Using Network Oriented Research Assistant (NORA) Technology to Compare Digital Photographic With In-Person Assessment of Acne Vulgaris

Abstract

undergone exponential growth in the past 2 decades. Many technological innovations are becoming available without necessarily undergoing validation studies for specific dermatologic applications.OBJECTIVE To determine whether patient-taken photographs of acne using Network Oriented Research Assistant (NORA) result in similar lesion counts and Investigator's Global Assessment (IGA) findings compared with in-person examination findings. DESIGN, SETTING, AND PARTICIPANTSThis pilot reliability study enrolled consecutive patients with acne vulgaris from a single general dermatology practice in Los Angeles, California, who were able to use NORA on an iPhone 6 to take self-photographs. Patients were enrolled from January 1 through March 31, 2016. Each individual underwent in-person and digital evaluation of his or her acne by the same dermatologist. A period of at least 1 week separated the in-person and digital assessments of acne.INTERVENTIONS All participants were trained on how to use NORA on the iPhone 6 and take photographs of their face with the rear-facing camera. MAIN OUTCOMES AND MEASURESReliability of patient-taken photographs with NORA for acne evaluation compared with in-person examination findings. Acne assessment measures included lesion count (total, inflammatory, noninflammatory, and cystic) and IGA for acne severity.RESULTS A total of 69 patients (37 male [54%] and 32 female [46%]; mean [SD] age, 22.7 [7.7] years) enrolled in the study. The intraclass correlation coefficients of in-person and photograph-based acne evaluations indicated strong agreement. The intraclass correlation coefficient for total lesion count was 0.81; for the IGA, 0.75. Inflammatory lesion count, noninflammatory lesion count, and cyst count had intraclass correlation coefficients of 0.72, 0.72, and 0.82, respectively.CONCLUSIONS AND RELEVANCE This study found agreement between acne evaluations performed in person and from self-photographs with NORA. As a reliable telehealth technology for acne, NORA can be used as a teledermatology platform for dermatology research and can increase access to dermatologic care.

Assessing effectiveness in acne clinical trials: steps towards a core outcome measure set

“…For example, a recent comparison was made between acne global severity and lesion counts made by a physician in the office and made later by the same physician on photographs submitted via smartphone technology. 29 The intraclass coefficients of variation for the global assessment and individual lesion counts ranged from 0Á72 to 0Á82, which are similar to those reported for in-person counting and automated technologies. 21,26,27,29 This technology has been used in an acne clinical trial.…”

“…29 The intraclass coefficients of variation for the global assessment and individual lesion counts ranged from 0Á72 to 0Á82, which are similar to those reported for in-person counting and automated technologies. 21,26,27,29 This technology has been used in an acne clinical trial. 30 Next steps towards agreeing how to measure the core outcomes The next steps for the ACORN group in order of priority and in accordance with the HOME roadmap are to determine which signs and symptoms of acne should be measured, who should measure them and whether a measure of physician-or patient-assessed acne global severity should be included in the COS. A priority of the COS development process is the inclusion of outcomes that are relevant to patients, and PROMs are certain to be included in the core set of outcome measures.…”

Virtual Clinical Trials: Perspectives in Dermatology

“…Several VCT have been conducted and are ongoing in dermatology [24]. In 2017 AOBiome's randomized, phase 2b hybrid study evaluated a topical probiotic spray containing beneficial bacteria for mild-to-moderate acne [25]. The 12-week clinical trial recruited volunteers through social media and internet advertisements.…”

Teledermatology: current indications and considerations for future use

“…In addition, patients who received the telemedicine modality reported high satisfaction with service throughout the study [21]. Further evidence of store-and-forward telemedicine as an effective diagnostic tool for acne was published in 2018 [22]. Researchers compared standardized scoring metrics of acne severity provided by dermatologists that used photos delivered remotely from patients (who were guided by an assistive phone application) to those provided by a dermatologist after an in-person examination.…”