JMIR Publications

ABSTRACT

Background:

The ‘exposome’ refers to the totality of internal and external environmental exposures that an individual experiences over their lifetime and how these exposures impact health. Increasing evidence suggests the exposome plays a significant role in immune-mediated inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis (PsO). However, exposome research on human subjects is often limited by reliance on in-person visits, which can be costly, time-consuming, and disruptive to participants’ lives, and by the inability to capture exposome data continuously over time.

Objective:

In this study, we conducted a remote exposome monitoring and multiomics investigation using SkinTracker, a mobile research application integrated with Apple Watch for longitudinal disease tracking, alongside an at-home capillary blood collection device for immune profiling.

Methods:

Twenty-five participants were enrolled: 10 with AD, 10 with PsO, and 5 healthy controls. Patients used SkinTracker to capture standardized photos monthly of their skin at home (months 1-5), supplemented by in-person skin photos and dermatology evaluations at baseline and month 6. Disease severity was subsequently assessed in-person, via in-app photos, and via single-lens reflex camera (SLR) photos using standard outcome measures (Investigator Global Assessment (IGA), Psoriasis Area and Severity Index (PASI) or Eczema Area and Severity Index (EASI)).

Results:

Patients reported high satisfaction with the convenience of the SkinTracker app for research participation (mean 6.2/7.0). Compliance was high with 87.2% of at-home photo tasks completed. Agreement between app-based and in-person scoring was excellent for PASI (pooled intraclass correlation coefficient (ICC): 0.955) and good for EASI (pooled ICC: 0.792). Apple Watch data was successfully collected from 100% of participants. Additionally, self-administered capillary blood samples enabled immunophenotyping data collection outside clinic settings.

Conclusions:

Overall, SkinTracker was a reliable and convenient tool for monitoring disease severity and quality of life and studying interactions between environmental exposures, immune function and disease activity in real-world settings.