TY - JOUR

T1 - Remote rating of atopic dermatitis severity using photo-based assessments

T2 - Proof-of-concept and reliability evaluation

AU - Ali, Zarqa

AU - Joergensen, Kristina Melbardis

AU - Andersen, Anders Daniel

AU - Chiriac, Andrei

AU - Bjerre-Christensen, Theis

AU - Manole, Ionela

AU - Dutei, Ana Maria

AU - Deaconescu, Irina

AU - Suru, Alina

AU - Serban, Adina

AU - Isberg, Ari Pall

AU - Dahiya, Priyanka

AU - Thomsen, Simon Francis

AU - Zibert, John Robert

N1 - Publisher Copyright: ©Zarqa Ali, Kristina Melbardis Joergensen, Anders Daniel Andersen, Andrei Chiriac, Theis Bjerre-Christensen, Ionela Manole, Ana-Maria Dutei, Irina Deaconescu, Alina Suru, Adina Serban, Ari Pall Isberg, Priyanka Dahiya, Simon Francis Thomsen, John Robert Zibert.

PY - 2021

Y1 - 2021

N2 - Background: 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. Objective: We 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. Methods: During 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. Results: A 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. Conclusions: 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 DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low.

AB - Background: 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. Objective: We 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. Methods: During 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. Results: A 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. Conclusions: 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 DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low.

KW - Agreement

KW - Assessment

KW - Atopic dermatitis

KW - EASI

KW - Eczema

KW - Photo

KW - Photographs

KW - Remote assessment

KW - SCORAD

KW - Severity

UR - http://www.scopus.com/inward/record.url?scp=85106924979&partnerID=8YFLogxK

U2 - 10.2196/24766

DO - 10.2196/24766

M3 - Journal article

C2 - 34032580

AN - SCOPUS:85106924979

VL - 5

JO - JMIR Formative Research

JF - JMIR Formative Research

SN - 2561-326X

IS - 5

M1 - e24766

ER -