Cardiology (16%) compared to the ACC/AHA (American Heart Association) and CCS (Canadian Cardiovascular Society) (28% and 26%, respectively) [3,5]. Similarly, Mamtani et al. analyzed 2087 international articles between January 1, 2014, and October 16, 2018 [1]. The focus was on the roles of authors in the first and last positions in both studies, leading us to evaluate the female role in dermatological publications [3,5].

Our results show that the proportion of women in total dermatological publications, in both first and last authorship positions, over the past four years was 58.3% (Fig. 4). This contrasted with the findings by Urrutia et al., who found that the proportion of female authors was 32.61%, and with Mamtani et al., whose analysis revealed that women physicians remain underrepresented in first and last authorship positions (17% and 12%, respectively) [3]. In our study, the proportion of women in first and last authorship was 32% and 26%, respectively, while the proportion of men in these roles was 20.6% and 21%, with a female-to-male ratio of 1.3:1. This contrasted with Urrutia et al., who reported a male-to-female ratio of 1.7:1 [5].

Figure 4: Proportion of women in the last three years.

In the present article, we analyzed female participation by article type and found it to be the highest in case reports (60%). Female first authorship predominated in Medicine and Culture articles (63%), while last authorship was most frequent in systematic reviews (54%). In contrast, Urrutia et al. reported the highest proportion of women in original articles (38.38%), with a similar trend for first authorship (35.7%) [5]. For last authorship, the article type with the highest proportion of female authors was review articles (30.4%), with no significant differences compared to other article types [3,5]. In a retrospective study from 1970 to 2004, the proportion of women among U.S. physician authors of original research in six medical journals increased from 5.9% to 29.3% of first authors and from 3.7% to 19.3% of senior authors [6].

The WHO states that, globally, women are the primary providers of healthcare services, while men are the ones who lead them. Progress toward gender parity in leadership varies by country and sector, but overall, men occupy the most leadership positions in healthcare sectors [1,8,9]. Globally, 69% of healthcare organizations are led by men, and 80% of board chairs are male [8]. It is noteworthy that, since 2024, the two leading dermatological associations in the country have been presided over by women.

Feramisco et al. conducted an observational study on gender distribution trends among U.S. authors in three prestigious general dermatology journals (1976, 1986, 1996, and 2006) and three subspecialty dermatology journals (2006 only) [2]. The journals were selected based on published impact factors and citation lifespans, including the Journal of Investigative Dermatology (JID), Archives of Dermatology, the British Journal of Dermatology (BJD), and the Journal of the American Academy of Dermatology (JAAD) [2,10]. They observed that, over the last three decades, the proportion of female manuscript authors in the top three general dermatology journals increased from 12% to 48% for first authors. While similar increases were seen in separate analyses for each journal and article type, men still predominated in publications, contrary to our findings, where women dominated in first and second authorship roles over the last four years [2,9]. In a study conducted in the U.K., the number of women first authors increased from 10.5% in 1970 to 36.5% in 2004 (p < 0.001) [11].

The history of women in medicine has been shaped by numerous challenges and accomplishments. While the role of women in medicine dates back many centuries, it has traditionally been male figures highlighted in historical accounts. Throughout antiquity, women were denied access to medical education. However, dermatology has been a field where women have showcased particular skills and expertise. Over time, their determination and competence allowed them to establish a presence in a world that was, for much of history, dominated by men [12].

This historical context is reflected in current trends. For instance, a study conducted at the Medical University in Wroclaw, Poland, found that 38.6% of students interested in studying dermatology were women [13]. Regional data further demonstrates the increasing presence of women in the medical field. In 1999, 52% of medical students enrolled in Mexico’s medical schools were women, and this figure is projected to reach 60% by 2027 [14]. Similarly, women now represent 45% of the total participation in Mexico’s national research system, although this representation decreases at higher researcher levels, from 50% at level I to just 20% at level III [15].

