Ethical considerations in dermatologic photography

In dermatology, clinical photographs are an essential component of patient care, enabling clinicians to document changes in skin pathology over time. Recent advances in digital technology and the electronic medical record have revolutionized clinical photography; however, these advances bring with them new ethical, legal, and social concerns. Photographs, more than other forms of documentation, have the potential to make patients uncomfortable. The act of photography, especially for those images requiring exposure of the genital area or the entire body, can be an uncomfortable experience for patients, necessitating the clinician and photographer to take an empathic stance in this setting. The Internet has elicited an increasing, and a very real, concern for patients about possible distribution and use of images outside of their individual care. The clinician and staff can allay these fears by professionally and empathetically addressing their concerns. In addition, it is important that patients receive appropriate informed consent about clinical photographs and the potential use of the images in their care, education, and research. Given the multitude of methods for recording clinical photographs, combined with the increasing complexity of image storage, standardization becomes a critical tool in providing consistency among images and achieving more equitable and efficacious care. To achieve this goal and improve the baseline standard of continuity of care for dermatological practices, we review the role of photographs, develop a model for patient consent, and establish standards for photography so as to provide the most ethical care for the patient.