JDERM JMIR Dermatol JMIR Dermatology 2562-0959 JMIR Publications Toronto, Canada v6i1e47142 37594779 10.2196/47142 Research Letter Research Letter A Review of Software and Mobile Apps to Support the Clinical Diagnosis of Hansen Disease Dellavalle Robert Khordastan Firoozeh do Vale de Souza Isabella Costa Wilbert Dener Lemos MSc 1 2 https://orcid.org/0000-0002-7848-3482 de Oliveira Alan Maicon MSc, PhD 1 3
School of Pharmaceutical Sciences of Ribeirão Preto University of São Paulo Avenida do Café, s/n Vila Monte Alegre Ribeirão Preto, 14040-900 Brazil 55 16 3315 41817 alanoliveira@usp.br
https://orcid.org/0000-0002-3880-0287 Aguilar Guilherme José MSc, PhD 1 4 https://orcid.org/0000-0001-7236-2682 dos Santos Luana Michelly Aparecida Costa MSc, PhD 1 2 https://orcid.org/0000-0002-9939-274X dos Santos Luiz Ricardo Albano MSc, PhD 1 2 https://orcid.org/0000-0003-3034-1407 Donato Dantony de Castro Barros BSc 1 2 https://orcid.org/0000-0003-0397-7485 Foresto Felipe BSc 1 5 https://orcid.org/0009-0001-9081-4344 Frade Marco Andrey Cipriani MSc, PhD 2 https://orcid.org/0000-0003-2700-5971 Intersection LTDA Ribeirão Preto Brazil Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil School of Pharmaceutical Sciences of Ribeirão Preto University of São Paulo Ribeirão Preto Brazil Faculty of Philosophy, Sciences and Letters at Ribeirão Preto University of São Paulo Ribeirão Preto Brazil School of Economics, Business Administration and Accounting at Ribeirão Preto University of São Paulo Ribeirão Preto Brazil Corresponding Author: Alan Maicon de Oliveira alanoliveira@usp.br 2023 18 8 2023 6 e47142 9 3 2023 27 6 2023 6 7 2023 4 8 2023 ©Wilbert Dener Lemos Costa, Alan Maicon de Oliveira, Guilherme José Aguilar, Luana Michelly Aparecida Costa dos Santos, Luiz Ricardo Albano dos Santos, Dantony de Castro Barros Donato, Felipe Foresto, Marco Andrey Cipriani Frade. Originally published in JMIR Dermatology (http://derma.jmir.org), 18.08.2023. 2023

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This scoping review indicates a lack of scientific articles that specifically explore software and mobile applications designed to assist in the clinical diagnosis of leprosy, and our findings have provided insights into the available tools, their usage methods, and the benefits offered by health technologies.

 software mobile apps leprosy medical informatics Mycobacterium leprae clinical diagnosis Hansen disease mHealth mobile health mobile app Hansen dermatology scoping review skin diagnosis diagnostic Introduction

Hansen disease, or leprosy, is a chronic infectious disease caused by Mycobacterium leprae (M leprae). It mainly affects the skin’s superficial nerves and peripheral nerve trunks and can also impact the eyes and internal organs. If untreated, leprosy becomes contagious and can lead to physical disabilities. Additionally, it imposes significant social, emotional, and economic burdens [1].

The diagnosis of leprosy is based on assessing clinical presentation, including signs and symptoms. Leprosy cases are classified into two types for treatment: paucibacillary and multibacillary. Paucibacillary cases have 1 to 5 skin lesions and no bacilli in a bacilloscopy, whereas multibacillary cases have more than 5 skin lesions and/or the presence of bacilli in a bacilloscopy [1,2].

The World Health Organization (WHO) encourages early leprosy detection and supports the development of mobile health (mHealth) innovations for this purpose [2]. The use of computational tools in health care is expanding, providing health care professionals with enhanced agility and precision and improving the overall patient-physician experience [3,4].

This study aimed to identify the scientific literature on software and mobile apps designed to assist in the clinical diagnosis of leprosy and describe their main characteristics.

 Methods

We used the methodology developed by Arksey and O’Malley [5], following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. This included defining the eligibility criteria, devising a search strategy (Multimedia Appendix 1), selecting sources of evidence (PubMed and Embase), collecting data, and synthesizing results. All steps of the methodology were documented in a previously registered protocol [6].

