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JMIR Dermatology
Technologies, devices, apps, and informatics applications for patient education in dermatology, including preventative interventions, and clinical care for dermatological populations
JMIR Dermatology (JDerm) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2018: 4.945), focusing on technologies, medical devices, apps, engineering, informatics applications for patient education in dermatology, including preventative interventions (e.g. skin cancer prevention) and clinical care for dermatological populations.
As an open access journal, we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
During a limited period of time, there are no fees to publish in this journal. Articles are carefully copyedited and XML-tagged, ready for submission in PubMed Central.
Skin cancer is a growing public health problem. Early and accurate detection is important, since prognosis and cost of treatment are highly dependent on cancer stage at detection. However, access to specialized health care professionals is not always straightforward, and population screening programs are unlikely to become implemented. Furthermore, there is a wide margin for improving the efficiency of skin cancer diagnostics. Specifically, the diagnostic accuracy of general practitioners and family physicians in differentiating benign and malignant skin tumors is relatively low. Both access to care and diagnostic accuracy fuel interest in developing smartphone apps equipped with algorithms for image analyses of suspicious lesions to detect skin cancer. Based on a recent review, seven smartphone apps claim to perform image analysis for skin cancer detection, but as of October 2018, only three seemed to be active. These apps have been criticized in the past due to their lack of diagnostic accuracy. Here, we review the development of the SkinVision smartphone app, which has more than 900,000 users worldwide. The latest version of the SkinVision app (October 2018) has a 95% sensitivity (78% specificity) for detection of skin cancer. The current accuracy of the algorithm may warrant the use of this app as an aid by lay users or general practitioners. Nonetheless, for mobile health apps to become broadly accepted, further research is needed on their health impact on the health system and the user population. Ultimately, mobile health apps could become a powerful tool to reduce health care costs related to skin cancer management and minimize the morbidity of skin cancer in the population.
Background: Teledermatology (TD) is one of the applications of electronic health and telemedicine that involves the use of information and communication technologies (ICTs) for the care of skin diseases. Previous studies on TD indicate that it seems to be effective in diagnosing early malignant pathologies, such as melanoma, and in reducing waiting lists by prioritizing urgent cases of pathology. Despite these advantages, the implementation of TD is still low in many areas. Objective: Most previous studies on TD have focused on analyzing the results of TD use. However, to completely understand TD, it is necessary to consider the determinants of its use. This study analyzes the factors that motivate medical professionals to use TD in their clinical practice. Methods: A survey that targeted a total population of 743 medical professionals from health care institutions in Andalusia (Spain) was used. The study sample comprised 223 doctors (87 dermatologists and 136 primary care physicians). Results: Using an extended Technology Acceptance Model and microdata for the 223 physicians, a cluster analysis (of the user’s ICT profile) and binary logistic regression analysis were conducted. This analysis demonstrated the presence of 3 clusters in the sample with respect to the use of technology (cluster 1: advanced use of ICTs; cluster 2: moderate use of ICTs; and cluster 3: scarce use of ICTs). The analysis performed confirmed the model’s goodness of fit, which allowed 69% of the variable’s variance to be explained. The outcomes revealed that the factors that were most important when implementing a TD system were the user’s ICT profile (P=.048), system efficiency (P<.001), and preference of the subjects involved (P=.008; P<.005). The quality of the assistance, the difficulties arising from the use of technology (information security and confidentiality), or interests of the administration were not decisive factors for the implementation of TD. Subsequently, we performed a logistic regression analysis, separating primary care doctors from dermatologists. For the former, the determining factors were the ICT profile and the efficiency of the system, whereas, among dermatologists, only the preference of each individual was considered to be a determining factor. Conclusions: The use of TD should be accompanied by a comprehensive program of validation and evaluation. These results show that determinants of TD implementation differ depending on the subjects involved. Therefore, it is essential to perform studies before the implementation of a TD system to identify and influence the aforementioned predictive factors.
