“eHealth devices are becoming increasingly popular among dermatologists and their patients,” according to Astrid Schmieder, MD, PhD. “There are many smartphone applications available for managing chronic skin diseases such as psoriasis or atopic dermatitis. However, compared to FDA- or EU-approved medical devices, these apps lack scientifically validated benefits. In addition, numerous apps have been developed without the input of patients and doctors. Therefore, our study team decided to develop and evaluate a technically simple smartphone app, but one that conforms to the needs of clinicians and patients.”

For a paper published in JMIR mHealth and uHealth, Dr. Schmieder and colleagues combined an educational program with their smartphone app to analyze the effects on the long-term disease management of psoriasis on patients’ mental health in a prospective clinical trial. Patients with psoriasis, Dr. Schmieder notes, often report stigmatization, depression, and anxiety as major impairments.

Significant Improvement in Depressive Symptoms

The researchers conducted a 60-week randomized intervention study comparing patients receiving the educational program, five exams during the study period, and access to the smartphone app with patients participating in regular in-person visits only. “With the app, patients were able to photo-document their psoriasis and answer weekly health questionnaires regarding their quality of life, mood, activity, pain, and pruritus,” Dr. Schmieder explains. “Furthermore, patients could contact their dermatologist via a chat feature within the app.” The researchers used scientifically validated scores, such as the Hospital Anxiety and Depression Scale–Anxiety/Depression (HADS-A/D), and the Dermatology Life Quality Index (DLQI).

“After 6 months, we found that there was a significant improvement in depressive symptoms in the intervention group,” Dr. Schmieder notes. “However, this effect decreased after 60 weeks. Interestingly, patients using the app less than once every 5 weeks had a significantly stronger reduction in depressive and anxiety symptoms than those who used it more frequently. This improvement in mental health lasted throughout the entire study period.”

The significant reduction in the HADS-D at weeks 12 and 24 persisted until week 60 in patients with an app usage frequency of less than 20% compared to controls (Figure 1).

Furthermore, patients with an app usage frequency of less than 20% experienced a significant decrease in the HADS-A at weeks 36 and 60. In patients using the app more than 20% of the time, no significant reduction of the HADS-D/A was observed throughout the 60-week study period (Figure 2).

Too Frequent Use of App Could Be Counteractive

Based on their findings, the researchers suggest it would be beneficial for dermatologists to offer a web-based education program for patients with psoriasis on a regular basis. “In addition, the inclusion of a hybrid monitoring app that allows patients direct contact with the treating physician may give patients with psoriasis peace of mind as long as they do not use the app too frequently,” Dr. Schmieder says. “We hypothesize that patients with psoriasis, especially during a time when new treatments such as biologics and small molecule inhibitors can lead to lesion-free skin, do not want to be constantly reminded about their disease. Therefore, too frequent use could counteract the positive effect and an optimal frequency of app use should be determined.”

Dr. Schmieder and colleagues concur that there is a great need for research in this area, especially at a time when artificial intelligence could help to detect psoriasis flare-ups in patients at an early stage. “Most importantly, patients and physicians need to be involved in the programming process of eHealth devices,” she says. “Apps, as a hybrid solution, should enable a good connection between physicians and their patients, as this strengthens their relationship and thus could promote treatment adherence, early detection of treatment side effects, and reduction of disease relapses.”

The study team points out that the use of such eHealth devices presents a few pitfalls that need to be addressed on a nationwide basis, such as data privacy, physician liability, and quality standards and reliability of the medical app. “Presently, we believe it’s important to conduct well-designed, large-scale clinical trials with eHealth devices to determine the pros and cons in order to arrive at good evidence-based data,” Dr. Schmieder says.