 Results Selection of Studies

In step 1, a database search yielded 416 publications. After removing duplicates (n=81), step 2 involved an eligibility assessment based on title and abstract analysis. Step 3 included reading the full texts of the selected studies. Excluded articles were mainly protocols or conference abstracts. Ultimately, 3 publications were analyzed in this scoping review [7-9] (Figure 1).

Flowchart outlining the study selection and inclusion process.

 Characteristics of the Included Studies

The studies included in this review were published between 2018 and 2021 (Table 1). Two were initiatives conducted in Brazil [8,9], and one was from the not-for-profit organization Netherlands Leprosy Relief [7]. One of the studies analyzed [8] used a computerized method to assess the Mitsuda test. This test involves assessing the skin’s immune response and can aid in identifying individuals at risk of developing illness upon exposure to M leprae. SkinApp, as described by Mieras et al [7], was still in development and was undergoing updates based on applicability tests, despite having already undergone several development stages. De Souza et al [9] proposed a cross-platform app, comprising a vast database to assist in the screening and differentiation of leprosy types. The Brazilian database Information System for Notifiable Diseases was used to develop this app.

Aims and outcomes of the included studies.

Reference and year of publication Study aims Software/app Methodology used by the software/app Positive aspects Negative aspects
Mieras et al [7], 2018

To describe the development process of a mobile phone app that supports peripheral health workers in diagnosing and treating skin diseases in resource-poor settings

SkinApp

Algorithm to support the process of diagnosis

Descriptions of skin diseases, supporting photos, as well as treatment and referral advice

Training tool

Easy to use

Clear treatment advice (ie, narrative and illustrative content was considered clear)

Clinical validation of a patient with a skin disease

Available in English and Portuguese (Android, Google Play Store; iOS, Apple App Store)

Free of charge

Can be used offline

Needs to improve intelligibility; a glossary explaining dermatological terminology could help

A reporting option was also mentioned as a possible improvement

Not all treatment options may be available

The studies that were carried out did not address the performance of SkinApp as a diagnostic tool
Alecrim et al [8], 2019

To compare the results between the standardized reading and the total area of the Mitsuda test obtained by a computerized method that was structured by associating the digital dermatoscopy, the Dermatology Web system, and the Image Tool 3.0 software

Dermatology Web + Image Tool 3.0

Dermatology Web: photographic documentation of dermatological treatments and photo storage

Image Tool 3.0: view, edit, analyze, process, save, and print images

Dermatology Web: can be used on any mobile platform or computer connected to the internet; ensured security and confidentiality of data stored in medical records

Image Tool 3.0: area calculation; image calibrated in millimeters; delineation of the contours of the reaction; results in a total area in square millimeters

Dermatology Web + Image Tool 3.0: improves reading precision; allows for the computerization of records

Dermatology Web + Image Tool 3.0: functions are not centralized in a single software
De Souza et al [9], 2021

To develop a cross-platform app for leprosy screening based on artificial intelligence

App for leprosy screening

Supervised learning (random forest)

Improves coverage and scalability to the health service regarding the choice of an appropriate treatment for leprosy

Accessibility via mobile or desktop option

Speed, scalability, and broadcasting to fight leprosy without compromising accuracy

High accuracy (92.38%), sensitivity (93.97%), and specificity (87.09%)

Not available without an internet connection

Quality of the data used by the app depends on many factors (quality of the items requested by the forms and their correct interpretation, correct clinical assessment of the patient, proper filling out of the forms)
Discussion Principal Findings

This review indicates a scarcity of software and mobile apps specifically designed to assist in the clinical diagnosis of leprosy, with their development documented in scientific articles. Despite their promising attributes for clinical practice, it is advisable to test these technologies using controlled trials to determine their actual impact.

The Global Leprosy Strategy 2021-2030 [2], initiated by the WHO, emphasized the importance of developing eHealth innovations to improve the diagnosis and care of patients with leprosy. Others have also supported the potential of digital technologies in health care [3,4]. As a result, our study aligns with the WHO initiative and offers valuable insights for enhancing strategies in this domain.

