Document Type : Original Article


1 Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,

3 Education Development Office, Shiraz University of Medical Sciences, Shiraz, Iran


BACKGROUND: Medical images have been widely used for various aims, especially for the
educational purposes. Patient confidentiality and consent should be deemed crucial. In this study,
we sought to assess patients’ satisfaction with taking medical photos of their skin lesions and giving
their physicians consent to use them for educational purposes.
MATERIALS AND METHODS: This multi‑method study included quantitative and qualitative phases
and was performed from April to November 2018 in the Dermatology Department of Shiraz Faghihi
Hospital in South Iran. Demographic information was analyzed using the descriptive statistics. To
resolve the simultaneous effect of demographic variables on patient satisfaction, we conducted linear
regression. All the tests were analyzed at the 0.05 significance level.
RESULTS: In this study, all the patients except one (99.5%) preferred that only a physician who had a
direct role in their care can access their digital photos. Of 200 patients, 134 patients (62.33%) preferred
the utilization of hospital cameras in photographing their skin lesions (P = 0.002). On the other hand,
131 patients (49.81%) did not gave consent about using a personal phone camera for photographing
their skin lesions (P = 0.001). In the qualitative phase, two major themes (trusting attending physician
and paying attention to patient confidentiality) and five sub‑themes (considering their physicians
as professional people who always do the right thing, allowing physicians to use their images for
educational purposes, covering patient’s face, using hospital cameras, and obtaining informed consent
from patients) were derived from qualitative semi‑structured interviews.
CONCLUSION: The results showed that there is a need for developing international and national
photography guidelines in the era of technology development.


1. CreightonS, AldersonJ, BrownS, Minto CL. Medical photography:
Ethics, consent and the intersex patient. BJU Int 2002;89:67‑71.
2. Adeyemo WL, Mofikoya BO, Akadiri OA, James O, Fashina AA.
Acceptance and perception of Nigerian patients to medical
photography. Dev World Bioeth 2013;13:105‑10.
3. Hacard F, Maruani A, Delaplace M, Caille A, Machet L, Lorette G,
et al. Patients’ acceptance of medical photography in a French
adult and paediatric dermatology department: A questionnaire
survey. Br J Dermatol 2013;169:298‑305.
4. Ashique KT, Kaliyadan F, Aurangabadkar SJ. Clinical
photography in dermatology using smartphones: An overview.
Indian Dermatol Online J 2015;6:158‑63.
5. Kunde L, McMeniman E, Parker M. Clinical photography in
dermatology: Ethical and medico‐legal considerations in the
age of digital and smartphone technology. Australas J Dermatol
6. Cunniff C, Byrne JL, Hudgins LM, Moeschler JB, Olney AH,
Pauli RM, et al. Informed consent for medical photographs.
Dysmorphology Subcommittee of the Clinical Practice
Committee, American College of Medical Genetics. Genet Med
7. Cho SI, Na JI, Han SS, Chung JH. Comment on “Just a quick pic:
Ethics of medical photography:” Generative adversarial networks
could be a solution. J Am Acad Dermatol 2019;81:e85‑6.
8. Murgic L, Hébert PC, Sovic S, Pavlekovic G. Paternalism
and autonomy: Views of patients and providers in a
transitional (post‑communist) country. BMC Med Ethics
9. Supe A. Ethical considerations in medical photography. Issues
Med Ethics 2003;11:83‑4.
10. Devakumar D, Brotherton H, Halbert J, Clarke A, Prost A, Hall J.
Taking ethical photos of children for medical and research
purposes in low‑resource settings: An exploratory qualitative
study. BMC Med Ethics 2013;14:27.
11. Arora CJ, Mitchell J, Rafiq M, Shumack S. Clinical photography
of skin lesions: Professional and legal considerations in primary
care. Aust J Gen Pract 2019;48:492‑4.12. Hsieh C, Yun D, Bhatia AC, Hsu JT, Ruiz de Luzuriaga AM.
Patient perception on the usage of smartphones for medical
photography and for reference in dermatology. Dermatol Surg
13. Lau CK, Schumacher HH, Irwin MS. Patients’ perception
of medical photography. J Plast Reconstr Aesthet Surg
14. Mehdizadeh H, Bahaadinbeigi K. Standards and Photography
Techniques in Teledermatology; Health Information Management.
15. Czerninski R, Zaidman B, Keshet N, HamburgerJ, Zini A. Clinical
photography: Attitudes among dental students in two dental
institutions. Eur J Dent Educ 2019;23:237‑43.
16. Leger MC, Wu T, Haimovic A, Kaplan R, Sanchez M, Cohen D,
et al. Patient perspectives on medical photography in dermatology.
Dermatol Surg 2014;40:1028‑37.
17. Nair AG, Potdar NA, Dadia S, Aulakh S, Ali MJ, Shinde CA.
Patient perceptions regarding the use of smart devices for medical
photography: Results of a patient‑based survey. Int Ophthalmol
18. Scheinfeld N. Photographic images, digital imaging, dermatology,
and the law. Arch Dermatol 2004;140:473‑6.