Indian Journal of Dermatology
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Table of Contents 
Year : 2013  |  Volume : 58  |  Issue : 3  |  Page : 194-196
A simple instrument designed to provide consistent digital facial images in dermatology

Department of Dermatology, Kasturba Medical College, Manipal, Manipal University, India

Date of Web Publication20-Apr-2013

Correspondence Address:
Sathish B Pai
Department of Dermatology, Kasturba Hospital, Manipal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.110827

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Photography has proven to be a valuable tool in the field of dermatology. The major reason for poor photographs is the inability to produce comparable images in the subsequent follow ups. Combining digital photography with image processing software analysis brings consistency in tracking serial images. Digital photographs were taken with the aid of an instrument which we designed in our workshop to ensure that photographs were taken with identical patient positioning, camera angles and distance. It is of paramount importance in aesthetic dermatology to appreciate even subtle changes after each treatment session which can be achieved by taking consistent digital images.

Keywords: Camera, photography, images

How to cite this article:
Nirmal B, Pai SB, Sripathi H. A simple instrument designed to provide consistent digital facial images in dermatology . Indian J Dermatol 2013;58:194-6

How to cite this URL:
Nirmal B, Pai SB, Sripathi H. A simple instrument designed to provide consistent digital facial images in dermatology . Indian J Dermatol [serial online] 2013 [cited 2019 Jul 22];58:194-6. Available from:

What was known? 1. Digital photography is a fundamental art in the day to day practice of a dermatologist. 2. The main issue in most of the clinical photographs is the lack of good, reproducible and consistent digital images.

   Introduction Top

Digital photography is a fundamental art in the day to day practice of a dermatologist. [1] A wide range of digital cameras are available in the market for photography. [2] But the main issue in most of the clinical photographs is the lack of good, reproducible and consistent digital images. Hence we designed an instrument to address all these deficits and provide quality digital images.

   Background and Materials Top

Reasons for inconsistent images

The lack of consistency of serial photographs is due to variation in:

  1. Patient positioning,
  2. Camera angles,
  3. Lighting and
  4. Distance between patient and camera.

Photography device

The instrument which we designed in our workshop is made up of stainless steel and has two parts viz. a fixed and a movable part [Figure 1]. The patient comfortably sits on a chair and rests the chin over a cup shaped cushion (41 inches from the ground) which is the fixed part [Figure 2]. The movable part is where the digital camera or ideally a SLR camera is mounted over a firm stainless steel plate. The camera is kept in position by means of screw (diameter ¼ inch, length ¾ inch) which fits into the socket provided on the undersurface of it. The settings in the camera are always kept constant. To ensure consistent lighting, photographs are taken in the same place with the patient's face against same dark background. The movable part rotates around a central axis so that photographs can be taken at 0°, 45° and 90° [Figure 3] with angles marked in the axis. The distance between the patient's face and camera (1 feet) is constant at all these angles.
Figure 1: Our instrument

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Figure 2: The distance between the camera and face constant in all angles

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Figure 3: 90° right, 45° right, 0° front, 45° left, 90° left profile images

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The device which we designed for perfectly aligned photographs was similar to the OMNIA Imaging Station which has a camera column to maintain correct distance through all camera positions, dual Intelli Flash to provide balanced lighting and Match Pose image overlay for accurate patient positioning. [3] The imaging station was highly expensive and hence we designed this instrument. The comparison with the instrument we designed is shown in [Table 1].
Table 1: Comparison of features between OMNIA imaging station and our instrument

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Alignment software

Small inconsistencies with patient positioning can be corrected using image analysis software Photoshop Adobe CS5. Each photograph is aligned to the previous photograph by manually selecting points of obvious anatomic landmarks [Figure 4]. After alignment, the photos are separated and held side by side. This increases the ability of the observers to confidently track the same lesions in the same place in serial photographs [Figure 5].
Figure 4: Alignment of images. (a) Before treatment photograph: Yellow dots are the anatomic landmarks chosen for alignment to match those in follow - up photograph. (b) Follow - up photograph: Same anatomic landmarks in red. (c) Without digital alignment: Photographs of before treatment and follow - up on overlaying shows mismatching of anatomic landmarks. (d) With digital alignment: Yellow and red dots are superimposed to exactly match both photographs

