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.
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