Technology proves better than human eye in acne assessment


Dermatologist evaluations of patient acne photos submitted via smartphone compare favorably to in-person evaluations, a JAMA Dermatology study shows.

Dermatologist evaluations of patient acne photos submitted via smartphone compare favorably to in-person evaluations, a JAMA Dermatology study shows.

There was “strong or excellent agreement across the board on different acne assessment measures,” said Vishal A. Patel, M.D., of Science 37 Inc., and the study’s corresponding author. This study was conducted to test the Network Oriented Research Assistant (NORA) technology platform.

Dr. Patel’s company is in the process of developing and testing the technology, which he said will expand access to care. “We feel very comfortable and confident that digital photos are equivalent to in-person evaluations. I think we can evaluate the patient in the same manner, whether it’s with a photograph or in person,” he said.

This was a pilot study of 69 patients (37 male, 32 female, mean age, 22.7 years) who were enrolled in a single general dermatology practice in Los Angeles over three months.

Patients were trained to use the NORA platform using the iPhone 6 camera to take pictures of acne. They took five photographs, one each on the forehead, chin, right and left cheek, and entire face.

Digital and in-person evaluations for each patient were performed by the same dermatologist. The second evaluation was done at least one week after the first in order to minimize chances that the dermatologist would recall scores of the initial evaluation.

The intra-class correlation coefficient (ICC) was 0.81 for total lesion count, and 0.75 for Investigator’s Global Assessment of acne severity. Specific lesion counts also demonstrated agreement, with ICCs of 0.72, 0.72, and 0.82 for inflammatory lesions, noninflammatory lesions, and cysts, investigators reported.

These intra-rater ICCs were similar to ICCs reported in other studies, Dr. Patel said. In a recent eview of published acne severity measures, 33 percent of studies reporting inter-rater reliability had ICCs of 0.75 or greater, and 71 percent that reported intra-rater reliability had ICCs of 0.80 or greater.

Analysis was based on the last 60 consecutive individuals, as the first none participants were used for prototyping the photography module and workflow.

“With iPhones becoming smarter some of them are even better than the human eye,” Dr. Patel said.


Science 37, Inc., recently announced completion of a Phase 2b, randomized, placebo-controlled study for AOBiome that included screening of more than 8,000 individuals mild-to-moderate acne, of whom 372 were enrolled and participated “one hundred percent virtually” using the NORA platform.

The NORA platform is being evaluated for other dermatologic conditions, including pemphigus, vitiligo, and rosacea, Dr. Patel said, as well as other therapeutic areas including psychiatry, neurology, diabetes, liver disease, and cancer.



The study was supported by Science 37, Inc., developer of the NORA teledermatology platform. Dr. Patel reported stock options and employment with Science 37, Inc., and employment with Good Dermatology.


Singer HM, Almazan T, Craft N, et al. “Using Network Oriented Research Assistant (NORA) Technology to Compare Digital Photographic with in-Person Assessment of Acne Vulgaris,” JAMA Dermatology. December 2017. DOI:10.1001/jamadermatol.2017.5141.

Agnew T, Furber G, Leach M, Segal L. “A Comprehensive Critique and Review of Published Measures of Acne Severity.” Journal of Clinical Aesthetic Dermatology. 2016;9(7):40-52.


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