%0 Journal Article
%@ 2561-326X
%I JMIR Publications
%V 5
%N 5
%P e24766
%T Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation
%A Ali,Zarqa
%A Joergensen,Kristina Melbardis
%A Andersen,Anders Daniel
%A Chiriac,Andrei
%A Bjerre-Christensen,Theis
%A Manole,Ionela
%A Dutei,Ana-Maria
%A Deaconescu,Irina
%A Suru,Alina
%A Serban,Adina
%A Isberg,Ari Pall
%A Dahiya,Priyanka
%A Thomsen,Simon Francis
%A Zibert,John Robert
%+ Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark, 45 60122596, zarqa_ali@hotmail.com
%K atopic dermatitis
%K eczema
%K remote assessment
%K photo
%K photographs
%K EASI
%K SCORAD
%K severity
%K assessment
%K agreement
%D 2021
%7 25.5.2021
%9 Original Paper
%J JMIR Form Res
%G English
%X 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. 
%M 34032580
%R 10.2196/24766
%U https://formative.jmir.org/2021/5/e24766
%U https://doi.org/10.2196/24766
%U http://www.ncbi.nlm.nih.gov/pubmed/34032580