These trends showcase the growing role of women in medicine, particularly in dermatology, where they have historically excelled. Yet, despite their increasing numbers, the path toward leadership positions remains challenging, underscoring the need for continued efforts to address gender disparities in both academic and clinical settings [15].

CONCLUSION

The findings in this article demonstrate a predominance of female participation in key publications in dermatology. However, this is still not achievable in several medical specialties such as cardiology. Therefore, it is necessary to continue encouraging women to address barriers to authorship and representation in scientific publications, especially in guidelines and clinical trials.

REFERENCES

1.Mamtani M, Shofer F, Mudan A, Khatri U, Walker R, Perrone J, Aysola J. Quantifying gender disparity in physician authorship among commentary articles in three high-impact medical journals:An observational study. BMJ Open. 2020;25;10:034056.

2.Fishman M, Williams WA 2^nd, Goodman DM, Ross LF. Gender differences in the authorship of original research in pediatric journals, 2001-2016. J Pediatr. 2017;191:244-249.1.

3.Feramisco JD, Leitenberger JJ, Redfern SI, Bian A, Xie XJ, Resneck JS Jr. A gender gap in the dermatology literature?Cross-sectional analysis of manuscript authorship trends in dermatology journals during 3 decades. J Am Acad Dermatol. 2009;60:63-9.

4.Borrayo Sánchez G. Gender inequality in publications focused on cardiology. Rev Fed Arg. Cardiol. 2023;52:1-2.

5.Urrutia YV, Cousirat Liendro M, Rosso AC, et al. The long road to gender equity:Women’s participation in scientific publications in Argentine cardiology-related journals. Rev Fed Arg Cardiol. 2023;52:14-9.

6.Jagsi R, Guancial EA, Worobey CC, Henault LE, Chang Y, Starr R, et al. The “gender gap“in authorship of academic medical literature:A 35-year perspective. N Engl J Med. 2006;355:281-7.

7.Bravo BSF, Carvalho RM, Vesco CAD, Elias MC, Almeida ART, Penedo L. Women in Dermatology:Considerations over Their Recognition and Prominence. Skinmed. 2024;2;22:203-4.

8.World Health Organization. Delivered by women, led by men:A gender and equity analysis of the global health and social workforce. 2019.

9.Madden C, O’Malley R, O’Connor P, O’Dowd E, Byrne D, Lydon S. Gender in authorship and editorship in medical education journals:A bibliometric review. Med Educ. 2021;55:678-88.

10.Ouyang D, Sing D, Shah S, Hu J, Duvernoy C, Harrington RA, Rodriguez F. Sex disparities in authorship order of cardiology scientific publications. Circ Cardiovasc Qual Outcomes. 2018;11:005040.

11.Sidhu R, Rajashekhar P, Lavin VL, Parry J, Attwood J, Holdcroft A,et al. The gender imbalance in academic medicine:A study of female authorship in the United Kingdom. J R Soc Med. 2009;102:337-42.

12.França K, Ledon J, Savas J, Nouri K. Women in medicine and dermatology:History and advances. An Bras Dermatol. 2014;89:182-3.

13.CisońH, Kostrzewska P, Łątka N, Krajewski P, Białynicki-Birula R, Konsur-Jankowska A. Exploring medical students’perceptions of dermatology and dermatologists. Our Dermatol Online. 2024;15:36-9.

14.Ng-Sueng LF, Vargas-Matos I, Mayta-Tristán P, Pereyra-Elías R, Montenegro-Idrogo JJ, Inga-Berrospi F, et al. Gender associated with the intention to choose a medical specialty in medical students:A cross-sectional study in 11 countries in Latin America. PLoS One. 2016;11:0161000.

15.Uribe-Zúñiga P, Corona-Vázquez T, Medina-Mora M, Ostrosky-Wegman P, Sarti E. Women and Health in Mexico. 1^st ed. México DF:Academia Nacional de Medicina;2014.