Standardized Clinical Photography for Improving Dermatological Treatment Adherence (Scoping Review): Evidence Landscape and Research Gaps

Abstract: Treatment adherence remains suboptimal across chronic dermatological conditions, contributing to poor clinical outcomes and increased healthcare burden. Despite the established role of standardized clinical photography in clinical documentation, its specific application as an adherence-promoting intervention remains poorly characterized. This scoping review aimed to systematically map the literature on photographic feedback in dermatology, identify research gaps, and propose methodological recommendations for future randomized controlled trials (RCTs). We conducted a scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Systematic searches of PubMed, Embase, Cochrane Library, and Web of Science, supplemented by Europe PMC, ClinicalTrials.gov, WHO ICTRP, and Google Scholar (first 200 records), were performed from database inception to December 31, 2025 (searches executed September 20– 27, 2026). Of 1181 identified records, 18 studies met the eligibility criteria: five provided direct evidence, five indirect evidence, and eight methodological evidence. Direct evidence comprised three observational studies in hair loss disorders encompassing 3,218 patients (93% of participants derived from a single retrospective cohort), one virtual feasibility study in atopic dermatitis, and one remote photographic wound-monitoring study in keloids; the remaining five prespecified conditions (psoriasis, acne, vitiligo, rosacea, and melasma) yielded zero direct evidence, although vitiligo has an established methodological photography literature. Of the five direct-evidence studies, four measured motivation, satisfaction, task completion, or image-upload compliance rather than treatment adherence per se. Indirect evidence from smartphone applications exists for psoriasis and atopic dermatitis, but these bundle photography with other digital functions. We propose the "early difference refutation” design to address reverse causality in future RCTs. High-quality RCTs are urgently needed to determine whether photographic feedback alone can improve dermatological treatment adherence. Keywords: adherence, clinical photography, dermatology, scoping review, photographic feedback, visual feedback