In a recent publication in JAMA Dermatology, experts are emphasizing the importance of refining dermatologic photography techniques to accurately represent skin of color. This call to action, highlighted in a special communication published online April 16, addresses a historical gap in medical imaging and its implications for dermatological practice and patient care.
Madison Grinnell, M.D., from the University of Nebraska Medical Center College of Medicine in Omaha, and colleagues conducted an examination of optimal practices for capturing clinically precise dermatologic digital images, with a focus on methods to enhance photography involving individuals of color, dermatologic conditions in skin of color, and pigmentary disorders. This focus is crucial for both Black and non-Black dermatologists to provide equitable and effective care.
“As the U.S. population rapidly diversifies, it is important to increase awareness of photography techniques that can better portray dermatologic processes in diverse skin types,” the authors write.
Historical Bias in Medical Photography
The authors highlight a significant historical issue: the calibration of color correction in photographic technologies has often relied on light-skinned participants. This has led to inaccuracies in photographs of individuals with darker skin tones, affecting the diagnosis and treatment of dermatological conditions. This systemic bias in imaging technology has the potential to perpetuate disparities in healthcare.
Optimizing Photography for Skin of Color
To counter these inaccuracies, the JAMA Dermatology communication provides specific recommendations. One key recommendation is the use of royal blue backgrounds when photographing darker skin. This color choice offers increased contrast, allowing for better visualization of dermatological findings without distorting the skin’s natural hues.
Lighting is another critical factor. The authors recommend using soft, diffuse lighting, such as that from an attachable ring light, whenever possible. Standardizing other aspects of clinical photography, including maintaining a fixed distance from the patient and utilizing a dedicated photography space, is also emphasized.
For certain dermatological conditions, specialized lighting techniques can be beneficial. Cross-polarization, for example, can aid in the accurate capture of erythema (redness), inflammation, and pigmentary changes. This technique reduces glare and reflections, providing a clearer view of the skin’s surface and subsurface structures.
The Humanistic Side of Dermatologic Photography
Beyond the technical aspects, the authors underscore the importance of humanistic considerations when photographing a patient’s dermatologic condition. This includes obtaining informed consent, ensuring patient comfort and privacy, and being mindful of the emotional impact of the condition on the patient.
Why This Matters for Dermatology as a Whole
The recommendations in JAMA Dermatology are not just about improving photographs; they’re about improving dermatological care for a diverse population. As the U.S. population becomes increasingly diverse, dermatologists need to be proficient in recognizing and treating skin conditions in all skin types.
Benefits of Inclusive Photographic Practices
- Improved Diagnostic Accuracy: Accurate photographs facilitate more precise diagnoses, reducing the risk of misdiagnosis, which is more prevalent in skin of color where certain conditions may present differently.
- Enhanced Communication: Clear and representative images improve communication between dermatologists, other healthcare providers, and patients.
- Better Education and Training: A diverse collection of dermatological images is invaluable for training future dermatologists, equipping them with the skills to diagnose and treat patients of all skin tones.
- Reduced Healthcare Disparities: By addressing the historical bias in medical imaging, these recommendations contribute to reducing healthcare disparities and promoting equitable care.
- Increased Patient Trust: When healthcare providers demonstrate competence and sensitivity in addressing the specific needs of patients with skin of color, it fosters trust and improves patient satisfaction.
This special communication provides essential guidance for dermatologists seeking to enhance their photographic techniques. By adopting these recommendations, dermatologists can improve the accuracy of their diagnoses, provide more equitable care, and contribute to a more inclusive and effective field of dermatology.