Journal of the American Academy of Dermatology
Volume 54, Issue 4 , Pages 633-637, April 2006

Detection and management of pornography-seeking in an online clinical dermatology atlas

  • Christoph U. Lehmann, MD

      Affiliations

    • From the Department of Dermatology
    • Division of Health Sciences Informatics, Johns Hopkins University School of Medicine
    • Corresponding Author InformationReprint requests: C. U. Lehmann, MD, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Nelson 2-133, Baltimore, MD 21287-3200.
    • ,
  • Bernard A. Cohen, MD

      Affiliations

    • From the Department of Dermatology
    • ,
  • George R. Kim, MD

      Affiliations

    • From the Department of Dermatology

Accepted 22 December 2005. published online 24 February 2006.

Baltimore, Maryland

Background

Increased use of an online educational archive of photographic dermatology case materials (DermAtlas) indicated unexpected pornography-seeking behavior and misuse.

Objective

We sought to assess the extent of archive misuse.

Methods

Web usage/request patterns were examined over a 6-month period for requests by anatomic site, diagnosis, and age group plus anatomic site. Free-text queries and referrals from external Web sites were reviewed.

Results

Of 7800 images, 5.5% contain genital sites. Of all requests, 11% were for anatomic sites (37% genital sites); 62% were specified for diagnoses (12% genital sites). When age group and anatomic site were specified, the relative risk of a child being requested (vs adult) was 1.48 (95% confidence interval 1.44-1.53). Of 10000 free text queries, 12% retrieved images containing genital sites. Of all referrals, 14.3% originated from nonmedical (pornography/fetish) Web sites.

Limitations

Requests are mixed with legitimate queries.

Conclusion

Online photographic dermatology archives are vulnerable to misuse. Monitoring and intervention are necessary to preserve their availability and integrity.

Abbreviations used: CI, confidence interval, DL, digital library, HIPAA, Health Insurance Portability and Accountability Act, IP, Internet protocol, NHS, National Health Service [Great Britain], OR, odds ratio, PHI, protected health information

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 Funding sources: None.Disclosure: Dr Lehmann has received a speaker's honorarium from Eclipsys Corporation; Dr Cohen is a member of the Speaker Bureau and Clinical Trials of 3M Corporation, Astellas Pharma Inc, and Novartis. Dr Kim has no conflicts of interest to disclose.Presented at the 2005 Annual Symposium of the American Medical Informatics Association.

PII: S0190-9622(05)04963-7

doi:10.1016/j.jaad.2005.12.037

Journal of the American Academy of Dermatology
Volume 54, Issue 4 , Pages 633-637, April 2006

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