Cohen DK, Nardone B, Cotton M, West DP, Kundu RV. Use of a Mobile Application to Characterize a Remote and Global Population of Acne Patients and to Disseminate Peer-Reviewed Acne-Related Health Education. JAMA Dermatol. 2014;150(6):660-662. doi:10.1001/jamadermatol.2013.9524
Acne is estimated to affect 85% of all people at some point in their lives and has been associated with psychosocial morbidity. Education is an integral component to the treatment of acne, and it is recognized that many patients receive educational information about acne from sources other than health care professionals.1 Mobile applications (apps) have seen explosive growth since the introduction of smartphones, with annual download projections for health apps reaching as many as 142 million by 2016.2 The field of mobile health apps, still in its early stages, has been scrutinized for lack of comprehensive regulation and rigorous expert oversight. Despite the challenging start, well-designed apps remain promising tools for collection of data from large populations and for dissemination of health information,3 particularly the predominantly adolescent and young adult acne population that increasingly uses smartphones.4
Based on observations of patients inquiring about dietary influence on acne, but lacking an accessible and credible mobile reference, we created a mobile app that systematically reviews current medical evidence on the topic. English language publications available online prior to March 15, 2013, were identified via PubMed literature search using search terms diet and acne and diet and nutrition. The peer-reviewed literature was systemically formulated into a mobile app, which was made available in English for download free of charge via the iTunes app store (Apple Inc) under the title “diet & acne.” After the app was made available, the institutional review board (IRB) at Northwestern University approved it along with a link within the app that takes users aged 18 years or older to a voluntary, anonymous survey. Survey items were developed to assess patient characteristics and patient interaction with the app. Data regarding app downloads and survey responses were collected via iTunes and Web Survey Creator, respectively, for a 5-month period starting April 1, 2013, and ending August 31, 2013.
The diet & acne app was newly downloaded to 5507 devices in 98 different countries. Updates to the IRB-approved version of the app from the previously downloaded version totaled 2233. A total of 110 people who downloaded the app completed the survey. Self-reported characteristics of survey respondents are summarized in Table 1. Forty-one respondents (37.3%) reported that they had not seen a physician for their acne, and 96 (87.3%) reported acne duration greater than 1 year. A total of 105 respondents (96.3%) found the app by searching the iTunes app store with varied terms, the most common being acne (85.7%). Search terms and the estimated time users spent viewing the app prior to survey completion are detailed in Table 2.
Globally, people are turning to mobile apps as a source of information regarding health issues such as acne. There remains concern surrounding the safety of select health apps, some of which are relevant to the field of dermatology (eg, an app designed to evaluate pigmented lesions).5 Despite the concern, a well-constructed app based on peer-reviewed literature, and following newly proposed guidelines,6 may be an effective method to disseminate medical information to a large and diverse population. Embedding a survey link within an app is a simple and inexpensive way to gather additional data about app users beyond that provided by app stores such as iTunes. As demonstrated by the survey linked within the diet & acne app, dermatologists can consider mobile apps as an avenue to collect data for research purposes, particularly if a remote and/or global population is desired. It should be noted that this particular study design introduces bias by targeting a population of English-speaking iPhone users that self-select for study inclusion. Making available equivalent apps on additional smartphone platforms and in additional languages can reduce bias in future studies.
We foresee further research to investigate the impact of an acne-related educational app on knowledge and behaviors of patients with acne, as well as outcomes including acne severity and psychosocial morbidity. In general, the dermatology community should strive to establish a greater presence in well-researched and systemically reviewed mobile health apps.
Accepted for Publication: November 11, 2013.
Corresponding Author: Roopal V. Kundu, MD, Northwestern University Feinberg School of Medicine, 676 North St Clair St, Ste 1600, Chicago, IL 60611 (firstname.lastname@example.org).
Published Online: March 12, 2014. doi:10.1001/jamadermatol.2013.9524.
Author Contributions: Dr Cohen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Cohen, Cotton, West, Kundu.
Acquisition of data: Cohen.
Analysis and interpretation of data: Cohen, Nardone, West, Kundu.
Drafting of the manuscript: Cohen.
Critical revision of the manuscript for important intellectual content: Cohen, Nardone, Cotton, West, Kundu.
Statistical analysis: Cohen.
Administrative, technical, and material support: Nardone, West, Kundu.
Study supervision: Kundu.
Conflict of Interest Disclosures: None reported.
Additional Contributions: Pranathi Lingam, MD, Northwestern University Feinberg School of Medicine, provided administrative support and assistance in editing the manuscript.