Patient images are missing in studies on atopic dermatitis

Scientific articles on the common skin condition atopic dermatitis contain almost no images of patients, according to a study from the University of Gothenburg. More images would make it easier for patients to participate in decisions about their own care.

"In recent years, patients' rights to participate have been strengthened. Health care professionals should today make treatment decisions together with the patient. But scientific articles have not kept pace with this development.

"We need more images of patients as visual aids in communication. It is difficult for patients to understand the figures used in scientific publications to describe severity or the effect a certain treatment may have," says Sam Polesie, Associate Professor at the Sahlgrenska Academy at the University of Gothenburg and a dermatologist at Sahlgrenska University Hospital.

A total of six depicted patients

Thus, without images, patients are excluded from decisions about their own care. Recently, Polesie, together with Danish colleagues, published a similar study, which showed that only a fraction of all patients with psoriasis in clinical trials are depicted in scientific articles. For atopic dermatitis, it turns out that even fewer patients are depicted.

The results of the study are published in the Journal of Dermatological Treatment. It is a systematic review article covering 60 studies with a total of nearly 18,000 patients. In all these studies, there were 16 images of a total of six patients. This means that as little as 0.3 per 1,000 of the patients were represented in images in the published articles.

Common skin disease

Atopic dermatitis is a chronic recurring inflammatory skin disease that causes dry, itchy areas on the skin. Approximately one in four children and one in ten adults have atopic dermatitis. The severity of the disease varies greatly. In severe cases, the entire life situation is affected.

These eczemas can manifest in several ways and look different depending on how rich in melanin the skin is.

"Images are also important for understanding that atopic dermatitis looks very different in different types of skin. In people with light skin, the eczema appears as redness, while in people with melanin-rich skin, the eczema often becomes darker, where the disease can be perceived as more purple or grayish," says Polesie.

Educational purpose

There is also a clear need for images of more patients with atopic dermatitis in medical education, according to Polesie.

"There is a need for readily available sets of images showing different types of atopic dermatitis in patient groups and the response to treatment that can be used in the education of health care professionals, medical students, and also for patient education," he says.

The education of patients is also a cornerstone in international recommendations and guidelines for atopic dermatitis.

The absence of images can also be significant for the development within AI, where machine learning algorithms need to be trained on large collections of images of atopic dermatitis. In the near future, such algorithms, which combine the appearance of the eczema with other relevant patient information, could help dermatologists identify the most effective treatment options for individual patients.