by Lauren Williams, PharmD student
Today’s use of mobile technology heavily influences and expands the way we interact and communicate with others. Not only has it provided us new ways to interact with our friends and family, but it is currently expanding patient access to medical advice and opening the way for innovative interactions with medical professionals. According to the Research2Guidance mobile research specialists, “500 million smartphone users worldwide will be using a health care application by 2015”.1 With the great ease of access to medical information and advice today, self-care is very prevalent. Are patients more likely to skip out on pharmacist consultation and doctor appointments to rely on their easily attained materials and video calls with physicians?
The article, “Study finds dermatology apps useful, but they can’t replace a doctor’s visit”, published by MedCity News, discussed a study on the use and availability of dermatology applications.2 After searching the Apple, Android, BlackBerry, Nokia and Windows app stores for products related to dermatology, researchers reported finding over 200 apps that offered its users medical material, treatment help and guidance to self-diagnosis concerning dermatology. Specifically, they give the users what they need to identify and treat dermatological concerns without having to consult with their pharmacist or visit their doctor. Although these apps increase user accessibility to medical information and advice, researchers are highly concerned that people may be getting the wrong information since only a few of these apps were clearly created by medical professionals. Their other concern was that some patients would value and grow confident in their app facts, and forego actually visiting the dermatologist. Despite these concerns, mobile apps are used not only by patients, but also by health care professionals. Because trusted professionals use these, the FDA has stepped into the picture and declared that they will regulate and set apart medical apps intended for the use of doctors.
I agree with the article that medical apps may be great sources to increase medical knowledge; however, we must approach them with skepticism, recommending users to cross-reference the information and consult with their pharmacist or doctor before beginning treatment options based on apps. I am comfortable with patients self-educating and treating on more minor topics, such as sunburn, but I believe that they should present to their doctor with any more serious concerns, such as a lumpy mole that has changed color, which could indicate melanoma. Common conditions, such as eczema, dry skin, contact dermatitis, insect bites, stings, head lice and sunburn can all be immediately self-treated or referred with consultation from a pharmacist. Pharmacists are easily assessable and qualified to identify self-care exclusion criteria with these dermatological conditions. Some conditions may easily be detected simply by viewing, but others may not be so simple since a biopsy, or other procedure, may be necessary for better understanding. Mobile apps cannot perform biopsies; they cannot give thorough follow-up examinations. Teledermatology, one of the most promising apps, has similar limitations.3 Although the patient and dermatologist evaluate via a live video call, the patient’s interpretation of symptoms may be different from the dermatologist’s interpretation. These mobile apps can only be used so much in self-treatment and self-examination, but they can continue to educate the user.
A study published by University of Florence’s Department of Dermatology asked the question “Is skin self-examination for cutaneous melanoma detection still adequate?” Researchers found that although the largest percentage, 36%, of found melanomas were results of a regular annual skin examination by a dermatologist, the next largest group, 33%, of found melanomas were by self-detection. Because these percentages were so close, one may think that self-detection is just as good as a visit to the dermatologist. This study also concluded “self-detection was associated with a greater probability of having a thick melanoma and, therefore, a poor prognosis (odds ratio 1.56)”. 4 Therefore, I believe that although self-detection with the aid of medical applications is beneficial, it is more beneficial and important to pay a visit to the dermatologist or seek immediate recommendation from a pharmacist.
Using mobile devices for self-care is different from the standard of care, but it is progressive, innovating, and exciting to try. We must always be cautious with any type of progression simply because it often takes us on an untraveled road to new outcomes, studies, and experiments. I believe that the utilization of mobile applications is a part of the natural movement of converging health practices with modern technology. Mobile technology is heavily integrated in our society, so it makes sense that patient care and medical advice is accessible by it.
The point of these applications is to increase medical knowledge, not to replace face-to-face interaction with a medical professional. Do you believe that the designers of these apps are aiming to increase medical knowledge, or to replace face-to-face interaction with a physician or pharmacist? How do you think patients will use them?
 Mikalajunaite, E. 500m people will be using healthcare mobile applications in 2015. http://www.research2guidance.com/500m-people-will-be-using-healthcare-mobile-applications-in-2015/. Published November 10, 2010. Accessed November 12, 2013.
 Pittman, G. Study finds dermatology apps useful, but they can’t replace a doctor’s visit. http://medcitynews.com/2013/09/study-finds-dermatology-apps-useful-cant-replace-doctors-visit/. Published September 26, 2013. Accessed October 23, 2013.
 Brewer A, Endly DC, Henley J, et al. Mobile Applications in Dermatology. JAMA Dermatol. 2013;149(11):1300-1304. doi:10.1001/jamadermatol.2013.5517.
 De Giorgi, V., Grazzini, M., Rossari, S., Gori, A., Papi, F., Scarfi, F.,Gandini, S. Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study. Dermatology. 2012;225(1), 31-6. doi: 10.1159/000339774.