ABSTRACT
The Coronavirus disease 2019 (COVID-19) pandemic revealed our need for reliable tools to evaluate patients with skin disease virtually. Thus far, there has not been a study that has attempted to score the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), a validated outcome measure of skin activity and damage, from photographs. In this study, patients were prospectively recruited during routine clinic visits and skin regions used in scoring the CDASI were photographed by research staff using two iPhone cameras (an iPhone 8 and iPhone 11). Two dermatologists served as the raters. The in-person CDASI assessment was scored by rater 1 at the clinic visit and the photographs were scored at a later date by both rater 1 and rater 2. Of the 34 patients participating in the study, 82.3% were female, 85.3% were Caucasian with a mean age of 54 years (SD=12). For the total activity score, the intraclass correlation coefficient (ICC) between rater 1’s in-person assessment compared to photograph assessment was 0.806 (95% CI 0.649-0.898 p<0.001) and was 0.822 (95% CI 0.675-0.907 p<0.001) between rater 2 and the in-person assessment. For the total damage score, the ICC between rater 1 and the in-person assessment was 0.54 (95% CI 0.254-0.739 p=0.004) and was 0.601 (95% CI 0.338-0.778 p<0.001) between rater 2 and the in-person assessment. The reliability was interpreted as “excellent” for skin activity, an important measure in clinical trials for dermatomyositis. Photographs may be a useful tool for evaluating clinical trial patients in the future. More research is needed to determine innovations for improving our ability to evaluate skin activity through photographs such as the use of a color checker card or color correction algorithm.