Parents Submit Smartphone Photos Offering Accurate Teledermatology Diagnoses

A recent study assessed whether smartphone photographs of pediatric dermatology conditions taken by parents are of adequate quality to permit accurate diagnosis.

Researchers from Children’s Hospital of Philadelphia (CHOP) assessed concordance between diagnoses made by pediatric dermatologists based on in-person exams and parental photographs among 40 patient-parent dyads from March 1—Sept. 30, 2016.

Findings concluded parents can reliably take high-quality photographs of children’s skin conditions to send to a dermatologist for a diagnosis, suggesting that direct-to-patient dermatology can accurately provide pediatric care.

“Our study shows that, for the majority of cases, parents can take photographs of sufficient quality to allow for accurate teledermatology diagnoses in pediatric skin conditions,” senior author of the study, Patrick McMahon, MD, pediatric dermatologist, CHOP, said in a statement. “This is important because pediatric dermatologists are in short supply, with fewer than 300 board-certified physicians serving the nations 75 million children.”

Researchers provided a 3-step photography instruction sheet to 20 families on how to best photograph with a smartphone, while the other 20 families were blinded and received no instructions.

Parents were asked to use personal smartphones to take photos of the 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 more than 1 skin condition, the parent was instructed to choose the primary condition.

The family population sample represented an expansive range of ages, ethnicities and socioeconomic backgrounds. Among the dyads, there were 22 female children and 18 male children, with a mean age of 6.96 years. A majority of the parents used iPhones, while the rest used an Android.

Researchers found that of the 87 images submitted, 83% of the time photograph-based diagnoses matched the in-person diagnosis, and only 3 images did not permit a conclusive diagnosis due to poor photographic quality.

Of those photos from submitted by 37 families that were considered high-quality enough to make an accurate diagnosis, there was an 89% agreement in diagnosis.

Study results are consistent with previous literature evaluating teledermatology in adults.

Diagnostic accuracy varied by category with the highest concordance seen for birthmarks (100%), rashes (92%) and alopecia-related diagnoses (64%).

While teledermatology had a high diagnostic accuracy, the effect of photography instructions was not statistically significant, as an 85% concordance was detected in the group that received instructions and 80% in the group that did not receive instructions.

On a scale of 1—10 (10=very willing), parents rated their willingness as an 8 out of 10 to use teledermatology as opposed to waiting for an in-person appointment.

Approximately 80% of participants were willing to pay a median price or $20 to use the application.

In cases with diagnostic disagreement, follow-up was suggested.

Study limitations included a small sample size, use of only 1 pediatric dermatologist and limited generalizability.

The study, “Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial,” was published in JAMA Dermatology.