Clinical images play an important role in informing clinical care and education in dermatology. Standardized informed consent for publishing patient images is an important concern regarding patient privacy, especially given increasing avenues for dissemination (eg, online publication and social media) [1,2]. Protecting patient privacy is a critical aim for dermatologists, as publishing images with potentially identifiable features is often necessary. Establishing trust between dermatologists and patients is imperative when complete anonymity cannot be guaranteed [2]. Clear guidelines and thorough consent practices can ensure that authors are accountable for upholding patients’ privacy and are transparent when obtaining photo consent, thereby empowering patients to make informed decisions about sharing their images [3]. This study assesses current informed consent practices in image publication for top dermatology journals, examining author-facing guidelines and patient consent forms.

In this cross-sectional study, we examined patient image submission guidelines and consent forms from the top 50 dermatology journals as defined by the 2023 Clarivate Journal Impact Factor ranking. We developed a checklist of image consent requirements informed by guidelines from the Declaration of Helsinki, International Committee of Medical Journal Editors (ICMJE), and Committee on Publication Ethics (COPE) as described in Multimedia Appendix 1 [4-6]. Between November 11 and 25, 2024, authors TT and BO reviewed journal websites to assess author requirements for image publication and examined patient consent forms when available. Checklist items were documented as present or absent in an Excel (Microsoft Corporation) spreadsheet. Criteria were considered met if explicitly stated in journal guidelines or consent forms, or if the Declaration of Helsinki, ICMJE, COPE, or publisher guidelines were explicitly referenced.

Among the 50 journals, 15 (30%) were published in the United States, 41 (82%) were indexed in MEDLINE (the National Library of Medicine’s primary bibliographic database and a component of PubMed), and 35 (70%) had a social media account on Facebook, X (formerly Twitter), Instagram, or LinkedIn. The median percentage of articles available through gold open access journal was 26% (IQR 14.1-78.8%). Results for image consent criteria from author-facing guidelines and patient consent forms are summarized in Tables 1 and 2.

This study highlights the lack of standardized patient image consent guidelines within dermatology journals. While most journals surveyed (n=44, 88%) required informed consent for patient image publication, only 44% (n=22) provided consent forms online, which could lead to heterogeneity in the process or documentation of obtaining consent. Among journals that offered a consent form, the inclusion of other key COPE guidelines varied. Taken together, differences in journal requirements regarding image modification, safeguards for protecting anonymity, and definitions of identifiable features could lead to ambiguity or variability in how institutions, researchers, and clinicians request informed consent which, in turn, could raise privacy concerns for patients [2,3].

Consent revocation policies were highly variable and were only explicitly stated in 45% (n=10) of journals. Importantly, some journals allowed revocation of consent only before publication. Additionally, a significant gap was seen in the few journals (n=3, 6%) with requirements regarding the disclosure of potential social media dissemination of published images, despite 70% (n=35) of journals having a social media presence on one or more major platforms.

This study was limited to a select number of dermatology journals, and potential interobserver variability was possible in the interpretation of published author guidelines. Additionally, whether journals enforce their stated privacy and consent requirements was not evaluated.

In conclusion, this study highlights a current lack of standardized requirements for publishing patient images in dermatology journals. This gap threatens patient privacy due to the potential for secondary uses and widespread online dissemination of published images, including via social media. These results identify important opportunities for journal editors to harmonize consent requirements among journals, including standardization of definitions of identifiable features, enhanced transparency about patient risks regarding the dissemination and secondary use of images online, and standards for obtaining patient consent.