MIND-the-SKIN Project: Multi-functional Innovative Digital Toolkit for the Skin Diseases in LMICs and Beyond The prevalence of skin diseases is extremely high in sub-Saharan Africa, particularly in children. If left untreated, some have debilitating lifelong physical disabilities and deformities, as well as social and mental effects. Among them are skin infections which are listed as members of the Neglected Tropical Diseases (NTDs) by the World Health Organization and targeted for disease control globally. Many of the NTDs, including leprosy, Buruli ulcers, yaws, and lymphatic filariasis, are co-endemic in West Africa. Early detection and treatment is currently the most effective measures for their disease control. However, this is hampered by a paucity of skilled healthcare workers in the remote areas of the LMICs where they prevail. On the other hand, diagnosis of these conditions can be done with patient history and simple skin examination, without undergoing invasive examinations requiring special skills and equipment. This is very well suited to field settings in LMICs. With a targeted training, technology-assisted decision-support system and a telemedicine network, local healthcare workers could be leveraged to enhance the diagnosis and management of the skin conditions. This project proposes to do so through development and validation of an mHealth tool for skin diseases in LMICs: the ‘eSkinHealth’ application. It is a portable smartphone or tablet application that could provide: a) direct diagnostic and management assistance to healthcare workers in remote setting, and through teledermatology, b) storage of longitudinal patients records for improved follow-up, and c) organization of clinical and image data of the skin. There is a general lack of good clinical photos of skin diseases on dark skin, and collection of photos made through this project could be further used for development of photo guides for wide use and future studies on dermatology of skin of color. The purpose of the proposed research is to complete development and optimization of eSkinHealth and carry out its effectiveness studies on the field. The R21 phase of the work will assess the feasibility, usability, and acceptability of the prototype, validation of a novel built-in wound scoring system, and standardization and optimization of dermatologic photography on dark skin. The R33 phase will evaluate the performance of the app on outcomes of surveillance and management of NTDs and further optimization of photo analysis of skin lesions on dark skin using the image optimization technology. The research will be carried out in a western-African country of Côte d’Ivoire. It will build on our previous work in surveillance of NTDs in rural Côte d’Ivoire and trainings to local healthcare workers, as well as our expertise in mHealth. It will leverage our multi-year collaboration with investigators from Côte d’Ivoire, application developers in Japan, and tropical medicine expertise from Tulane University. If successful, eSkinHealth will be instrumental in overcoming the current gaps and weaknesses in dermatological services in LMICs providing a breakthrough to management of skin diseases in this underserved populations, as well as contributing to the dermatology of skin of color worldwide, envisioning Skin Health for All.

PROJECT NARRATIVE While the prevalence of skin diseases are very high in LMICs, especially in children, dermatological services in LMICs are lacking mainly due to lack of clinical skills, and further, ways to document and store clinical course which is important for individual patient follow-up do not exist. If there is a field-adapted platform for data collection and sharing for skin conditions allowing clinical decision support for healthcare providers onsite, and remotely through teledermatology, this could serve as a breakthrough to management of skin diseases in this underserved populations. In this project, we will complete the development and optimization of a powerful and comprehensive, but easy-to-use smartphone / tablet application tool that addresses these gaps, envisioning Skin Health for All.