How's your image?
One of the benefits of dermatology is that is a very visual subject and consequently, it is ideally suited to photography. An accurate depiction of a lesion has many benefits. Not least for inclusion in the patients records as a baseline assessment but also to help judge the progression of a skin problem over time judging its response to any treatment. On the foot, many patients may be unable to fully visualize their feet and so by using a smartphone it offers an opportunity to educate patients on foot health as well.
In addition, a good quality image can be helpful for seeking a remote opinion from colleagues (with patient consent, of course) via various platforms such as WhatsApp etc, or including an image in a referral letter. In dermatology, with the rise of dermatoscopy (click here for blog on this subject), recording an image is of great value and modern dermatoscopes all allow smartphone attachments for this purpose.
Photography has become accessible – the quality of the smartphone cameras has improved dramatically over recent years allowing patients and practitioners alike to take high-quality images. Despite the availability of technology, healthcare practitioners are rarely given instruction in the best way to take clinical photographs.
In the Australasian Journal of Dermatology, an article has been published to help practitioners obtain high-quality images. Lisa Abbot and Peter Soyer  have developed a simple acronym as a guide to help practitioners take better pictures. The acronym “CLOSE-UP” is adopted and in brief, covers:
Set the scene
Upload the image
When taking any clinical image, the first step is to obtain consent from the patient. Laws about consent and data protection policies differ from country to country, clinic to clinic but its good practice that that patient should give permission to any image being taken and be aware of what it may be used for (clinical records, teaching education, publication etc.,) and where it is stored.
Lighting is important. Natural light is by far the best when capturing images of the skin. Where this is not possible LED lamps (with tripods if necessary) are relatively cheap and can provide bright illumination for darker environments. The next part is to consider orientation. So often we may see a skin lesion in an image but wonder where it is exactly on the foot! Therefore, if this is an issue, it is recommended that first an orientating image is taken from a further distance to give context to a lesion’s location, before taking a second and third, closer image to depict the finer detail.
Where possible, distractions in the background should be eliminated. The background should be as plain as possible – using a clinical drape or cloth. The area of interest should then be in the centre of the photograph. Once the image is taken, always refer back to the camera screen and check all the images are sharp, in focus with the correct colour balance and contrast. Most clinical images are then uploaded and appended to patients' notes.
If the image is going to be used to solicit a second opinion, remember that a full patient history should be included. So often, images are sent with a request for a diagnosis but have no detail or history. A history contains about 60% of the information required to make a diagnosis and so its omission makes the job of diagnosis much more difficult for the person at the other end.
Patients taking images.
At the moment, remote consultations with patients are commonplace and often clinical images may be requested by practitioners from patients to assist in assessment. A number of patient guides are available online for this purpose but for dermatology, the Primary Care Dermatology Society provides information for patients on this (Click here):
College of Podiatry – Consent Forms for Clinical Photography.
Log in to www.cop.org.uk and the forms can be found at:
Patients guide to clinical photography
Advice sheet from Cardiff and Vale NHS University Health Board (click here)
1. Abbott LM, Soyer HP. A CLOSE-UP guide to capturing clinical images [https://doi.org/10.1111/ajd.13330]. Australas J Dermatol. 2020 2020/11/01;61(4):353-354.