Digital Photography Guide for Dermatologists With Special Considerations for Diverse Populations

Importance: Dermatology has a complex history with photography, particularly photographs of those with skin of color. Evaluation of best practices for capturing clinically accurate digital images, particularly emphasizing techniques to improve photography portraying individuals of color, dermatologic conditions in skin of color, and pigmentary disorders is needed. Observations: Historically, many different kinds of photographic technologies have calibrated color correction using participants with light skin, thus creating inaccurate photographs of those with skin of color. In photographing darker skin, royal blue backgrounds are often preferred, as this background color offers increased contrast without creating aberrant hues. Soft diffuse lighting, such as that emitted from an attachable ring light, should be used when possible. Furthermore, other aspects of photography in the clinical setting should be standardized to include a fixed distance from the patient and a dedicated space for photography. In accurately capturing erythema, inflammation, and pigmentary alterations in skin of color, specific lighting techniques such as cross-polarization may be used. In addition to these photographic techniques, there are several humanistic aspects that should be considered when photographing a patient's dermatologic condition. Conclusions and Relevance: The techniques discussed in this digital photography guide can help capture high-quality images representative of dermatologic disease processes across all skin colors, facilitate the monitoring of dermatologic disease, and create a positive experience for patients. Beyond the utility of high-quality photographs in dermatology clinics, high-quality photography can enhance skin of color representation in educational materials, expand access to dermatologic services by improving on the provision of teledermatology care, and may serve as a valuable tool for grading disease severity in clinical trials. Progress in these areas can help improve dermatologic care and health equity for diverse populations.