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


CONCLUSIONS
Requests are mixed with legitimate queries.


CONCLUSIONS
Online photographic dermatology archives are vulnerable to misuse. Monitoring and intervention are necessary to preserve their availability and integrity.
Division of Health Sciences Informatics, Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-3200, USA. clehmann@jhmi.edu
Christoph U
CU
Lehmann
Bernard A
BA
Cohen
George R
GR
Kim
D003880:Dermatology; D004882:Erotica; D006801:Humans; D020407:Internet; D010781:Photography