Background: Skin cancer is the most common type of cancer in the United States. Rates of melanoma, a malignant form of skin cancer, are on the rise and are high among people under 30 years of age. Objective: This study aims to explore factors related to sun protection and tanning behavior and examine the influence of social media use and health information-seeking behaviors (HISB) on sun protection actions among a group of college students. Methods: In this cross-sectional study, students (N=258) at a large public university completed a survey that included questions on sun safety and tanning attitudes and behaviors, as well as HISB. A sun protection behavior score was created on the basis of behaviors related to seeking shade, using sunscreen, tanning booth and bed use, and the number of lifetime blistering sunburns. Multivariate logistic regression analyses were performed to assess associations between high and low sun protection behavior and sun safety and tanning attitudes and HISB. Results: The majority of participants were females (164/258, 63.8%), 31.0% (80/258) were white, and the mean age was 20.3 (SD 4.1) years. Females (odds ratio [OR] 0.42, 95% CI 0.22-0.81) and believers that suntan improves appearance (OR 0.25, 95% CI 0.10-0.66) were less likely to have “high” sun protection behaviors. Conclusions: The cultural belief that having a suntan improves appearance, especially among female college students, results in low sun protection behaviors. Interventions can be developed to improve skin cancer-related HISB among college students with the aim of developing better cognizance of skin cancer and sun protection behaviors.
Background: Teledermatology provides timely access to consultative dermatology services while reducing the need for travel among patients in rural and underserviced areas. However, knowledge about the potential benefits of such a service in urban areas is limited. Objective: This study aimed to determine the impact of a geographically unrestricted, intrainstitutional, secure, email teledermatology service for dermatology. Methods: We employed a mixed-methods approach using chart review, surveys, and semistructured interviews from the Canada Health Infoway Benefits Evaluation Framework. Patient charts were reviewed for demographics, clinical characteristics, and outcomes. Electronic and paper surveys were sent to patients and providers to quantify aspects of the service, such as satisfaction and usability, on a Likert scale. Semistructured interviews of referring providers and a convenience sample of academic consultant dermatologists who were considering teledermatology for their practice were conducted. Interviews were transcribed and analyzed using manual coding and thematic analysis by both the primary author and a second independent reviewer. All results were concurrently triangulated in an overarching analysis. Results: A total of 76 consultations were reviewed over a period of 18 months, of which 84% were completely managed without an in-person visit. Only 6% of rashes required a subsequent in-person visit to a dermatologist for management, compared to 41% of lesions. In addition, 28% (21/76) of patients responded to the survey. Patients “strongly agreed” to use the service again, were satisfied with the management of their skin issue, and thought the service saved them time. In general, providers who answered the electronic survey “strongly agreed” that the service demonstrated quality, timeliness, and an educational benefit, but increased their administrative time. A total of 9 interviews of 5 referring providers and 4 dermatologists were completed. Triangulation of all study components supported the hypothesis that teledermatology benefits providers, patients, and the health care system. Conclusions: Intrainstitutional teledermatology has high satisfaction among patients and providers and saves patients time, even when there are no geographic or systemic barriers to access. This service may be most effective when targeted at rashes rather than lesions. Additional research on the cost-effectiveness and educational benefits of this service is warranted.
