Eczema Apps Conformance With Clinical Guidelines

A Systematic Assessment of Functions, Tools and Content

L.S. van Galen; X. Xu; M.J.A. Koh; S. Thng; J. Car


The British Journal of Dermatology. 2020;182(2):444-453. 

In This Article

Abstract and Introduction


Background: Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps that aim to support eczema self-management.

Objectives: To evaluate the quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients and/or their caregivers.

Methods: A systematic assessment of eczema apps from July 2018 to November 2018. The assessment criteria were based on conformance with international eczema guidelines. The following domains were assessed: consistency and comprehensiveness of eczema-specific educational information; quality and comprehensiveness of eczema-specific tracking functions; compliance with health information best practice principles.

Results: In total, 98 apps were assessed: 82 (84%) provided educational information; 38 (39%) tracking functions; and 13 (13%) both. We found that 34% (28/82) of apps provided misleading information, particularly regarding aspects of treatment and disease progression of eczema. Only 15% (12/82) provided international guideline supported information on pharmacological therapies and 16% (13/82) on nonpharmacological therapies. Among 38 apps with a tracking function, 82% (31/38) measured specific symptoms, disease severity or current skin condition and 89% (34/38) helped users to record medication usage including application of topicals. Environmental or dietary allergens were recorded by 34% (13/38). None of the included apps complied with all criteria for educational information, tracking functions or health information principles.

Conclusions: Eczema apps have not yet reached their potential. The large variance in quality of eczema apps highlights the need for quality assurance mechanisms for health apps and guidance for clinicians that would enable them to make personalized recommendations for patients and caregivers.


Eczema is the most common skin disease. One in five people are affected during their lifetime and recent data shows that its prevalence is still increasing, especially in low-income countries.[1] Eczema is a complex chronic disease that causes various distressing symptoms such as itch, sleep disturbance as well as changed skin appearance. It can have a great impact on patients' mental and physical health.[2] The psychosocial impact and stress on caregivers of individuals with eczema has been found to be greater than those patients with insulin-dependent diabetes.[3] Self-management plays a pivotal role in improving the quality of life of patients with eczema; however, evidence and practice show there is low adherence to recommended prevention and management measures including use of topical and oral medication.[4]

Understanding of the disease increases patient satisfaction with the treatment and results in improved outcomes and adherence.[5] Well-educated patients have significant improvements in their disease severity scores compared with controls.[6] For timely recognition of flares and informed treatment decisions during clinic visits, guidelines advocate tracking of the disease by: (i) monitoring possible triggers (e.g. allergens); (ii) recording disease severity including specifically symptoms and signs; and (iii) response to therapy.[7] There is an increasing need for various monitoring means to support patients, their caregivers and healthcare professionals in managing the disease.

Smartphone apps can increase patients' and carers' knowledge of the disease, support self-management and empowerment by, for example, giving patients insight into their health condition, enabling them to make informed choices and engaging them in self-care activities and potentially diminishing the need for face-to-face contact with their healthcare professionals.[8] Dermatological conditions are deemed suitable for smartphone-supported management, as clinical diagnosis and assessment of severity partly rely on visualization. This is reflected by the number of dermatology-related mobile apps that have more than doubled in recent years.[9] Studies have, however, found diagnostic inaccuracy of smartphone applications and several other reports have also suggested that there is much that needs improvement in the app marketplace.[10] For apps to be used and recommended to patients and their healthcare providers, accuracy and reliability are essential. Incorrect information and recommendations, in addition to privacy issues, are some of the key challenges of current apps.[11]

Research has not yet focused on eczema smartphone apps. Given the hypothetical benefits and challenges, the quality and comprehensiveness of available eczema self-management apps should be evaluated to guide clinicians and patients in recommending and using the most appropriate apps. To assess the global marketplace, apps available in the most commonly spoken languages (English, Chinese, and Spanish) will provide a comprehensive overview covering a population of nearly two billion people.[12] This study systematically assesses the self-management functionalities of all available apps accessible to English-, Chinese- and Spanish-speaking patients with eczema or their caregivers.