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Figure.
Standardized Form for Data Collection
Standardized Form for Data Collection
Table.  
Characteristics of 162 Study Patients According to Additional Information Provided by Smartphone Photographsa
Characteristics of 162 Study Patients According to Additional Information Provided by Smartphone Photographsa
1.
Fox  S, Duggan  M. Mobile Health 2012. Pew Research Center. http://www.pewinternet.org/2012/11/08/mobile-health-2012/. Published November 8, 2012. Accessed March 15, 2015.
2.
Mosa  AS, Yoo  I, Sheets  L.  A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012;12:67. doi:10.1186/1472-6947-12-67.PubMedArticle
3.
Tollefson  MM, Frieden  IJ.  Early growth of infantile hemangiomas: what parents’ photographs tell us. Pediatrics. 2012;130(2):e314-e320. doi:10.1542/peds.2011-3683.PubMedArticle
Research Letter
January 2016

Visualization of Patients’ Skin Lesions on Their SmartphonesA New Step During Dermatology Visits

Thomas Hubiche, MD1; Laure Valério, MD2; Franck Boralevi, MD, PhD3; et al Emmanuel Mahe, MD4; Christine Bodemer Skandalis, MD, PhD5; Alice Phan, MD, PhD6; Pascal del Giudice, MD1; for the Research Group of the French Society of Pediatric Dermatology (Groupe de Recherche de la Société Française de Dermatologie Pédiatrique)
Author Affiliations
  • 1Infectious and Dermatology Unit, Centre Hospitalier Intercommunal (CHI) Fréjus Saint Raphaël, Fréjus, France
  • 2Department of Statistics, CHI Fréjus Saint Raphaël, Fréjus, France
  • 3Pediatric Dermatology Unit, Centre Hospitalier Universitaire Bordeaux, Université Victor Ségalen, Bordeaux, France
  • 4Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France
  • 5Department of Dermatology, Hôpital Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris, Université Paris Descartes, Paris, France
  • 6Pediatric Dermatology Unit, Claude Bernard–Lyon 1 University and Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, France
JAMA Dermatol. 2016;152(1):95-97. doi:10.1001/jamadermatol.2015.2977

Smartphones are a new potential source of medical data.1,2 During dermatology appointments, we have observed an increasing number of patients presenting a picture of their skin lesions during the visit. The utility of the information provided by pictures on smartphones has not been evaluated. To assess their utility, we determined the proportion of patients whose smartphone photographs provided information relevant to their diagnosis.

Methods

We conducted a cross-sectional study from March 14 to May 31, 2014, in 21 departments of pediatric and general dermatology. The final follow-up occurred on June 4, 2014. We included all outpatients presenting a picture of their skin lesion during the visit. Data on the patients’ characteristics, the quality of the photographs, the diagnosis, and the information provided by the photograph were collected through a standardized survey completed by the senior treating dermatologists (Figure); identification of the patients was not possible in accord with the French rules of ethics. The main outcome variable was the value of the information gained by viewing the picture as assessed by the study dermatologists: namely, whether the information strengthened, modified, or confirmed the diagnosis. Data analysis was performed from June 4 to June 14, 2014. We used the χ2 test, the Fisher exact test, or the t test as appropriate. All tests were 2 sided with a level of significance of .05. The institutional and ethical review board of Nice University stated that approval was not required for this study; oral consent was obtained from all patients after they received oral information about the study. We used SPSS software (version 16.0; SPSS Inc) for the statistical analysis.

Results

We included 162 patients (male to female ratio, 0.4), of whom 109 (67.3%) were younger than 10 years. Sixty different diagnoses were recorded, with the most frequent being urticaria (22 patients [13.6%]), eczema (11 patients [6.8%]), psoriasis (11 patients [6.8%]), viral exanthema (10 patients [6.2%]), atopic dermatitis (9 patients [5.6%]), and infantile hemangioma (8 patients [4.9%]). One hundred fifty-three patients (94.4%) reported obtaining the photograph for medical reasons. The median period from the date of the photograph to the visit was 20.0 days (interquartile range, 7.0-52.0 days). The quality of the photograph was considered good in 74 patients (45.7%), average in 70 (43.2%), and poor in 18 (11.1%). When compared with the photograph, skin lesions had changed by the time of the visit in 141 patients (87.0%). Physicians considered that the photographs provided additional information for 124 patients (76.5%). This information strengthened the diagnosis in 83 patients (66.9%), modified it in 19 (15.3%), and confirmed it in 22 (17.7%). Treatment was changed in 44 of these 124 patients (35.5%) because of the information provided by the photographs.

