Digital vs In-Person Acne Evaluation: Is Teledermatology Reliable?

A binder labeled "acne" next to a tablet and stethoscope
A binder labeled “acne” next to a tablet and stethoscope
The small pilot study indicates that teledermatology can be a reliable clinical tool that may improve access to dermatologic care.

Consensus has been demonstrated between evaluations of acne vulgaris performed in person and from digital self-photographs using Network Oriented Research Assistant (NORA) technology, according to the results of a recent pilot reliability study published in JAMA Dermatology.

The investigators sought to evaluate whether the use of patient-taken photographs of acne using NORA is associated with similar lesion counts and Investigator’s Global Assessment (IGA) findings when compared with findings from in-person examinations.

Consecutive patients with acne vulgaris who were able to use NORA on an iPhone 6 to take self- photographs were enrolled in the study from January 1 through March 31, 2016.

All participants underwent both in-person and digital assessment of their acne by the same dermatologist. A period of between 1 and 2 weeks separated the in-person from the digital evaluations of acne. Measures of acne assessment included lesion count (total, inflammatory, noninflammatory, and cystic) and IGA scale for acne severity.

A total of 69 patients age 12 to 54 were enrolled in the study. Overall, 54% (37 of 69) of the patients were men; mean patient age was 22.7±7.7. Interclass correlation coefficients (ICCs) of in-person vs digital photographic assessments demonstrated strong agreement.

The ICC for total lesion count was 0.81 and the ICC for the IGA was 0.75. ICCs for inflammatory lesion counts, noninflammatory lesions counts, and cyst counts were 0.71, 0.72, and 0.82, respectively.

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Limitations of the study included its small size and the fact that the patient population was representative of a single geographic area. Future studies with multicenter participation might help to address these issues.

The investigators concluded that NORA can be used as a teledermatology platform for dermatology research and can help increase patient access to dermatologic care.


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 [published online December 20, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.5141