Patient Consent and Case Reports
Our Dermatology Online is committed to protecting patient privacy and maintaining high ethical standards in the publication of clinical case reports, case series, clinical images, and other publications containing information relating to identifiable or potentially identifiable patients.
The publication of a clinical case may provide valuable information to clinicians and researchers. However, patients and other individuals described in case reports have a right to privacy.
Authors are therefore responsible for obtaining appropriate consent for publication and for removing unnecessary identifying information before submission.
1. Patient Consent for Publication
Authors must obtain appropriate informed consent for publication when a patient or other individual may be identified directly or indirectly from the published material.
This applies to, among other things:
- clinical case reports;
- case series;
- clinical photographs;
- dermoscopic images;
- radiological or other diagnostic images;
- videos;
- detailed case histories;
- pedigrees or family information;
- genetic information;
- unusual clinical characteristics;
- combinations of demographic or clinical details that could permit identification.
Consent for medical treatment is not the same as consent for publication.
Where publication consent is required, authors must obtain consent specifically covering publication of the relevant case information and images.
2. Case Reports and Case Series
Authors submitting case reports or case series should ensure that the manuscript contains sufficient information to understand the clinical case while avoiding unnecessary identifying information.
The journal encourages authors to follow the CARE guidelines when preparing case reports.
Case reports and case series should be clearly identified as such in the article title or article type where appropriate.
Authors should ensure that any information that is not necessary for understanding the case is removed.
3. Clinical and Patient Images
Patient photographs and other clinical images may contain identifying information even when the patient’s face is not visible.
Authors must consider whether a patient could be recognised from:
- the face;
- distinctive physical characteristics;
- tattoos, scars, birthmarks, or other features;
- clinical history;
- unusual diseases or presentations;
- dates or locations;
- combinations of information contained in the manuscript.
When a patient could reasonably be identified, appropriate consent for publication must be obtained.
Cropping, masking, blurring, or other image modification does not automatically replace the need for patient consent.
Authors should not alter images in a way that changes or misrepresents clinically relevant information.
4. Potentially Identifiable Information
Authors should remove information that is not necessary for the scientific purpose of the article and could identify the patient.
Potential identifiers may include:
- full name;
- initials where they could identify the patient;
- exact address;
- telephone number;
- e-mail address;
- medical record number;
- hospital identification number;
- exact dates where they are not necessary;
- detailed geographic information;
- distinctive personal characteristics;
- photographs or other images;
- rare combinations of demographic and clinical information.
The journal recognises that complete anonymity cannot always be guaranteed, particularly in unusual or rare cases.
Authors should therefore obtain consent whenever a reasonable possibility exists that the patient could be identified.
5. Anonymisation
Authors must make reasonable efforts to anonymise patients and other individuals described in manuscripts.
Anonymisation should be proportionate to the nature of the case and should remove unnecessary identifying information without compromising the scientific value of the report.
Authors should not assume that removing a patient’s name alone makes a case anonymous.
A patient may be identifiable from a combination of clinical, demographic, photographic, genetic, geographic, or other information.
Where complete anonymisation cannot reasonably be achieved, publication consent is required.
6. Consent for Deceased Patients
Appropriate consent for publication should also be considered when a case concerns a deceased patient.
Where the patient is deceased and cannot provide consent, authors should follow applicable legal, institutional, and ethical requirements concerning consent from an appropriate representative or proxy.
The journal may request information concerning the basis on which consent for publication was obtained.
7. Children and Individuals Unable to Consent
When the patient is a minor or lacks the capacity to provide informed consent, consent should be obtained from an appropriate parent, legal guardian, or authorised representative in accordance with applicable law and ethical requirements.
Where the patient later obtains the capacity to provide consent, authors should follow applicable ethical and institutional requirements concerning the patient’s own consent.
The fact that a parent, guardian, or representative has provided consent does not remove the author’s responsibility to minimise identifying information.
8. Patient or Proxy Consent
The person providing consent should understand:
- that the case may be published online;
- that the article may be freely accessible;
- that images and clinical information may be viewed by readers worldwide;
- that the article may be indexed, archived, and included in scholarly databases;
- that the information may remain available as part of the permanent scholarly record.
Where appropriate, the patient or authorised representative should be given an opportunity to review the material intended for publication, including relevant photographs or other identifying information.
9. Withdrawal of Consent
Patients or their authorised representatives should be informed that consent may be withdrawn before publication, subject to the circumstances of the case and the stage of the editorial process.
Once an article has been published, withdrawal of consent cannot normally result in removal of the article from the scholarly record.
In exceptional circumstances involving serious privacy, legal, or ethical concerns, the journal may consider appropriate post-publication action.
10. Consent Form
The journal expects authors to obtain written consent for publication when consent is required.
Authors may use the journal’s consent form or another consent form that contains equivalent information and protections.
The consent form should identify:
- the patient or person providing consent;
- the person obtaining the consent;
- the nature of the material to be published;
- the fact that the material will be published online;
- the possibility of worldwide access;
- the possibility of permanent inclusion in the scholarly record;
- relevant information concerning photographs, videos, or other images;
- the patient’s or representative’s agreement to publication.
