Impact of an eHealth Smartphone App on Quality of Life and Clinical Outcome of Patients With Hand and Foot Eczema: Prospective Randomized Controlled Intervention Study

BACKGROUND: Chronic hand and foot eczema is a polyetiological dermatological condition. Patients experience pain, itching, and sleep disturbances and have a reduced quality of life. Skin care programs and patient education can improve the clinical outcome. eHealth devices offer a new opportunity to better inform and monitor patients. OBJECTIVE: This study aimed to systematically analyze the effect of a monitoring smartphone app combined with patient education on the quality of life and clinical outcome of patients with hand and foot eczema. METHODS: Patients in the intervention group received an educational program; attended study visits on weeks 0, 12, and 24; and had access to the study app. Patients in the control group attended the study visits only. The primary end point was a statistically significant reduction in Dermatology Life Quality Index, pruritus, and pain at weeks 12 and 24. The secondary end point was a statistically significant reduction in the modified Hand Eczema Severity Index (HECSI) score at weeks 12 and 24. This is an interim analysis at week 24 of the 60-week randomized controlled study. RESULTS: In total, 87 patients were included in the study and randomized to the intervention group (n=43, 49%) or control group (n=44, 51%). Of the 87 patients, 59 (68%) completed the study visit at week 24. There were no significant differences between the intervention and control groups regarding quality of life, pain, itch, activity, and clinical outcome at weeks 12 and 24. Subgroup analysis revealed that, compared with the control group, the intervention group with an app use frequency of fewer than once every 5 weeks had a significant improvement in the Dermatology Life Quality Index at weeks 12 (P=.001) and 24 (P=.05), in pain measured on a numeric rating scale at weeks 12 (P=.02) and 24 (P=.02), and in the HECSI score at week 12 (P=.02). In addition, the HECSI scores assessed on the basis of pictures taken by the patients of their hands and feet correlated strongly with the HECSI scores recorded by physicians during regular personal visits (r=0.898; P=.002) even when the quality of the images was not that good. CONCLUSIONS: An educational program combined with a monitoring app that connects patients with their treating dermatologists can improve quality of life if the app is not used too frequently. In addition, telemedical care can at least partially replace personal care in patients with hand and foot eczema because the analysis of the pictures taken by the patients correlates strongly with that of the in vivo images. A monitoring app such as the one presented in this study has the potential to improve patient care and should be implemented in daily practice. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963