Dermatology information on the Internet: An appraisal by dermatologists and dermatology residents
Authors: James Daniel Jensen, Cory A. Dunnick, H. Alan Arbuckle, Sylvia Brice, Scott R. Freeman, Whitney High, William Howe, Renata Prado, Lori Prok, Gregory Seitz, Karl Vance, Ryan G. Gamble, Robert P. Dellavalle
Journal: Journal of the American Academy of Dermatology (2010)

To the Editor: Patients increasingly seek health information on the World Wide Web both for personal knowledge and to facilitate patient–physician discussion at the time of medical consultation. In January 2008, approximately 44% of all health-related Web site traffic was on pages found via search engines, an increase of 3% in health-related traffic share from the previous year.1Hitwise.com Web site. Google steady at 66 percent of U.S. search in January 2008. Available from: http://www.hitwise.com/press-center/hitwiseHS2004/google-steady-at-66-percent.php. Accessed February 2, 2009.Google ScholarGoogle.com received the greatest portion of this Internet traffic.1Hitwise.com Web site. Google steady at 66 percent of U.S. search in January 2008. Available from: http://www.hitwise.com/press-center/hitwiseHS2004/google-steady-at-66-percent.php. Accessed February 2, 2009.Google Scholar The Internet provides an easily accessible forum through which health information, with varying accuracy, can be spread.2Silberg W.M. Lundberg G.D. Musacchio R.A. Assessing, controlling, and assuring the quality of medical information on the internet. Caveant lector et viewor—let the reader and buyer beware.JAMA. 1997; 277: 1244-1245Crossref PubMed Google Scholar, 3Roberts J.M. Copeland K.L. Clinical websites are currently dangerous to health.Int J Med Inf. 2001; 62: 181-187Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar This holds especially true with the development of Web 2.0, which is comprised of Web sites that are geared toward the facilitation of communication between Internet users (Wikipedia, blogs, etc). We sought to assess the content, accuracy, and quality of dermatologic health information on the Internet. The top three Web sites found through a query of the top eight dermatologic diagnoses4Feldman S.R. Fleischer Jr., A.B. McConnell R.C. Most common dermatologic problems identified by internists, 1990-1994.Arch Intern Med. 1998; 158: 726-730Crossref PubMed Scopus (78) Google Scholar using Google were analyzed by six board-certified dermatologists and three dermatology residents for accuracy, content, and completeness. Each Web site was given a positive, neutral, or negative rating according to the evaluators' overall impression of the Web site, the accuracy of its disease description, treatment description, and photographic depiction, and its user-friendliness. Web sites were also categorized according to target audience, sponsorship or affiliation, number of languages, presence of reliability certification (ie, Health on the Net Foundation), and types and extent of consumer advertising. Flesch–Kincaid grade levels for readability were calculated for all Web sites using Microsoft Office Word software (Microsoft; Redmond, WA). Twenty-four Web sites were found by searching for the top eight dermatologic diagnoses on the search engine Google. There were no duplicate Web sites or broken links among the returned search results. Common Internet domains included: Wikipedia.org (8 Web sites), MayoClinic.com (2), and MedicineNet.com (2). Six additional Web sites were represented by dermatology-specific organizations (one each from AOCD.org, SkinCarePhysicians.com, SkinCancer.org, Psoriasis.org, Acne.org, and Acne.com), and five additional Web sites were represented by organizations with a general medical focus (one each from WebMD.com, eMedicine.com, Medline [NIH.gov], FamilyDoctor.org, and Merck.com). One Web site (About.com) was not specifically health-related. No Web sites were excluded. Dermatologists and dermatology residents rated dermatology Web sites found through Google as generally accurate (Table I). Importantly, Web 2.0 Web sites that were evaluated were found to be generally equal in accuracy and completeness to their non–Web 2.0 counterparts. Furthermore, each