Patient-taken iPhone photos transmitted and stored in the Network Oriented Research Assistant (NORA) teledermatology program may be as useful for acne evaluations as in-person consultations, a pilot study suggests.
“In-person and telemedicine acne lesion count and Investigator’s Global Assessment (IGA) scoring were strongly correlated,” said Dr. Vishal Patel of Science 37 in Los Angeles. “This study paves the way for performing more and more high-quality science and clinical trials using digital devices and telemedicine.”
At a single dermatology practice, Dr. Patel et al. enrolled 69 patients with acne (mean age 22.7, 54% male) capable of using the company’s NORA platform on an iPhone 6 to take self-photographs.
Nine participants were used to prototype the photography module and workflow, while 60 underwent an in-person acne evaluation followed by a digital evaluation by the same dermatologist at least one week later.
Intraclass correlation coefficients (ICCs) of in-person and photograph-based acne evaluations indicated “strong agreement,” the authors reported online in JAMA Dermatology. ICCs were 0.81 for total lesion count, 0.75 for IGA, 0.72 for inflammatory lesion count, 0.72 for noninflammatory lesion count, and 0.82 for cyst count.
Dermatologist Dr. Suzanne Friedler, a clinical instructor commented, “Not all information can be gleaned from a video or photograph. When I examine acne, I lightly touch the skin to feel for cysts that are below the surface of the skin and invisible to the naked eye.”
“Teledermatology is dependent on the resolution of the image and skill of the photographer. For some conditions, a constellation or pattern of findings help a physician arrive at the correct diagnosis,” she noted. “This can be difficult to appreciate through photos alone.”
“This study found consistent acne evaluations for both in person and photographic visits,” Dr. Friedler continued. “However, it was typically the same physician evaluating photographs only one to two weeks after seeing that patient in person. This may cause a recall bias.”
“Future studies with a larger patient population, a longer time duration and multi-center involvement would be needed to see if these results hold up,” she concluded.
Dr. Jack Resneck, from San Francisco School of Medicine reported, Telemedicine done right has the potential to increase access to quality care for patients, and physicians are quick to incorporate technologies when their benefits are proven. “Having physicians involved at the early stages of evolving digital health systems, as well as performing high quality studies to test those systems, are essential.”
He hopes that telehealth companies will increasingly focus on helping physicians offer coordinated follow-up care for chronic conditions where there are significant access limitations for patients. “Many companies are unfortunately now concentrating on quick prescriptions for common colds, urinary infections, acne, and pink-eye.”
“I also hope that more insurers will pay for patients to utilize telehealth follow-up with their existing health care teams who know them well and can see them in person when needed, rather than just covering stand-alone telehealth services where evidence shows that care is often fragmented,” Dr. Resneck said.