Apps make delivery of medicine more personal

Miami Beach, Fla. - Smartphone applications (apps) have become very popular in mainstream medicine and dermatology. Though the use of apps can and should not replace clinical judgment or physician interaction, smartphone apps can be practical and helpful in facilitating dermatologic care on both sides of the physician-patient spectrum.

A recent study headed by Ann Chang Brewer, M.D., department of dermatology, Mayo Clinic, Scottsdale, Ariz., looked at a variety of smartphone apps currently available in the field of dermatology, evaluating the app software options offered for Apple, Android, BlackBerry and Nokia/Windows platforms (Brewer AC, Endly DC, Henley J, et al. JAMA Dermatol. Epub 2013 Sept 25).

“Many physicians today are using smartphone apps on a daily basis, including apps for dermatology. These apps can be very useful for quick references for physicians in a busy practice as well as for patients who are interested in their own health surveillance,” says Dr. Brewer, who spoke at the annual meeting of the American Academy of Dermatology.

Investigators performed an online search in the respective app stores using the terms dermatology, melanoma, skin cancer, psoriasis, rosacea and acne. The apps were categorized by their description and the most popular skin-related apps were ranked according to the number of online reviews.

Analyzing apps

Dr. Brewer and her fellow researchers identified a total of 229 unique apps for dermatology, of which 117 are intended for patients, 94 for health care providers, and 18 for both. The categories of apps included general dermatology reference (61), self-surveillance/diagnosis (41), disease guide (39), education aid (20), sunscreen/UV recommendation (19), calculator tool (12), teledermatology (8), journal (6), conference (6), photo storage or sharing (5), dermoscopy (2), pathology (2), and other (8). The most reviewed apps included Ultraviolet-UV Index (355 reviews), VisualDx (306), SPF (128), iSore (61) and SpotMole (50).

There were 209 unique apps, with 17 apps existing on more than one operating system. More than half of the apps were offered for free (117) and paid apps (112) ranged from 99 cents to $139.99 (median, $2.99).

Physicians can benefit from a range of apps including those that list a quick and comprehensive review of commonly used drugs, their dosages and side effects. Apps that offer medical calculation tools help physicians quickly and accurately calculate laser fluence levels, and critical patient parameters and disease severity indices such as psoriasis area and severity index (PASI) and vitiligo area scoring index (VASI).

“Some smartphone apps can quickly help remind you how to calculate things like the body surface area when formulating treatment strategies of topical medications or skin areas of involvement when looking at different diseases,” says Girish S. Munavalli, M.D., Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, N.C., and department of dermatology, Wake Forest University, Winston Salem, N.C. “They can be useful in the clinical decision making process as well as help to keep track of a patient’s progress or manage their therapeutics.”

Apps that address sunscreen and UV-exposure are growing in popularity, Dr. Brewer says, particularly for patients. Some apps include timers that remind the patient when to reapply sunscreen depending on the skin type, and provide sun-exposure information in terms of the current UV-index using the smartphone’s global positioning system, she says.

“Sometimes the hardest part in dermatology is coming up with the differential diagnosis of a given condition or disease. Apps which aid with this, either by providing lists or access to a bank of images could quickly help in uncertain cases,” Dr. Munavalli says.

Personalizing medicine

Although it is not very widely used, teledermatology could play an expanding role in the management of patients. According to Dr. Brewer, teledermatology is a useful way of providing access to dermatologists, particularly in rural or underserved areas where patients often do not have easy access to subspecialists.

“The use of mobile apps has made the access to relevant important information a lot easier, and I think it will make the delivery of medicine a little bit more personal as well. They also give patients and their providers a tool to help keep track of their patients’ health,” Dr. Brewer says.

Triage apps, such as those that help clinicians assess a patient’s moles, can also be a practical way for patients to monitor their own lesions. Mole-tracking mobile apps allow the patient to essentially store photos of moles (that they have taken themselves) as they change over time, which can be sent to the dermatologist for a quick evaluation.

“Patients who just need a spot checked can wait sometimes months for their appointment with their dermatologist. One day, I envision apps that could facilitate teledermatology and save both physician and patient valuable time. Certainly, I wouldn’t base any critical decisions strictly on the information gathered from these apps, as a personal consultation is always the preferred approach. However, they can be useful in certain scenarios,” Dr. Munavalli says.

Nevertheless, the reliability regarding the information contained in smartphone apps remains a gray area, Dr. Brewer says, as none of them are scrutinized or approved by the Food and Drug Administration, and one cannot always be sure of the source. Out of the 229 apps studied, Dr. Brewer says most were not developed by medical professionals or did not have clear authorship stated in the developers. There are a few, however, that were developed by academic institutions such as the Mayo Clinic or the University of Michigan, she says.

The apps containing drugs dosing and prescription reference information have been around for a long time and are frequently updated as new information comes along, and, according to Dr. Munavalli, these are usually designed and put together by trusted sources.

“I think the use of smartphone apps is a growing trend and better quality apps are coming out every year. As I tell my patients, (it is) ‘buyer beware’ in terms of what you are getting and how accurate the app is,” Dr. Munavalli says.

Disclosures: Dr. Munavalli reports no relevant financial interests.