RESUMEN
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.
RESUMEN
PURPOSE: To identify factors perceived as most important regarding choice and continued use of moisturizers for adult patients with AD. METHOD AND MATERIALS: Online survey among members of the Atopic eczema society Denmark. RESULTS: Among 75 participants, the most commonly tried (89.3%) and preferred (16%) product was Locobase® (Leo Pharma, Denmark). A-derma® (Pierre Fabre, France) had most continued use. The main reason for choosing preferred product was 'Best effect, in my experience' (36%). 'High lipid content' and 'GP/dermatologist suggested product' were considered as important main factors. 'Consistency', 'absorbs fast', and 'nice to wear' were secondary reasons for preferred product. A majority, 81.3% of respondents claimed to be very aware of perfumes and additives, 52% were very aware of allergy certification bodies on the product. CONCLUSION: AD patients state that the most important factor when choosing a product is out of personal experience followed by high lipid content and recommended by GP/dermatologist. As secondary reasons 'consistency', 'absorbs fast', and 'nice to wear' were important. Respondents generally use more than one product and are aware of additives. Evidence-based guidance on the choice of emollients is needed. The role of the professionals supporting the patient in navigating this market of emollients is therefore particularly important.