In 2020, a total of 127,396 new cases of leprosy were reported worldwide. As a result, Brazil ranks second globally in terms of leprosy cases, with India having the highest number of cases [2]. These data may help explain why the majority of the software and apps described in our study was developed in Brazil.

It is important to note that not all health technology tools have their development documented in scientific studies [10], and it is possible that relevant evidence might not have been indexed in the databases we used for our search. Consequently, some initiatives [10] did not meet our inclusion criteria. Nevertheless, our study underscores the importance of documenting technological advancements in scientific studies and encourages their implementation through controlled trials.

 Limitations

Our study involved searching for relevant studies using 2 databases. We did not use additional health databases or multidisciplinary databases, which may have influenced our results. Furthermore, we specifically focused on publications related to the clinical diagnosis of leprosy, excluding studies pertaining to laboratory diagnosis and disease follow-up. As a result, the scope of our findings was limited.

Search strategy for databases.

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

 Abbreviations mHealth

mobile health

 PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews

 WHO

World Health Organization

We would like to acknowledge the funding agency Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [CAPES]) for providing financial support for this study (88882.328412/2019-01). Additionally, we would like to express our gratitude to the team at Intersection LTDA for inspiring us to conduct this study.

WDLC, GJA, LMACdS, LRAdS, DdCBD, FF, and AMdO contributed to the writing of this manuscript as well as data acquisition, analysis, and interpretation. AMdO and MACF contributed to the study concept and design, writing of the manuscript, and critical review of the manuscript for important intellectual content. All authors read and approved the final manuscript.

None declared.

 Regional Office for South-East Asia Guidelines for the diagnosis, treatment and prevention of leprosy World Health Organization 2018 2023-08-14 https://apps.who.int/iris/handle/10665/274127 Control of Neglected Tropical Diseases, SEARO Regional Office for the South East Asia (RGO) Towards zero leprosy: global leprosy (Hansen's disease) strategy 2021-2030 World Health Organization 2021 04 15 2023-08-14 https://www.who.int/publications/i/item/9789290228509 Marcolino MS Oliveira JAQ D'Agostino M Ribeiro AL Alkmim MBM Novillo-Ortiz D The impact of mHealth interventions: systematic review of systematic reviews JMIR Mhealth Uhealth 2018 01 17 6 1 e23 10.2196/mhealth.8873 29343463 v6i1e23 PMC5792697 Mao Y Lin W Wen J Chen G Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis BMJ Open Diabetes Res Care 2020 09 8 1 10.1136/bmjdrc-2020-001225 32988849 8/1/e001225 PMC7523197 Arksey H O'Malley L Scoping studies: towards a methodological framework Int J Soc Res Methodol 2005 02 8 1 19 32 10.1080/1364557032000119616 Costa W de OA Aguilar G Santos L Santos L Donato D Software and mobile apps to support the clinical diagnosis of Hansen's disease: a scoping review OSF Registries 2023 03 27 2023-08-14 https://doi.org/10.17605/OSF.IO/JFMS2 Mieras L Taal A Post E Ndeve A van Hees C The development of a mobile application to support peripheral health workers to diagnose and treat people with skin diseases in resource-poor settings Trop Med Infect Dis 2018 09 15 3 3 102 10.3390/tropicalmed3030102 30274498 tropicalmed3030102 PMC6160956 Alecrim ESD Chaves AT Pôrto Luiz Alberto Bomjardim Grossi MADF Lyon S Rocha MODC Reading of the Mitsuda test: comparison between diameter and total area by means of a computerized method Rev Inst Med Trop Sao Paulo 2019 02 14 61 e5 10.1590/S1678-9946201961005 30785559 S0036-46652019005000200 PMC6376929 De Souza MLM Lopes GA Branco AC Fairley JK Fraga LADO Leprosy screening based on artificial intelligence: development of a cross-platform app JMIR Mhealth Uhealth 2021 04 07 9 4 e23718 10.2196/23718 33825685 v9i4e23718 PMC8060869 Neglected tropical diseases of the skin: WHO launches mobile application to facilitate diagnosis World Health Organization 2020 07 16 2023-03-02 https://tinyurl.com/297hamn5