Recently I have seen some bad outcomes from patients using search engines or mobile apps to self-diagnose and treat their skin conditions.
A young woman with a minor dermatitis used search engines to diagnosis her condition. When she presented to the office she was sure she had psoriasis and wanted to know if Humira, a biologic medication, was right for her. She had spent several hours coming up with her online diagnosis. In the process, she had become very anxious about the prospect of having psoriasis, a lifetime condition. I prescribed a steroid cream for her rash, which is likely to clear it up in a week or two.
A young man made the self-diagnosis of athlete’s foot. He then searched for “natural cures” and came up with using bleach wipes and vinegar soaks. By the time he came in to see me, his localized foot rash had spread to involve his entire leg up to the knee with a red blistering rash. At that point, the reaction to the bleach and vinegar made it difficult to diagnose the original problem. Note of caution: online diagnosis and mobile apps may help you determine if you have a condition that needs medical attention. If you try an over the counter treatment that worsens the condition, stop immediately and see a doctor.
In both of these cases, the use of online diagnosis for their skin condition made the patient worse by causing unnecessary anxiety or by recommending an ineffective treatment. Here’s a summary of the latest information regarding mobile apps and online diagnosis.
Can I use “symptom search” mobile apps to self-diagnose skin conditions?
In January of 2016 Google rolled out a feature called symptom search. This app shows a description of the problem, options for self-treatment and suggestions on whether or not to see a doctor. The company got help from experts at Mayo Clinic and Harvard Medical School. WebMD, Symtomate and others already offer symptom checking apps. A recent review of online symptom checkers was conducted by Harvard Medical School and published in the British Medical Journal. Online diagnosis by symptom checking apps was accurate a mere 34% of the time. About half the time, the correct diagnosis was one of the top three options. While these apps may be helpful for patients deciding whether or not to make an immediate doctor appointment, users should be cautious. In the study, the more accurate symptom checking mobile apps were those provided by medical schools or government agencies.
Can I trust Skin Cancer Mobile Apps to self-diagnose melanoma?
Skin cancer apps are an attempt to help patients monitor their moles for worrisome changes. Typically, the app requires that a user photographs their moles with a smartphone and then enter information about moles such as size, color and recent change. The mobile apps then determines the risk of the melanoma as: low, medium or high. The FTC has found that claims by some of the companies, Mole Detective and MelApp, to accurately detect melanoma risk, were not backed up by evidence. JAMA Dermatology published a study in 2013 evaluating how accurately the skin cancer apps detected melanoma risk. Three of the four apps incorrectly classified melanoma as benign in 30-93% of cases. If you notice a change in a mole, make an appointment with a dermatologist, don’t rely on skin cancer mobile apps to self-diagnose.
Is there Bias in Artificial Intelligence used in mobile apps or search engines?
There is existing bias in healthcare data, creating a risk that AI could exacerbate, rather than eliminate bias. Clinical trials are highly selective in choosing their subjects. Many trials exclude the elderly, those with multiple medical conditions and may disfavor women. Pregnant women are almost always excluded from trials. Patients who are poor and do not have access to high quality healthcare are often excluded. Therefore, medical data may disproportionately favor white men. Women are more likely to have medication side effects and may have different heart attack symptoms than men. Because AI uses medical data which has inherent biases, symptom checker mobile apps and online searches may be less accurate if you are not a white male!
The internet can be an excellent source of information. I think search engines are best used after a medical visit to learn more. Some of the best online sites for dermatology are: www.skincancer.org and https://www.aad.org (the American Academy of Dermatology) as well as disease specific sites sponsored by patient advocacy groups such as www.psoriasis.org and nationaleczema.org
If you are concerned about symptoms you are experiencing, see your doctor. The mobile apps may not be helpful!