Dermatologist evaluation of photographs of acne taken by patients using a telemedicine and mobile data collection tool produced similar Investigator’s Global Assessment (IGA) findings and lesion counts, compared with traditional in-person examinations, in a pilot study sponsored by the tool’s manufacturer.
, the Network Oriented Research Assistant (NORA), Hannah Singer, a medical student at Columbia University, New York, and her coinvestigators concluded. The study was published online Dec. 20 in JAMA Dermatology.
To determine the effectiveness of the tool, investigators compared in-person evaluations of acne patients with digital evaluations in 60 patients in one dermatology practice. The “intraclass correlation coefficient (ICC)” was used to compare the in-person exam and the digital photo assessments of the IGA score and acne lesion counts; ICC scores ranged from 0 to 1, with 0 indicating no agreement and 1 indicating perfect agreement.
Study participants, who were aged 12-54 years (mean age 23 years) were trained to use NORA on an iPhone 6 and were instructed to take five photographs of different facial regions: the forehead, chin, right cheek, left cheek, and the whole face. The evaluation of patient-photographed acne and the in-person evaluation were separated by 1 week.
The ICC for IGA scores was 0.75, and the ICC for total lesion count was 0.81. Inflammatory lesion count and noninflammatory lesion count both had an ICC score of 0.72, while cyst count had the highest ICC score of 0.82. The ICC results demonstrated “strong agreement” between assessment scores from in-person examinations and the patient-taken digital photos, the authors wrote.
The study had several limitations, including the small patient sample size and limited geographic area, and although there was a 1- to 2-week gap between the digital and in-person evaluations, there may have been recall bias because the same physicians conducted both evaluations, they added.
Future studies should collect data from multiple centers, with a longer follow-up, and cost analysis and patient-reported measures, the researchers wrote.
The NORA technology platform is currently being evaluated in studies of patients with diagnoses including atopic dermatitis, pemphigus vulgaris, and liver disease. “Use of the NORA platform in telemedicine-based clinical trials will allow for increased access, a broader diversity of patients, and improved adherence among participants in trials for acne vulgaris and other therapeutic areas,” the researchers noted.
The study was sponsored by Science 37, a mobile technology and clinical trial company that developed NORA, the software used in this study. Other than Ms. Singer, who had no disclosures, the remaining 10 authors are Science 37 employees and have stock options in the company.
SOURCE: M. Singer, JAMA Dermatol 2017 Dec 20; doi:10.1001/jamadermatol.2017.5141.