Augmented reality supported medication adherence for patients with atopic dermatitis and psoriasis

Abstract Augmented reality (AR) is a technology that enables digital information layers, such as text, image, video and audio, to be positioned in the real environment seamlessly as holograms. The holograms are displayed through a smartphone camera view. AR-specific computer vision algorithms remodel the hologram’s position based on the device’s movement in real-time and create a mediated illusion of projection in reality. As dermatologic diagnosis primarily relies on visual perception, integrating AR can provide novel benefits for patients and doctors. Medication adherence challenges for patients with inflammatory skin diseases, specifically atopic dermatitis (AD) and psoriasis, are many and complex. Nearly one-third of patients with AD do not adhere to the therapy for their lesions. Factors such as lack of understanding, patients’ forgetfulness and dissatisfaction with the healing progress or the complementary therapy are the prominent influencers which lead to treatment interruption. The benefits of AR as an enabler of positive learning experiences have been addressed in various research in healthcare, with a strong focus on medical students. However, in-depth studies have yet to be conducted regarding the impact and opportunities for patients. Our project explores how AR can increase patients’ understanding of the inflammatory skin diseases AD and psoriasis. Since AR can visualize complex information, such as different stages of the treatment, AD patients have opportunities to overcome inadequate treatment compliance without any restrictions of mobility or location due to the nature of AR experiences. The project identifies the factors for integrating a mobile AR application into patients’ daily lives to increase their medication adherence. The characteristics of AR experiences and the existing studies and research results on AR in dermatology underline the value of creating interactive experiences compared to static images or printed information. Subsequently, an AR prototype is developed to investigate and evaluate the concept of AR in therapy understanding and medication adherence. The prototype allows patients to project the different stages of development of inflammatory skin diseases onto their skin as holograms and thus visualize the onset of treatment. The prototype was demonstrated to two dermatologists and four patients. They were asked to test the prototype and were surveyed using a semi-structured interview. AR was reported beneficial in increasing patients’ understanding of their disease and the motivation to adhere to the prescribed therapy. Moreover, AR visualizations of different developments of the affected skin were acknowledged as helpful. Within the analysis framework, the dermatologists and patients described many needs to ensure integration into everyday life. One of the core challenges reported is that the AR visualizations must be adapted to the patient’s skin type as realistically as possible. Henceforth, the interviewed dermatologists and patients critically evaluated that integrating such an application into patients’ daily life requires that the functions and content are valuable at every stage, explicitly mentioning a digital medication plan. A critical success factor is identified as communication between dermatologists and patients. Analysis suggests that an auxiliary function that facilitates sharing images of lesions for initial diagnosis has been specified as helpful by both stakeholder groups. In addition, these images document the course of the disease, which not only has a positive effect on the overall treatment but also helps to document changes in the course of the therapy. As an outlook, we integrate Artificial Intelligence (AI) techniques for patients to receive customized support in medication adherence and well-being-related content. AI will enable building a knowledge base about AD and psoriasis, reinforced with AR-supported visual feedback on treatment and references of individual adherence patterns.