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Figure 5: Separation of images after alignment

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The photo-editing software allows perfect alignment of photographs taken serially without altering color or contours of the lesions. By monitoring the same area over time sequentially, interpretation of changes is made easy [Figure 6]. Do et al. [4] had used serial digital photographs and similar spatial alignment software, the software Picture Window Pro 4.0 (Digital Light and Color, Belmont, MA, USA) to examine the evolution of facial acne lesions.
Figure 6: Serial tracking of acne scars before each laser sitting -Images are comparable and consistent

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Uses in dermatology

The applications of digital photography in our field include: [5]

  • Tracking serial photographs after cosmetic procedures like peels and lasers,
  • Storing patient data,
  • Medico-legal proof,
  • Discussion in forums and
  • Medical publications.

Future directions

The digital photography forms the basis of store-and-forward system of teledermatology. [6] The medical images are captured in the referring center and subsequently forwarded to the specialty centre. A proper digital photograph highlighting the representative lesions is essential for a dermatologist to make a reliable diagnosis. A number of issues have been raised regarding the standardization of telemedicine equipment. [7] Our instrument can be used by all referring centers to provide quality face images. It can also be used in the field of dentistry [8] to assess the improvement of facial profile after wearing orthodontic braces.

   Conclusion Top

Digital photography is transforming the specialty of dermatology [9] and standardization of photographs is of prime importance in this era of digital technology. The major limiting factor in a developing country like India is the cost of such sophisticated instruments to provide images of high quality. Hence there are always alternatives to get the best out of the resources we have and this device is one kind of it. Digital photography along with image analysis will open avenues onto a more detailed view of the patient and their response to treatment. [10]

   Acknowledgement Top

We would like to thank the Manipal workshop for designing the instrument as per our instructions.

   References Top

1.Kaliyadan F, Manoj J, Venkitakrishnan S, Dharmaratnam AD. Basic digital photography in dermatology. Indian J Dermatol Venereol Leprol 2008;74:532-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Patricoski C, Ferguson AS, Brudzinski J, Spargo G. Selecting the right digital camera for telemedicine-choice for 2009. Telemed J E Health 2010;16:201-8.  Back to cited text no. 2
3.OMNIA imaging system. Available from: [Last Accessed on 2011 Nov 25].  Back to cited text no. 3
4.Do TT, Zarkhin S, Orringer JS, Nemeth S, Hamilton T, Sachs D, et al. Computer-assisted alignment and tracking of acne lesions indicate that most inflammatory lesions arise from comedones and de novo. J Am Acad Dermatol 2008;58:603-8.  Back to cited text no. 4
5.Mutalik S. Digital clinical photography: Practical tips. J Cutan Aesthet Surg 2010;3:48-51.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Kanthraj GR. Teledermatology: Its role in dermatosurgery. J Cutan Aesthet Surg 2008;1:68-74.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Feroze K. Teledermatology in India: Practical implications. Indian J Med Sci 2008;62:208-14.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Chossegros C, Guyot L, Mantout B, Cheynet F, Olivi P, Blank JL. [Medical and dental digital photography. Choosing a cheap and user-friendly camera]. Rev Stomatol Chir Maxillofac 2010;111:79-83.  Back to cited text no. 8
9.Ratner D, Thomas CO, Bickers D. The uses of digital photography in dermatology. J Am Acad Dermatol 1999;41:749-56.  Back to cited text no. 9
10.Papier A, Peres MR, Bobrow M, Bhatia A. The digital imaging system and dermatology. Int J Dermatol 2000;39:561-75.  Back to cited text no. 10

What is new? A low-cost instrument has been devised to provide consistent digital facial images that is comparable to the higher end alternatives.


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

  [Table 1]


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