Teledermatological Monitoring of Psoriasis Patients on Biologic Therapy

Abstract

Patients with psoriasis who are being treated with biologics require intensive monitoring. However, the monitoring tool teledermatology is not commonly used. We investigated the applicability of a mobile phone based teledermatological system for monitoring psoriasis patients on biologic therapy. Nineteen patients were given mobile phones with built-in cameras, in order to transmit health status data and images (mobile visits) weekly for a 6-month period. Face-to-face visits were carried out at weeks 0, 4, 12 and 24. Image quality, the Psoriasis Area and Severity Index (PASI), the handling of adverse events, and patients' feedback questionnaires were evaluated. Ninety-five percent of the images were of sufficient quality to enable accurate assessment of the PASI. The distance between the interpolated face-to-face PASIs and the corresponding mobile visit PASIs was 0.46 ± 2.15 (median ± interquartile range). All 155 adverse events were handled correctly by the system. This teledermatological system represents a reliable tool for management of psoriasis patients who are on systemic treatment.

Educational and motivational support service: a pilot study for mobile-phone-based interventions in patients with psoriasis

“…To this aim teledermatology could be considered a useful tool, even though it is not commonly used in the management of patients with psoriasis. Recently, some authors have proposed teledermatology as a home‐monitoring device for patients with psoriasis, developing a continuous monitoring system and collaborative model of care, simplifying the patient–physician interaction and increasing compliance 10–12 . In the present study we have shown that mobile phones, through TM interventions, contributed to improving adherence to treatment, clinical outcomes and quality of life as well as patient–physician communication.…”

Patient-assisted teledermatology practice: What is it? When, where, and how it is applied?

“…Further, severity measurements in psoriasis obtained by a clinical dermatologist and teledermatologists displayed strong correlation. [33] Thus, mobile teledermatology is a feasible method for monitoring disease severity in patients with psoriasis and teledermatology assessments were in accordance with PASI assessments. Recently, an online PASI training video as a user friendly model has been developed for measuring the severity of psoriasis [48] measure.…”

“…Many studies have confirmed that feasibility and diagnostic accuracy for teledermatology practice have been excellent. [33][34][35][36][37][38][39] In addition, chronic dermatologic conditions that are characterized by periodic flares, waxing and waning e.g. psoriasis, acne, leprosy or conditions like leg ulcers and vitiligo can be provided the frequent follow-up care that is required by patient-assisted teledermatology practice.…”

“…The process records periodic changes in area, perimeter and percentage of regression of the ulcer and serves as an objective assessment to deliver follow-up care. [44,45] Computerized assessments of psoriasis area severity index (PASI), [3,33,41] atopic dermatitis, [46] hand eczema, [47] and leg ulcers make it possible to deliver teledermatology follow up care using a standard scoring system. Patient-assisted teledermatology practice delivered effective follow up care in high-need patients with psoriasis after etanercept treatment.…”

A reliability study using Network Oriented Research Assistant (NORA ® ) examining the use of digital photographs in the assessment of psoriasis

“…For the DCT model to be successful, investigators must be able to perform clinician‐reported outcome measures reliably via telemedicine. The utility of telemedicine in the evaluation and management of psoriasis in clinical care settings has been documented . Additionally, previous studies have demonstrated that telemedicine‐based clinical assessments using standardized digital photographs are comparable with in‐person assessments in several dermatological conditions …”