Accurate Remote Assessment of Psoriasis Possible From Patient Photographs, Questionnaire Responses, Study Finds

Patients with mild to moderate psoriasis can be accurately assessed using photographs and patient-reported body region (BR) scores, a new study suggests.

These findings, published in JAAD International, could pave the way for the expanded use of tele-dermatology.

The study investigators explained that the use of tele-dermatology is already expanding, and they noted that it can be useful not only to reduce the need for in-person consultations, but also to facilitate clinical trials. However, they said it is not yet clear whether assessments performed remotely have an adequate level of accuracy to be clinically meaningful.

In the new study, they decided to compare in-person assessments of psoriasis severity with assessments based on photos and patient reports. They recruited 32 people with psoriasis and sent them to a clinic to be evaluated independently by 2 physicians using the Psoriasis Area and Severity Index (PASI) and the Physician’s Global Assessment (PGA). On the same day, patients were asked to photograph representative lesions from 4 body regions: head/neck, upper limbs, trunk, and lower limbs. They were also asked questions about their sleep, itchiness, and the extent of their psoriasis. The patient photographs and questions were then evaluated independently by 5 board-certified dermatologists.

After the in-person and remote assessments, the investigators evaluated the scores to see the degree of agreement between the 2 assessment settings.

Based on the in-person clinical assessments, 6% of the participants had PASI scores indicating their skin was almost clear, 69% had mild psoriasis, and the remaining 25% had moderate psoriasis.

The level of agreement between the in-person and remote examinations was similar to the level of agreement between the 2 in-clinic assessments, the authors found.

“In our study, perfect agreement regarding BR score between the patients and the doctors was observed for 59%, and for 71% between the first and second doctor assessing the psoriasis severity in the clinic,” they noted. “Perfect or near-perfect agreement with deviation of max 1 score was 92% between the patients and doctor and 93% between the 2 clinical doctors.”

In about 1 of 4 cases, the scores based on patient assessment produced higher severity scores, the authors said. And in 1 of 5 cases, the patient-based severity scores were lower.

“With proper patient education, it might be possible to reach even higher agreement level between BR score evaluated by the patient and the doctor, making the severity assessment based on remote PASI more accurate,” they wrote.

They noted that the inter-rater reliability was high in general, but also that it was highest among the 5 physicians who rated patients based on the photographs and questionnaires. The investigators said that phenomenon may be because all of the raters were dermatologists or because they were assessing the same particular lesions chosen and photographed by patients.

The investigators noted limitations to their findings. For instance, they said in a real-world setting, the experience levels of the physicians assessing patients would vary more widely. In addition, they said the fact that patients knew they were participating in a trial might have caused them to be more careful to take high-quality photographs. They added that their study was limited to people with almost clear, mild, or moderate symptoms.

“Future studies should investigate the validation of photographic assessment in the entire range of psoriasis severity and across all skin types and ethnicities,” they wrote.

Reference

Ali Z, Zibert JR, Dahiya P, Johansen CB, et al. Mild to moderate severity of psoriasis may be assessed remotely based on photographs and self-reported extent of skin involvement, JAAD International. Published online February 12, 2023. doi:10.1016/j.jdin.2023.02.004