Web site was categorized according to the various criteria mentioned above (Table II). Web sites found through Google are generally targeted for a lay patient audience, represent a wide variety of types of sponsorships and affiliations (Web 2.0 developments being the most common), have a number of language translations, possess some version of health reliability certification, and contain a fair amount of advertising. In general, however, Web sites had a Flesch–Kincaid grade level well above the recommended5National Institutes of Health Web site. MedlinePlus: how to write easy to read health materials. Available at: http://www.nlm.nih.gov/medlineplus/etr.html. Accessed January 7, 2010.Google Scholar sixth grade level.Table IEvaluator-assigned ratings of websites included in the study∗Websites generally received positive ratings overall. Wikipedia Web sites and non-Wikipedia Web sites scored equally well in terms of overall Web site rating, accuracy, and user-friendliness when evaluated by dermatologists and residents.Overall, n (%)Wikipedia, n (%)Non-Wikipedia, n (%)PositiveNeutralNegativePositiveNeutralNegativePositiveNeutralNegativenP†Comparison between Wikipedia and non-Wikipedia Web sites. The Fisher exact test was used unless otherwise specified.Overall Web site rating158 (73.83)42 (19.63)14 (6.54)52 (72.22)15 (20.83)5 (6.94)106 (74.65)27 (19.01)9 (6.34)214.9055Accuracy of Disease description153 (71.50)40 (18.69)21 (9.81)47 (65.28)15 (20.83)10 (13.89)106 (74.65)25 (17.61)11 (7.75)214.2606‡χ2 test. Photographic depiction106 (70.67)23 (15.33)21 (14.10)44 (75.86)10 (17.24)4 (6.90)62 (67.39)13 (14.13)17 (18.48)150.1279 Treatment description149 (70.28)47 (22.17)16 (7.55)50 (70.42)17 (23.94)4 (5.63)99 (70.21)30 (21.28)12 (8.51)212.7374User-friendliness176 (84.62)16 (7.69)16 (7.69)61 (89.71)5 (7.35)2 (2.94)115 (82.14)11 (7.86)14 (10.00)208.2201∗ Websites generally received positive ratings overall. Wikipedia Web sites and non-Wikipedia Web sites scored equally well in terms of overall Web site rating, accuracy, and user-friendliness when evaluated by dermatologists and residents.† Comparison between Wikipedia and non-Wikipedia Web sites. The Fisher exact test was used unless otherwise specified.‡ χ2 test. Open table in a new tab Table IICompiled characteristics of each of the 24 Web sites from Table I∗Web sites were categorized according to target audience, sponsorship/affiliation, number of languages (including English), reliability certification, and the presence of advertisements. Composite Flesch–Kincaid grade levels also shown with distribution.WikipediaNon-WikipediaOverallTarget audience Lay10093.895.8 Professional06.24.2Sponsorship/affiliation Public domain (Wikipedia)(—)(—)33.3 Nonprofit medical organization(—)(—)29.2 Medical publisher(—)(—)20.8 Private corporation(—)(—)12.5 Government(—)(—)4.2Languages (average number/Web site)201.47.6Reliability certification Any certification075.050.0 Health on the Net062.541.7 None10025.050.0Advertisements (% of total Web sites) Dermatology-specific, % (average/Web site)012.5 (2.0)8.3 (2.0) Non–dermatology-specific, % (average/Web site)056.3 (2.3)37.5 (2.3) Total, % (average/Web site)068.8 (2.3)45.8 (2.3)Flesch-Kincaid Grade Level11.49.310.0 No. of Web sites by grade level <6000 6.0-7.9066 8.0-9.9235 10.0-11.9268 >12415∗ Web sites were categorized according to target audience, sponsorship/affiliation, number of languages (including English), reliability certification, and the presence of advertisements. Composite Flesch–Kincaid grade levels also shown with distribution. Open table in a new tab While Internet resources regarding health information are subject to misinformation, dermatologic Web sites are relatively accurate and complete according to dermatologists and dermatology residents. However, our findings also suggest that Internet-based information may be too difficult for comprehension by a substantial portion of the patient population. Patients who want to know more about specific dermatologic conditions may benefit seeking information from reliable Web sites found through Google.com. Special thanks to Jodi Duke, BS, for her assistance with statistical analysis.