> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # How to take your dermatology photos > The photograph is what the doctor grades. Lighting, distance, angles, bare skin, no filters, and the file limits the upload actually enforces. The dermatology consultation is fully asynchronous. There is no video call, no telephone consultation and no live examination, so the photograph you upload does the work that an in-person examination would normally do. A good photograph is the difference between a case a doctor can grade and a case they cannot. This guide covers what to send and how, and the file limits the upload actually enforces. ## Where photos are required The twelve-step rosacea questionnaire cannot be submitted without a photograph. The differential — seborrhoeic dermatitis, perioral dermatitis, contact dermatitis, lupus — is wide, and none of it can be separated from a description alone. The thirteen-step melasma questionnaire likewise cannot be submitted without one. Symmetry, border and distribution are what distinguish melasma from the pigmented lesions that need an in-person examination instead. The acne questionnaire lets you choose to send photos later. Choosing that flags the case internally as missing them. A doctor grading acne severity with no image has very little to grade. The anti-ageing questionnaire also offers the send-later choice, and flags the case the same way. Photoageing is graded visually or not at all. "Optional" here means the form will accept the submission. It does not mean the doctor can reach a decision without the image. On the two optional pathways, an ungradeable case is a common reason no prescription is issued. ## What the doctor is actually grading Knowing what they are looking for is what makes the difference between four snapshots and four useful photographs. * **Lesion type.** In acne, whether there are comedones — blackheads and whiteheads — and whether the inflammatory lesions are papules, pustules, or something deeper. The presence or absence of comedones is the main thing separating acne from rosacea. * **Severity and distribution.** How much of the face is affected, how densely, and where. Central-face concentration means something different from a jawline pattern. * **Sequelae.** Scarring, post-inflammatory redness and post-inflammatory pigment. Scarring is the finding most likely to change the answer, because it means in-person care. * **Background skin.** Erythema, visible vessels, thickening, texture, and how photoaged the surrounding skin is. * **Anything that argues against the working diagnosis.** Asymmetry, a single odd lesion, an irregular border, several colours within one lesion, crusting or bleeding. These are the findings that stop an online consultation rather than steer it. ## Taking the photographs Wash gently and pat dry. **No makeup, no concealer, no foundation, no tinted sunscreen, no serum sheen.** Makeup hides exactly what the doctor is grading, and colour-correcting products are specifically designed to disguise the redness a rosacea assessment depends on. Wait until the skin is fully dry — wet skin reflects and the highlights read as lesions. Stand facing a window during the day, with the light on your face and not behind you. Daylight is neutral; indoor bulbs push the colour warm or green and change how red the skin looks. Avoid direct sun, which throws hard shadows and blows out detail. Turn off the overhead light — downward light casts shadows that mimic texture. Flash flattens texture and washes out redness, which is the opposite of useful. Turn off any beauty, smoothing or portrait mode, and any automatic skin-tone adjustment. A filtered photograph is not evidence; it is a picture of what a filter thinks your skin should look like. Portrait mode also blurs the background and sometimes the edges of the face, which loses information. Roughly an arm's length. Close enough that individual lesions are visible, far enough that the whole affected area is in one frame. Hold the camera at eye level rather than above or below. Keep still, tap the screen on the affected area to focus, and check the result is sharp before you accept it. Straight on, left profile, right profile, and a close-up of the worst-affected area. Faces are three-dimensional and a single frontal shot hides the cheeks and the jawline. For a body area, take a wide shot showing the location and a close-up showing the lesions. Look at it full-screen. If you cannot see the individual spots, the doctor cannot either. Blurred, dark, yellow-tinted, filtered or too-distant images are the four most common reasons a case cannot be graded. **Do not use a photograph as a skin cancer check.** Any mole or pigmented lesion that is new, changing, asymmetric, irregularly bordered, multicoloured, larger than about six millimetres, bleeding, crusting or itching needs an in-person examination with dermoscopy. A dermatology consultation for acne, rosacea, melasma or photoageing is not a skin lesion assessment and must not be treated as one. ## What the upload accepts There are two separate image surfaces, and their limits are not the same. ### The questionnaire photo answer This is the upload step inside the questionnaire itself. The file is stored as a patient document and its identifier becomes the answer to that step. | Constraint | Value | | ---------------------- | -------------------------------------------------------------- | | Formats | JPEG, PNG or WebP (PDF is also accepted by the document store) | | Maximum file size | 20 MiB | | Maximum dimension | 10,000 pixels on the longest side | | Maximum resolution | 25 megapixels | | Filename length | up to 180 characters | | Documents per patient | 50 in total | | Photos per upload step | **exactly one** | The upload step takes **one** photograph, not a set. The answer is a single document, so if you have four angles you cannot attach all four to that one step. Either upload the single most representative image — usually the straight-on shot, or the close-up of the worst-affected area — or send the rest through the consultation once it exists, which is the second surface below. ### Photos added to an existing consultation Once a consultation exists, further images can be attached to it directly. This is a different endpoint with different limits. | Constraint | Value | | ------------------ | --------------------------------- | | Formats | PNG, JPEG or WebP | | Maximum file size | 10 MB | | Maximum images | 10 per consultation | | Maximum dimension | 10,000 pixels on the longest side | | Maximum resolution | 25 megapixels | The technical detail for both is in the [API reference](/api-reference/introduction) if you are building against them. ## Common mistakes * **Makeup left on.** The most frequent cause of an ungradeable rosacea or melasma photograph. * **A filter or beauty mode left enabled by default.** Many phones apply smoothing without announcing it. Check. * **Bathroom lighting.** Overhead bulbs above a mirror produce downward shadows and a colour cast, and both distort the assessment. * **Too far away.** A photograph of a whole head from two metres shows a doctor nothing about individual lesions. * **A screenshot of a photograph.** Recompression destroys the detail that was the point of taking it. * **A photograph from six months ago.** The doctor is grading what your skin is doing now. * **Sending only one angle when the condition is on the cheeks.** A frontal shot foreshortens the cheeks badly. ## After you submit A registered doctor reviews the questionnaire and the images together and decides whether treatment is appropriate. If they need a better image or a different angle, they message you through the private chat in your account — that is the channel for it, and the review remains asynchronous throughout. A prescription is never guaranteed, and if one is not issued, the consultation fee is refunded in full. ## Related reading * [Acne](/library/conditions/acne) · [rosacea](/library/conditions/rosacea) · [melasma](/library/conditions/melasma) · [skin ageing](/library/conditions/skin-ageing) * [How to apply a prescription topical](/library/guides/how-to-apply-topicals) * [Side effects of dermatology topicals](/library/guides/side-effects-dermatology) * [How a consultation works](/essentials/how-it-works) · [safety and eligibility](/essentials/safety) ## Start a consultation Four pathways use photographs: [acne](https://hi-doctor.ai/consultation/dermatology-acne/1), [rosacea](https://hi-doctor.ai/consultation/dermatology-rosacea/1), [melasma](https://hi-doctor.ai/consultation/dermatology-melasma/1) and [anti-ageing](https://hi-doctor.ai/consultation/dermatology-antiaging/1). A registered doctor reviews each one and declining is a normal outcome. See [what it costs](/essentials/pricing) and [how the review works](/essentials/how-it-works). This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.