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The transient nature of skin-related symptoms of urticaria鈥攚heals, angioedema, or both鈥攎ake a clinical diagnosis difficult. But help in the form of a common technology may be on the way.

According to the investigators of a newly published survey in the journal Dermatology, photographs of skin lesions taken by patients are quickly becoming widely used in the evaluation and diagnosis of dermatological conditions. These photos, the authors suggest, could reduce the need for in-person visits and primary care referrals to a dermatologist.¹

Bringing the smartphone into clinic

The current observational study evaluated the quality and diagnostic usefulness of smartphone photos taken by 118 patients with chronic urticaria before an in-person visit to an outpatient clinic, characterized in this study as a Urticaria Center of Reference and Excellence (UCARE).¹ Four primary care physicians with significant experience in urticaria participated in the assessment. They were surveyed about the quality and utility of up to 3 patient-selected photos taken with a smartphone of urticarial skin lesions before a first-time, in-person UCARE clinic visit.

Criteria used to evaluate the quality of the photos included focus, resolution, lighting, and blurriness. Examples of photos labeled as either 鈥済ood鈥� or 鈥渂ad鈥� were provided to the surveyed physicians to standardize their decision-making criteria. 

Smartphone photos of lesions were significantly more common from patients with recurrent angioedema compared to those without angioedema (P=.04), even after adjusting for age, sex, disease duration, and other variables. Further, among those who took photos, a significantly longer disease duration was observed in the patients with recurrent angioedema compared to those without angioedema (69 months versus 32 months; P=.03). Nevertheless, the investigators reported that 90% of the photographed cases were of wheals, while just 8% were of angioedema. While 15 of 56 patients (27%) with recurrent angioedema had photos of their condition, 97 of 102 (95%) had taken photographs of their wheals. 

Lots of photos, but are they helpful?

According to the surveyed physicians, 72% of the photos had the skin lesion in focus, 64% had good resolution, and 48% had good lighting. Very few of the images were blurred, poorly lit, or lacked resolution. Overall, physicians thought the photos were useful for clinical evaluation and diagnosis in 86% of cases. In fact, at least 1 photograph from each patient was considered helpful for diagnostic and clinical evaluation in 97% of cases. 

鈥淧atients with chronic urticaria often take smartphone photographs of skin lesions on their own initiative, completely unprompted and without instructions,鈥� says the study鈥檚 lead investigator Zarqa Ali, MD, PhD, of Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark. 鈥淭hese photographs are generally of good quality and can be used clinically.鈥�

Dr. Ali says that 鈥渟tandardized guidelines around how a photograph should be taken could increase the quality and help to increase the use of photographs in the clinic.鈥� Moreover, she says, 鈥渢his makes it possible to diagnose urticaria and monitor the disease remotely based on photographs.鈥�

Study limitations included a lack of a standardized system for evaluating the smartphone photos. This can lead to inconsistent evaluation from physician to physician. However, the investigators do not believe that 鈥渦tility should be standardized, as it always should depend on the attending physicians whether they find the photograph useful.鈥�¹

Published: April 10, 2024