Images for New Zealand Teledermatology

Identifying the subject

It's a good idea to photograph the patient's identification label, or a consent form that includes the suspected diagnosis and date.

Tips to taking good photographs

  • Optimise room lighting. If you have reflector or slave lighting, use it.
  • Choose a position to take the photograph that has a suitable background.
  • The background should be plain, preferably of a medium shade such as mid-grey, green or blue. A white background tends to underexpose an image, and a very dark background can lead to overexposure. A pulldown blind or plain curtain is ideal.
  • Prepare the subject. Explain the purpose of the images.
  • Ask him or her to remove clothing so that the entire body site is revealed. Remove jewellery or other potentially identifiable items when possible.
  • Compose the picture carefully.
  • Look at the background and avoid imaging or remove extraneous items such as power sockets, chair legs, basins or people.
  • Ensure the camera lens is level with the subject. You may have to sit the patient down, or you may need to kneel down. Images taking at an angle are poorly focussed.
  • When imaging legs, the patient may stand or lie on the bed. Lower the bed if possible, or stand on a stool to take the photograph from above. Take images from the side as well. Minimise images of curved surfaces.
  • When imaging trunk and upper limbs, it's often best to have the arms crossed over the chest. Ask the patient to keep their legs together then imaging these.
  • If imaging hands, place them on a cloth on a desk or table. The camera should be directly above.
  • If imaging feet, be aware of the angle of approach. To image the sole, you may need to ask the patient to kneel down or roll over on a bed into a prone position.
  • Often, the automatic function of a camera takes the best images. It may be necessary to add flash. If in doubt, take images with and without flash.
  • If the image is poorly focussed or exposed, try again.
  • Use a reflector such as silver or white card to reduce shadow, eg under the chin or in the groin.

Refer to the University of Bristol Hospital's excellent photo tips.

Anatomic images

These are intended to show the distribution of a rash or the location of a skin lesion. For example:

  • Full face
  • Upper or lower back
  • Chest or abdomen
  • Upper arm or forearm
  • Thigh or lower leg; it may be useful to show both legs
  • Dorsum of one or both hands or feet
  • Palms or soles

Download the American Telemedicine Association's Teledermatology poster demonstrating suitable poses (2.4 MB PDF file). Courtesy Canfield Scientific.

Macroscopic images

These are intended to show the details of a solitary lesion or rash. You may need to take several images at different locations, angles or distance.

  • Add a rule to show the size of a lesion: take an image without the rule as well
  • If a rash has various morphologies, take images to reveal these
  • If a rash involves more than one body site, take close-up images from several sites
  • When using flash, partial shading or "flash burn" indicates the camera is too close to the subject. Back off and use the zoom.
  • Check the exposure. If under or overexposed, adjust it and take the images again.

Dermatoscopic images

We require dermatoscopic images to accurately diagnose pigmented and non-pigmented skin lesions. These require a dermatoscope, an adapter, and a suitable camera (such as a smartphone).

  • Both polarised and non-polarised images are helpful, especially for seborrhoeic keratoses, basal cell carcinomas and melanoma.
  • Apply fluid to the skin (eg sterilising gel) to minimise scale
  • Ensure focus and exposure are suitable

If you are using MoleMap's MoleTrac software to upload images from DermLite Cam, please select Image Quality High (Large file size) when creating the report, which you can upload to Collegium Telemedicus as a PDF file.

Processing/editing the images

Images can sometimes be processed on the camera, but it is often easier to edit when the image is on a larger screen.

  • Crop to remove unnecessary background.
  • Enhance brightness and contrast if necessary.
  • Save the image to an archiving folder. This might be the patient's notes, a folder for the month, or other system.
  • It's best to rename the file. A common system is to combine date, time and NHI number. Many camera or computer software programs can semi-automate this for you.
  • Add keywords, eg NHI, diagnosis, body location
  • There is no need to keyword the date the image was taken, because this is recorded by the camera's metatagging system (as long as the correct date has been set for the camera originally).

Preparing the image for the teledermatology consultation

Very often, the original image size is much larger than is necessary for teledermatology consultations.

  • Save a copy of the original with a new name (eg date, time, NHI plus a suffix—I use "s" for small verison.
  • Use your system's software to reduce the size of the new image to around 1200 x 900 px (medium size). Save it.
  • Check the image looks satisfactory.

Uploading the images to NZT

See instructions on the "Help" page. Note:

  • There is no point in uploading multiple images that show the same thing.
  • Do not include images that are out of focus or poorly exposed. Take the pictures again—if necessary call the patient back to do this once you have figured out what went wrong.


waikato-consentWaikato DHB consent form

Canfield ATA Photography Guide for TeledermatologyPhotography Guide

anatomic view of a backAnatomic view of a back

Macroscopic view of hand with scabies burrowsMacroscopic view of burrows

Dermoscopy of scabies burrowsDermatoscopic view of burrows

Moletrac HQ imageMoleTrac: Select High Image Quality

Please note, New Zealand Teledermatology does not provide a direct-to-patient consultation service. Please see your own General Practitioner or other healthcare professional to find out how you can access a dermatologist. New Zealand Dermatologists are listed on the New Zealand Dermatological Society's website.
For further information about skin diseases and their treatment, refer to DermNet New Zealand at www.dermnetnz.org.