PMID- 34032580
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210629
IS  - 2561-326X (Electronic)
IS  - 2561-326X (Linking)
VI  - 5
IP  - 5
DP  - 2021 May 25
TI  - Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: 
      Proof-of-Concept and Reliability Evaluation.
PG  - e24766
LID - 10.2196/24766 [doi]
LID - e24766
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.
CI  - (c)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. Originally published in JMIR Formative 
      Research (https://formative.jmir.org), 25.05.2021.
FAU - Ali, Zarqa
AU  - Ali Z
AUID- ORCID: 0000-0003-2411-7177
AD  - Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, 
      Copenhagen, Denmark.
FAU - Joergensen, Kristina Melbardis
AU  - Joergensen KM
AUID- ORCID: 0000-0002-5411-4770
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Andersen, Anders Daniel
AU  - Andersen AD
AUID- ORCID: 0000-0002-4784-0010
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Chiriac, Andrei
AU  - Chiriac A
AUID- ORCID: 0000-0002-8514-7567
AD  - Omhu A/S, Copenhagen, Denmark.
FAU - Bjerre-Christensen, Theis
AU  - Bjerre-Christensen T
AUID- ORCID: 0000-0002-1613-2978
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Manole, Ionela
AU  - Manole I
AUID- ORCID: 0000-0002-3323-102X
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Dutei, Ana-Maria
AU  - Dutei AM
AUID- ORCID: 0000-0001-8797-2934
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Deaconescu, Irina
AU  - Deaconescu I
AUID- ORCID: 0000-0002-2298-0818
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Suru, Alina
AU  - Suru A
AUID- ORCID: 0000-0002-9747-9091
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Serban, Adina
AU  - Serban A
AUID- ORCID: 0000-0003-3656-9023
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Isberg, Ari Pall
AU  - Isberg AP
AUID- ORCID: 0000-0002-7957-6285
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Dahiya, Priyanka
AU  - Dahiya P
AUID- ORCID: 0000-0002-4484-5406
AD  - Studies&Me, Copenhagen, Denmark.
FAU - Thomsen, Simon Francis
AU  - Thomsen SF
AUID- ORCID: 0000-0002-4838-300X
AD  - Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, 
      Copenhagen, Denmark.
AD  - Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
FAU - Zibert, John Robert
AU  - Zibert JR
AUID- ORCID: 0000-0002-3220-8303
AD  - Studies&Me, Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
DEP - 20210525
PL  - Canada
TA  - JMIR Form Res
JT  - JMIR formative research
JID - 101726394
PMC - PMC8188317
OTO - NOTNLM
OT  - EASI
OT  - SCORAD
OT  - agreement
OT  - assessment
OT  - atopic dermatitis
OT  - eczema
OT  - photo
OT  - photographs
OT  - remote assessment
OT  - severity
COIS- Conflicts of Interest: ZA and SFT have no conflicts of interest. KMJ, ADA, AC, 
      TB-C, IM, A-MD, ID, A Suru, A Serban, API, PD, and JRZ are employed by 
      Studies&Me, which sponsored this study.
EDAT- 2021/05/26 06:00
MHDA- 2021/05/26 06:01
PMCR- 2021/05/25
CRDT- 2021/05/25 13:47
PHST- 2020/10/04 00:00 [received]
PHST- 2021/04/23 00:00 [accepted]
PHST- 2020/12/08 00:00 [revised]
PHST- 2021/05/25 13:47 [entrez]
PHST- 2021/05/26 06:00 [pubmed]
PHST- 2021/05/26 06:01 [medline]
PHST- 2021/05/25 00:00 [pmc-release]
AID - v5i5e24766 [pii]
AID - 10.2196/24766 [doi]
PST - epublish
SO  - JMIR Form Res. 2021 May 25;5(5):e24766. doi: 10.2196/24766.