Background: Despite their elevated melanoma risk, young-onset melanoma patients and their families exhibit low rates of engagement in skin cancer surveillance and sun protection behaviors. Interventions that improve skin cancer surveillance (total cutaneous exam [TCE] and skin self-exam [SSE]) and prevention (sun protection) practices among young-onset patients and their family members would likely have an impact on skin cancer morbidity and mortality; however, such interventions are lacking. Objective: The objective of our study was to examine the development, feasibility, and preliminary impact of a family-focused Facebook intervention to increase engagement in TCE, SSE, and sun protection among young-onset melanoma patients and their families. Methods: In this study, 48 young-onset melanoma patients and their 40 family members completed measures of knowledge; beliefs; and TCE, SSE, and sun protection intentions before and 1 month after participating in 1 of 5 separate “secret” (ie, private) Facebook groups. The intervention content consisted of daily postings about skin cancer, skin cancer risk factors, TCE, SSE, and sun protection. Results: Patient and family member participation rates differed by recruitment setting, with acceptance rates ranging from 24.6% to 39.0% among families recruited from a cancer center setting and from 12.7% to 61.5% among families recruited from a state registry. Among the 5 consecutive groups conducted, engagement, as measured by comments and likes in response to postings, increased across the groups. In addition, participants positively evaluated the intervention content and approach. Preliminary analyses indicated increases in TCE, SSE, and sun protection intentions. Conclusions: Our family-focused Facebook intervention showed promise as a potentially feasible and efficacious method to increase sun protection and skin cancer surveillance among individuals at increased risk for melanoma.
Background: The overall distribution of all skin and wound problems experienced by residents in skilled nursing facilities, with respect to the location on the body, is poorly understood. Previous studies focused largely on one disease type, rather than all possible skin lesions. Hence, the relative distribution of skin and wound problems as mapped on the body has not previously been reported. In addition, existing data come mainly from clinical studies and voluntarily reported statistics; unbiased real-world evidence is lacking. Objective: The aim of this study was to understand the type and location of skin and wound lesions found in skilled nursing facilities and to map these on the body. Methods: Data from 23,453 wounds were used to generate heat maps to identify the most common areas of skin and wound lesions, as well as the most common wound types at different body locations. Results: The most common wound types were abrasion (8792/23,453, 37.49%), pressure ulcers (4089/23,453, 17.43%), surgical wounds (3107/23,453, 13.25%), skin tears (2206/23,453, 9.41%), and moisture-associated skin damage (959/23,453, 4.09%). The most common skin and wound locations were the coccyx (962/23,453, 4.10%), right (853/23,453, 3.64%) and left (841/23,453, 3.59%) forearms, and sacrum (818/23,453, 3.49%). Conclusions: Here, we present the body location hot spots of skin and wound lesions experienced by residents of skilled nursing facilities. In addition, the relative prevalence of these conditions is presented. We believe that identifying areas on the body prone to preventable wounds can help direct actions by care workers and improve the quality of care for skilled nursing residents. This study represents an example of how analysis of specialized electronic medical records can be used to generate insights to educate and inform facility managers where to focus their efforts to prevent these injuries from occurring, not only from retrospective database analysis but also in near real time.
Background: Social media is increasingly used as a source of health information and is useful for information exchange and patient support. Objective: The aim of this study is to describe the Facebook groups and pages that are available for melanoma patients. Methods: A systematic search of Facebook groups and pages was performed using the word “melanoma.” The first 50 pages found in the search, sorted by most relevant, were analyzed for several characteristics, namely page name, category, verification status, number of likes, number of followers, visitor posts per week, page posts per week, ability to donate, date of inception, and for-profit or nonprofit. The first 50 groups found in the search, sorted by most relevant, were analyzed for name, category, number of members, and privacy setting. Results: There were 669 pages and 568 groups related to melanoma found on Facebook. The first 50 pages had a combined total of 266,709 likes and 257,183 followers and, of these, 30% (15/50) were verified by Facebook. Within the analyzed Facebook pages, the average number of visitor posts per week was 0.48, the average number of posts by the page per week was 5.6, and the most common page categories were community and nonprofit. Of the 50 groups analyzed, 18 were public and 32 were private (closed). The total number of combined group members in all 50 groups was found to be 23,047 and 52% (26/50) of the groups were categorized as support. Conclusions: Melanoma pages and groups on Facebook reach a large portion of the population. To provide resources for the population of patients diagnosed with malignant melanoma and ensure that proper information is distributed, physicians and health care organizations may consider using Facebook as a platform to support and educate patients with melanoma.
Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8)
