Smartphone Pics Aid in Diagnosing Kids' Skin Conditions


Parent-provided smartphone photos may be used for the accurate diagnosis of skin conditions in children, researchers reported.

Results from a randomized clinical trial of 40 patient-parent dyads found that overall concordance between photograph-based diagnosis and in-person diagnosis was 83% (95% CI 71-94%, κ=0.81), according to Daniel M. O'Connor, MD, of the Children's Hospital of Philadelphia (CHOP), and colleagues.

"Parents can reliably take high-quality photographs of their child's skin condition using smartphone cameras," the authors wrote in JAMA Dermatology. "This finding suggests that direct-to-patient pediatric teledermatology should not be limited by image quality, especially when appropriate photography instructions are provided."

O'Connor's group prospectively collected data on patient-parent dyads from a pediatric dermatology clinic at CHOP from March 1 to Sept. 30, 2016. Mean age of children was 7 years and just more than half (n=22) were female.

They randomized the patient-parent dyads 1:1 to an intervention group that received a simple, three-step instruction sheet on how to take photos with a smartphone or a control group that didn't receive instructions. Clinicians were blinded to whether parents had received photography instructions.

All parents were asked to use their personal smartphones to take photos of their child's skin condition in the clinic examination room and then upload the photos to the child's electronic health record via MyChart, an application linked to lab results, appointment information, current medications, and immunization history. If the child presented for more than one skin condition, the parent was instructed to choose the primary condition.

Cohen κ was used to quantify concordance between the two groups.

O'Connor's group reported that diagnostic concordance between photograph-based diagnosis and in-person diagnosis was 89% (95% CI 75%-97%, κ=0.88) among the 37 dyads with photographs that were of high enough quality to make a diagnosis. Diagnostic accuracy varied by diagnostic category with the highest concordance seen for birthmarks (100%), rashes (92%), and alopecia-related diagnoses (64%).

Parents who received photographic instructions shared more and higher quality images compared with those didn't (mean photograph quality rating scale score 8.9 versus 9.5, P=0.04), but no statistical difference in diagnostic concordance was observed (85% versus 80%).

Overall, parents rated their willingness to use a teledermatology as opposed to waiting for an in-person appointment as an 8 out of 10 (10=very willing), and 80% were willing to pay a median price of $20 (range $0-$160) to use the application.

The researchers concluded that the findings support a recent recommendation that telemedicine can be successfully performed by physicians who are part of a patient's medical home or health system.

"When a teledermatology diagnosis is uncertain or requires further management, there must be a system in place to facilitate appropriate follow-up with the patient's primary clinician, dermatologist, or other specialists. Without the opportunity for in-person follow-up, patients may not receive accurate diagnoses when teledermatology is insufficient, may be sent to emergency departments, or may not receive further care at all," they wrote

Study limitations included the small sample size, use of only one pediatric dermatologist to provide remote diagnoses, and limited generalizability.

Reuters Health: U.S. schools missing chances to protect kids from sun

By Lisa Rapaport

(Reuters Health) - Most U.S. schools could do a lot more to protect students from the sun, with efforts like keeping kids indoors at high noon or making time for sunscreen application, a recent study suggests. 

Researchers examined data on policies at 577 schools nationwide. Just 16 percent of schools asked parents to apply sunscreen before school, and even fewer supplied sunscreen to students or scheduled outdoor activities to avoid the peak intensity of the sun’s ultraviolet (UV) rays.

“In spite of both strong evidence that UV exposure can lead to skin cancer and multiple calls for improvements in school programs including policies to prevent skin cancer, our study found that most schools still lacked practices that could protect children and adolescents from sun exposure while at school,” said lead study author Sherry Everett Jones of the U.S. Centers for Disease Control and Prevention in Atlanta.

Students most at risk from the sun may get the least help with sun protection from schools, Jones added by email.

“High schools were less likely to adopt several practices even though high school students may be at particular risk for sun exposure because of their desire for a tan,” Jones said.

The researchers examined data from surveys on health policies and practices that were completed by school representatives in 2014.

Among other things, questions touched on use of sunscreen at home and in school, scheduling outdoor time, and rules for wearing hats or sunglasses.

Overall, 48 percent of respondents said teachers allowed time for students to put on sunscreen at school, researchers report in JAMA Dermatology.

But just 28 percent said teachers reminded students to apply sunscreen right before going outside and only 13 percent had sunscreen on hand for students to use.

Beyond sunscreen, about 30 percent of schools encouraged students to wear long sleeves or pants outside to limit sun exposure, while 33 percent recommended hats and 21 percent advised students to wear sunglasses outside.

High schools were less likely to encourage sun protection than schools serving younger students, the study also found.

Just 4 percent of high schools asked parents to have students apply sunscreen before school, for example, compared with 17 percent of middle schools and 21 percent of elementary schools.

Sun safety practices varied by region, the researchers found. Schools in southern states, for example, were more likely to always or almost always schedule outdoor activities to avoid times when the sun was at peak intensity.

The study wasn’t a randomized experiment designed to prove that certain school characteristics cause sun safety practices to be more or less common, the authors note.

Another limitation is the possibility that the individual completing the survey might not be aware of all school policies or practices related to sun safety, researchers also point out.

Still, the results suggest that more public education about sun safety is needed, Dr. Henry Lim of Henry Ford Hospital in Detroit, Michigan writes in an accompanying editorial.

“Importantly, students can apply the sun safety habits they develop in school to other outdoor activities with their families and friends, throughout their lives,” said Dr. Mary Tripp of the University of Texas MD Anderson Cancer Center in Houston.

Parents can encourage schools to allow children to carry and apply sunscreen if current policies prohibit this or don’t make it a priority, Tripp, who wasn’t involved in the study, added by email. Parents can also make sure kids have hats, sunglasses and clothing that covers their arms and legs when they’re going to be outdoors.

“UV rays from the sun can damage unprotected skin, even after a brief exposure period such as 15 minutes,” Tripp said. “Students may also receive significant UV exposure during outdoor field trips and after-school activities.”

SOURCE: JAMA Dermatology, online March 3, 2017.