Supplementary Material for: Using smartphone data to frequently measure atopic dermatitis severity and understand triggers: A decentralized 12-week observational study

Abstract
Introduction
Atopic dermatitis (AD) severity is traditionally evaluated during in-office consultations; however, this does not provide continuous monitoring and any intermittent flare/remission cycles are usually not recorded.
The aim was to apply smartphone technology to evaluate AD severity; to explore if severity based on highly frequent sampling of photographs are associated with patient reported outcomes, and to investigate disease fluctuations and trigger associations based on passively collected environmental data.
Methods
In this 12-week decentralized observational study adult patients with AD were recruited online and used a tailored remote clinical trial platform app to perform all study tasks including capturing photographs and completing the patient-oriented eczema measure (POEM) weekly. AD severity was assessed based on photographs using the Eczema Area and Severity Index (EASI) and SCORing Atopic Dermatitis (SCORAD). Geographical location collected in the app was used to retrieve data on ambient temperature and carbon monoxide (CO), a common air pollutant.
Results
A total of 42 patients (35 women) were recruited online. A total of 712 photographs were taken, with an average of 17 photographs per participant. Photographic SCORAD (r=0.450) and EASI (r=0.206) were significantly associated with subjective severity POEM. Patients experiencing AD fluctuation (n=10) based on SCORAD had significantly higher risk of also having a psychiatric disorder (60 vs. 17%, p=0.008). Anxiety was significantly associated with disease fluctuation based on EASI (40 vs. 7%, p=0.01) and a tendency was observed for depression (40 vs. 13%, p=0.06). Decreasing temperature was significantly associated with higher POEM (estimate -0.18, p=0.012) and EASI score (estimate -0.14, p=0.007), but not with SCORAD. High levels of CO were significantly associated with higher SCORAD (estimate 15.9, p

摘要
引言
特应性皮炎（AD）的严重程度传统上是在门诊咨询期间进行评估的；然而，这种方式无法提供持续的监测，且间歇性的发作/缓解周期通常不会被记录。本研究旨在应用智能手机技术评估AD的严重程度；探究基于高度频繁的摄影样本的严重程度是否与患者报告的结果相关联，并基于被动收集的环境数据研究疾病的波动和触发因素。方法
在本项为期12周的分布式观察性研究中，通过在线招募了成人AD患者，并使用定制的远程临床试验平台应用程序执行所有研究任务，包括捕捉照片和每周完成针对患者的湿疹测量（POEM）。AD的严重程度是基于照片使用湿疹面积和严重度指数（EASI）和特应性皮炎评分系统（SCORAD）进行评估。应用程序中收集的地理位置用于检索环境温度和一氧化碳（CO）的数据，后者是一种常见的空气污染物。结果
共招募了42名患者（35名女性）。共拍摄了712张照片，平均每位参与者拍摄17张照片。摄影SCORAD（r=0.450）和EASI（r=0.206）与主观严重程度POEM显著相关。基于SCORAD的AD波动患者（n=10）患有精神疾病的危险性显著较高（60% vs. 17%，p=0.008）。焦虑与基于EASI的疾病波动显著相关（40% vs. 7%，p=0.01），并观察到抑郁的倾向（40% vs. 13%，p=0.06）。温度的下降与更高的POEM（估计值-0.18，p=0.012）和EASI评分（估计值-0.14，p=0.007）显著相关，但与SCORAD无关。高浓度的一氧化碳与更高的SCORAD（估计值15.9，p