Clinical photography of skin of color for dermatologic assessment and education can be improved using natural light, indirect lighting, avoiding patterned backgrounds, and using parallel light polarization, according findings from a paper published in the British Journal of Dermatology.
In the paper, a small team of study authors from the University of California San Francisco and Stanford University School of Medicine note that the first step in taking pictures of patients for clinical assessment and education is to obtain consent. And in patients with skin of color, extra steps should be taken to capture detailed, high-quality photos that will ensure accurate assessment and diagnosis.
The study authors recommend using natural light to ensure the best possible outcome when taking pictures of dark skin, as this will highlight the skin’s natural appearance. Clinicians could take a photo in front of a window or outside to accomplish this task. Although natural lighting is the best option for dark skin, the investigators suggest the next best option could be room light, but this could lead to color distortions.
Flashes and direct lighting should be avoided when taking images of dark skin, they add, as this could cause flash artifact. Indirect lighting techniques could also be used to reflect light onto the patient, it was pointed out. In this scenario, the lighting should come from behind as well as on both sides the patient. The photographer could use a white muslin cloth or white sheet placed on either side of the patient to offer a reflective light source.
Brightly colored and patterned backgrounds should be avoided, as these backgrounds could lead to color contamination. Ideally, clinicians should use a background that offers the highest contrast to the subject, including white or light backgrounds. In addition, the investigators suggest that a separate overhead exam light should be useful for photographing dark hair in patients with skin of color.
To enhance the appearance of epidermal processes, clinicians may wish to consider parallel light polarization, it was noted. This technique may be useful for images intended for education purposes or publications. Cross-polarization can also decrease light reflectance and glare in dark skin types, especially for lesions featuring erythema or changes in pigmentation. A plastic linear polarizer sheet could be taped over the lens of the camera and flash to accomplish this technique inexpensively.
The study authors suggest that “with practice and understanding of the aforementioned principles, it is possible to achieve accurate representation” of skin of color in photographs.
Lester JC, Clark L Jr, Linos E, Daneshjou R. Clinical photography in skin of color: Tips and best practices. Published online January 15, 2021. Br J Dermatol. doi:10.1111/bjd.19811