Abstract
BackgroundDigital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground.ObjectiveWe aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation.MethodsDuring scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability.ResultsA total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively.ConclusionsIn terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low.
Highlights
Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote clinical trials are gaining ground.Clinical trials are a cornerstone of drug development and provide scientific evidence on safety and efficacy of a new pharmaceutical drug
In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a digital single-lens reflex camera (DSLR) camera
Of the 95 participants who were assessed by the investigator using the Scoring AD (SCORAD) in clinic, 50 (52%) were categorized as having mild atopic dermatitis (AD), 36 (38%) as having moderate AD, and 10 (10%) as having severe AD
Summary
Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote clinical trials are gaining ground. Clinical trials are a cornerstone of drug development and provide scientific evidence on safety and efficacy of a new pharmaceutical drug. Traditional clinical trials take a long time to complete and are expensive and inefficient in terms of high dropout rates [1]. Decentralized virtual clinical trials (VCTs) that incorporate remote outcome assessments may accelerate clinical trials, increase adherence, reduce dropout rates, and bring new treatments to the market faster [2]. Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground
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