The journal does not normally require authors to send the signed patient consent form with the manuscript.
Authors should retain the original signed consent documentation securely and in accordance with applicable institutional, legal, and ethical requirements.
The journal may request confirmation that appropriate consent has been obtained and, where necessary, may request evidence that the consent process complied with this policy.
11. Consent Statement in the Published Article
For case reports, case series, and other articles involving potentially identifiable patient information, the manuscript should contain a clear statement concerning consent for publication.
Where consent has been obtained, authors should use a statement such as:
Patient Consent: Written informed consent for publication of the clinical details and accompanying images was obtained from the patient.
Where applicable, the statement may identify that consent was obtained from a parent, legal guardian, or authorised representative.
If consent was not required, the manuscript should clearly explain the basis for this determination, where appropriate.
The journal may request clarification when the consent statement is absent, unclear, or inconsistent with the content of the manuscript.
12. Ethics Committee or Institutional Approval
Patient consent for publication is distinct from research ethics approval.
Where a case report or case series requires approval or determination by an institutional review board, ethics committee, or other competent body, authors must comply with the applicable requirements.
The manuscript should identify the relevant ethics committee or institutional body and approval or reference number where applicable.
If formal ethics approval was not required, authors should state this where appropriate and explain the basis for the determination.
13. Patient Privacy and the Right to Confidentiality
The journal will not knowingly publish unnecessary personal information about patients.
Authors are responsible for ensuring that manuscripts comply with applicable privacy, confidentiality, and data-protection requirements.
The journal may request removal or modification of information that is not necessary for the scientific purpose of the article.
The protection of patient privacy takes precedence over the inclusion of unnecessary identifying details.
14. Photographs and Image Consent
For photographs that could identify a patient, written consent for publication should be obtained before submission.
Authors should not rely solely on:
- covering the eyes;
- blurring the face;
- cropping the photograph;
- removing the patient’s name.
Such techniques may reduce identifiability but do not necessarily make a patient unidentifiable.
Where a patient could reasonably recognise themselves or be recognised by others, appropriate publication consent should be obtained.
15. Case Reports Submitted Without Consent
If a manuscript contains potentially identifiable patient information but the authors cannot demonstrate that appropriate consent has been obtained, the journal may:
- request that the authors obtain appropriate consent;
- request removal or anonymisation of the identifying information;
- request modification of images;
- suspend editorial processing;
- reject the manuscript if the ethical requirements cannot be satisfied.
The journal will not knowingly publish identifiable patient information without an appropriate ethical basis for publication.
16. Previously Published Case Information
Authors must disclose if substantially similar patient information, photographs, or case material has previously been published.
Authors are responsible for ensuring that reuse of previously published patient information complies with applicable copyright, licensing, ethical, and consent requirements.
A previous consent for publication does not automatically resolve copyright or licensing issues relating to previously published material.
17. Responsibility of Authors
The corresponding author is responsible for confirming that:
- appropriate consent for publication has been obtained where required;
- the consent covers the material submitted for publication;
- patient information has been appropriately anonymised where possible;
- unnecessary identifying information has been removed;
- clinical photographs and other images are handled appropriately;
- any required ethics approval or determination has been obtained;
- the consent statement included in the manuscript is accurate.
All authors share responsibility for ensuring that the manuscript complies with the journal’s ethical requirements.
18. Editorial Assessment
The journal may assess the adequacy of patient-consent information during editorial assessment and peer review.
Editors may request clarification, additional information, or changes to the manuscript where necessary to protect patient privacy.
A manuscript may be rejected if the journal determines that the ethical requirements for publication have not been adequately satisfied.
Patient-consent considerations may also be reviewed after publication if a credible concern is raised.
19. Post-Publication Concerns
If a patient, representative, author, institution, or other party raises a credible concern regarding consent, privacy, or identification after publication, the journal will assess the matter in accordance with its Corrections and Retractions and publication-ethics policies.
Depending on the circumstances, the journal may:
- request clarification from the authors;
- request documentation concerning consent;
- correct or anonymise information where appropriate;
- publish an editorial notice;
- issue an Expression of Concern;
- consider retraction or other appropriate action.
The journal’s objective is to protect the integrity of the scholarly record while respecting patient privacy.
20. Case Report Reviewer Guidelines
Reviewers evaluating case reports and case series should pay particular attention to:
- patient confidentiality;
- potentially identifying information;
- the adequacy of anonymisation;
- the presence of an appropriate consent statement;
- the appropriateness of clinical images;
- ethical approval or determination where applicable;
- the scientific and educational value of the case.
Reviewers must not request unnecessary patient-identifying information.
Reviewers must treat all patient-related information contained in manuscripts as confidential.
Concerns regarding patient consent or confidentiality should be reported confidentially to the handling editor rather than discussed directly with the patient or other external parties.
21. Contact
Questions concerning patient consent, case reports, clinical images, or patient privacy should be directed to the editorial office:
Authors should include the manuscript title and reference number, where applicable.
The journal may request additional information when necessary to assess compliance with this policy.
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