Benefits to Smartphone Photo Use in Dermatology Depend on Image Quality

Smartphone image use in dermatology consultations may lead to more optimal outcomes among patients, but new findings suggest that such positive outcomes depend on the transmitted photographic image’s quality.1

Sophie Walter, from the faculty of medicine and health at the University of New South Wales in Australia, led a team of investigators in this analysis of skin photograph use in the diagnosis and treatment of different dermatologic conditions. Walter et al. expressed that the use of smartphone-transmitted photographs has received more attention in recent years in relation to dermatology.

The team noted, however, that advice given by healthcare providers when teledermatology is implemented still depends on the receiving of images that are suitable in quality.

“Accordingly, in a companion study, we sought to examine, firstly, the quality of skin photographs sent to dermatology registrars for advice about diagnosis and treatment, secondly, areas in which the images could be improved, and, thirdly, confidence giving diagnostic and treatment advice based on the images received,” Walter and colleagues wrote.1

Potential Improvements to Smartphone Images in Teledermatology

The investigative team had dermatology registrars for Prince of Wales Hospital inSydney evaluate, over 6 months lasting from 2023 - 2024, the quality and usability of skin condition photographs that had been submitted by hospital medical staff as part of routine consultations.

The registrars filled out a questionnaire made up of 5 items, using 1 questionnaire for each consecutively referred patient. These questionnaires were crafted through the implementation of the theoretical framework of acceptability (TFA) in collaboration with key stakeholders.

Walter and colleagues’ analysis received approval from the Human Research Ethics Committee of South Eastern Sydney Local Health District. All photographs assessed in the study were captured via smartphones. The aforementioned questionnaire that had been given out included an open-response section for suggestions on improving quality of photographs.

To assess the relationship between diagnostic confidence and various aspects of image quality, a Chi-square test would be conducted. The photographs ended up being submitted by a range of medical personnel, including medical specialists (7.6%), interns (28.3%), junior medical officers (33.7%), registrars (23.9%), and nurse practitioners (6.5%).

Registrars were asked by the investigators to assess these images for a total of 92 patients. Among the images that were assessed in this study, it was concluded that 94.6% had been acceptable and 5.4% were rated as unacceptable.

Diagnostic confidence, in terms of clinical decision-making, was noted by registrarsin 73.9% of cases, and preliminary treatment recommendations given these images were deemed appropriate for 90.2% of cases. The investigators highlighted that both image clarity (P = .018) and lighting (P = .006) were shown to have statistically significant associations with diagnostic confidence.

When looking at the most commonly cited areas for improvement in these photographs, areas to improve included lighting in 39.1% of patients, photograph clarity in 54.3%, color accuracy in 12%, and proper centering of lesions in 10.9%. The registrars in this analysis further suggested that more photographs would have been helpful in 69.6% of these cases.

Overall, the research team noted the potential of smartphone-captured image use in dermatology consultations, highlighting improvements in efficiency within the hospital's emergency departments. However, the team added that ensuring optimal outcomes among those being diagnosed depends heavily on the transmitted image quality.

“Centring of lesions, incorporation of anatomical landmarks, efforts to improve lighting, and use of appropriate neutral backgrounds are among the photographic techniques that are able to improve image quality,” they concluded.1,2

References

1. Walter, S., Koutsis, J., Gorji, M., Kherlopian, A., Wong, T., Lo, S.N., Chiew, A.L. and Martin, L.K. (2025), Quality and usability of photographs of skin conditions taken in emergency departments for dermatology consultation. Emergency Medicine Australasia, 37: e70019. https://doi.org/10.1111/1742-6723.70019.

2. Cummins MR, Ong T, Ivanova J et al. Consensus guidelines for teledermatology: scoping review. JMIR Dermatol. 2023; 6: 1–13.