In 48 patients without a skin lesion at the time of the visit (29.6%), the photographs strengthened the diagnosis in 21 patients (43.8%), modified it in 10 (20.8%), and confirmed it in 12 (25.0%), respectively. The absence of a skin lesion at the visit was the only factor associated with a significant reported gain of information (P = .01; Table). Among the 114 patients with skin lesions at the visit, the main information provided by the photographs consisted of evolution of the skin lesions in 25 patients (21.9%), visualization of a complication or a flare-up of a chronic disease in 18 (15.8%), and the initial appearance of the skin lesion in 30 (26.3%).

Discussion

This study shows that photographs obtained by patients on their smartphones are a new source of data for dermatologic diagnosis. Patients’ photographs provide information on the evolution of skin lesions, the onset of a flare-up or a complication of a chronic skin disease, and the initial aspect of the skin disease, which was especially important in the one-third of patients who came to the visit without a skin lesion. Recently, the relevance of patients’ pictures was demonstrated in infantile hemangioma growth during the first weeks of life.3

No differences in the dermatologic condition recorded in patients’ photographs were observed. The lack of statistical difference could be owing to the small number of patients for each disease group. However, this lack of significance suggests that the information provided by photographs may be useful for most skin diseases.

Patients seem to have adopted this new tool easily for health purposes. Patients’ smartphone photographs provided relevant information for the diagnosis and treatment decision, which usually is based only on the medical history reported by patients. Because the photographs influence diagnosis and treatment, the photographs should be saved in the patients’ medical records. With such digital tools, patients can assist physicians and become more involved in their health care.

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Article Information

Corresponding Author: Thomas Hubiche, MD, Infectious and Dermatology Unit, Centre Hospitalier Intercommunal Fréjus Saint Raphaël, 240 av de Saint Lambert, 83600 Fréjus, France (hubiche-t@chi-frejus-saint-raphel.fr).

Accepted for Publication: July 11, 2015.

Published Online: October 7, 2015. doi:10.1001/jamadermatol.2015.2977.

Author Contributions: Drs Hubiche and Valério had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Hubiche, Valério, del Giudice.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Hubiche, Valério, del Giudice.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Hubiche, Valério.

Administrative, technical, or material support: Hubiche, Mahe, Phan.

Study supervision: Hubiche, Boralevi, Bodemer Skandalis, del Giudice.

Conflict of Interest Disclosures: None reported.

Group Information: The following members of the Research Group of the French Society of Pediatric Dermatology (Groupe de Recherche de la Société Française de Dermatologie Pédiatrique) participated in the acquisition of the data: Juliette Mazereeuw-Hautier, MD, PhD, Reference Center for Rare Skin Diseases, Dermatology Department, Université Paul Sabatier, Toulouse, France; Juliette Miquel, MD, Pediatric Department, Centre Hospitalier Universitaire (CHU) Sud Réunion, Saint Pierre, France; Annabelle Maruani, MD, PhD, Dermatology Department, Université François-Rabelais Tours, Centre Hospitalier Régional Universitaire (CHRU) Tours, Tours, France; Anne-Claire Bursztein-Ben Mahmoud, MD, PhD, Dermatology Department, CHU Nancy, Nancy, France; Christine Chiaverini, MD, PhD, Department of Dermatology, Nice University Hospital, Nice, France; Eve Puzenat, MD, Dermatology Department, CHU Jean Minjoz, Besançon, France; Claire Abascq-Thomas, MD, Dermatology Department, CHU Brest, Brest, France; Edouard Begon, MD, Dermatology Unit, Hôpital René-Dubos, Pontoise, France; Patrice Plantin, MD, Dermatology Department, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France; Benoit Catteau, MD, Dermatology Department, Hôpital Claude Huriez, CHRU Lille, Lille, France; Didier Bessis, MD, Dermatology Department, Hôpital Saint-Éloi, CHRU de Montpellier, Montpellier, France; Maryam Piram, MD, MPH, Department of Pediatric Rheumatology, University of Paris Sud, Hôpital de Bicetre, Assistance Publique–Hôpitaux de Paris, Paris, France; Audrey Lasek, MD, Dermatology Department, Hôpital Saint Vincent de Paul, Groupement des Hôpitaux de l’Institut Catholique de Lille, Lille, France; Stéphanie Mallet, MD, Dermatology Department, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France; Hélène Aubert, MD, Dermatology Department, Nantes University Hospital, Nantes, France; and Sophie Ronceray, MD, Dermatology Department, CHU Rennes, Rennes.

References
1.
Fox  S, Duggan  M. Mobile Health 2012. Pew Research Center. http://www.pewinternet.org/2012/11/08/mobile-health-2012/. Published November 8, 2012. Accessed March 15, 2015.
2.
Mosa  AS, Yoo  I, Sheets  L.  A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012;12:67. doi:10.1186/1472-6947-12-67.PubMedArticle
3.
Tollefson  MM, Frieden  IJ.  Early growth of infantile hemangiomas: what parents’ photographs tell us. Pediatrics. 2012;130(2):e314-e320. doi:10.1542/peds.2011-3683.PubMedArticle
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