Development potential of dermatological artificial intelligence and U-healthcare: perceptions reported by middle-aged people in the Republic of Korea

Introduction

In contemporary society, average life expectancy is experiencing an upward trend, primarily due to medical advancements and the advantages of modern civilization. In South Korea, as of January 2024, male life expectancy is 86.3 years and female life expectancy is 90.7 years. This shows an increase compared to 2023. This is an increase of 0.3 years for men and 0.4 years for women (1). This development is pushing the boundaries of human lifespan extension. It is particularly noticeable in developed countries, where population aging is outpacing that of developing regions. The Republic of Korea’s demographic shift toward an aging society is representative of this global phenomenon. In 2000, the population of adults aged 65 or older comprised 7.2% of the total population, marking the country as an “aging society”. By 2018, this segment had grown to 14.3% of the population, qualifying the Republic of Korea as an “aged society”. By 2025, adults over 65 are projected to account for 20.3% of the population, and the Republic of Korea will have reached the threshold of a “super-aged society”—an unprecedented demographic transition. As populations age, there is a rising prevalence of postmenopausal women worldwide (2). Menopause can be associated with chronological aging, exposure to sunlight, and various environmental and endogenous stimuli. Menopause significantly impacts skin condition and appearance, leading to problems such as epidermal dryness and consequent functional changes. As individuals age, the dermis tends to thin and become less elastic, and bone mass decreases. Skin microcirculation is also adversely affected (3). The process of facial skin aging can be categorized into two primary mechanisms: intrinsic and extrinsic. Intrinsic aging is inherently associated with chronological age and indicated by age-related skin changes that are detectable through clinical and biophysical methods. Extrinsic aging is associated with additional factors that contribute to changes in skin elasticity, the development of wrinkles and sagging, and the yellowing of the skin. Chronological age serves as a surrogate marker for intrinsic aging and has been found to significantly influence most signs of facial skin aging. In a study conducted with 24 female subjects of three ages, the following results were confirmed. Firstly, it progressed to overall facial skin aging and secondly to wrinkles and sagging. Additionally, biophysical measurements of roughness, color, skin elasticity, and barrier function were performed on both upper cheeks. Most of the measured parameters showed correlation with chronological age wrinkle score, r=0.901. Additionally, correlation with residual skin deformity and wrinkle score, r=0.606 (4,5).

The Fourth Industrial Revolution is characterized as an intelligent revolution precipitated by digital technologies such as artificial intelligence (AI) and big data that foster hyper-connectivity. This revolution is often seen as a cyber-physical space upheaval driven by 3D printing, robotics, and AI, though this view is subject to numerous debates. A concurrent, significant advancement is the development of ubiquitous healthcare, also called ubiquitous healthcare (U-healthcare). AI and U-healthcare pertains to health management services that harness ubiquitous and telemedicine technologies. The convergence of information and medical communication technology including information and communications technology (ICT) has enabled disease prevention, diagnosis, treatment, and follow-up care at any time and place. This widespread accessibility has been facilitated by the continuous global development of ICT (6-9). In this context, U-healthcare has gained attention as an effective solution for managing the growing population of older adults and the attendant growth in individuals living with chronic diseases (6-9). Wearable healthcare systems are small, convenient programs that users can easily wear. This is known to be able to accurately measure physiological signals in daily life without any inconvenience. To meet these requirements, we utilized the U-healthcare system, which consists of a smart headband and a health status monitor program. This not only allows you to monitor health conditions such as walking and running, but also enables smart management. Amorepacific, a Korean cosmetic brand, developed the AI facial aging diagnosis system Dr.AMORE^® v1.2. It was created using **SSR-Net (Soft Stagewise Regression Network) ** as the backbone. This research method was learned by collecting 11,000 facial images from Korean volunteers aged 19 to 79 years old. The system integrates a de-identification processing process for facial structure to predict age and suggest personalized cosmetics. In this way, research is being conducted on skin health management using AI. The health status monitor program is a new concept program like UMPC (Ultra Mobile Personal Computer) that runs on a portable computer and can be used in various ways (10-15). This new paradigm integrates existing data communication technology with radio frequency identification and biometric and information management technology. This fusion facilitates remote identification and regulation of all objects within the ubiquitous information and communication network, thereby ushering in a new era of healthcare services. This service can be utilized by anyone, anywhere, for disease prevention, diagnosis, treatment, and maintenance of good health (16). The Internet of Things (IoT), the networking capability to connect objects and devices with processing capabilities, is projected to be a crucial future technology in healthcare services. To develop a healthcare service that can offer functional, nutritional dietary regimens tailored to diverse health conditions, it is necessary to utilize the IoT for accumulating data on bodily state, activity levels, exercise routines, dietary habits, and diet (16,17).

This study addresses the urgent issue of providing safe medical services for the elderly, which is a topic of considerable interest as populations age. The definition we introduced a new healthcare service concept to efficiently manage “healthy beauty”, a concept that accelerates healthcare provision to an aging society. The purpose of this study is to examine the perception of Korean adults aged 50 years and older who are unfamiliar with digital devices amid the rapid progress of the Fourth Industrial Revolution and explore the demand and development potential of AI in the evolving U-healthcare field. We present this article in accordance with the SURGE reporting checklist (available at https://jmai.amegroups.com/article/view/10.21037/jmai-24-161/rc).

Materials and methods

Participants and procedures

This survey conducted an offline by face-to-face survey for 4 weeks from May 1st to May 30th, 2023, and the subjects of this study were men in their aged 50s or older in Seoul Metropolitan City, Gwangju Metropolitan City, Busan Metropolitan City, and Jeju Special Self-Governing Province in Republic of Korea. All participants signed an informed consent form and could cancel their participation at any time during the study. Since the minimum sample size was 374 based on the population 2000, 95% confidence level, and tolerance of 0.05, a total of 400 people were surveyed in this study. Also, all procedures performed in this study were in accordance with the Ethical Standards of Dongguk University and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Providing questionnaires to voluntarily participating workers is not perceived as a hazardous activity that needs special screening. The study was not a clinical trial, and the data are robustly anonymized and informed consent and thus did not require ethics committee approval.

Validity and reliability of the questionnaire

To verify the reliability and validity of the three scales, the number of samples of 30 was confirmed through a pretest, and the results of reconfirming the number of samples of 374 for the final analysis after entering this survey.

Data analysis

Statistical processing of data collected with the data analysis method were analyzed using the Statistical Package for Social Science (SPSS) WIN25.0 statistical package program through the process of data coding and cleaning. The collected data were coded, organized, and analyzed using the SPSS WIN25.0 software. The significance levels for verification in this study were set at P<0.05, P<0.01, and P<0.001 (18).

Frequency analysis

A frequency analysis was performed to examine interest levels and the intention to use the U-healthcare skin health service. This analysis encompassed attributes such as knowledge about U-healthcare, the intention of utilizing the U-healthcare skin health service, prospects of U-healthcare, service fields of interest, computer and smartphone usage, preferred portal sites, areas of interest in search fields, and telemedicine service. The research model diagram is shown in Figure 1.

Figure 1 Research model diagram. IT, information technology; U-healthcare, ubiquitous healthcare.

Results

U-healthcare skin health service promotion, expectations by age group

Table 1 shows the expectations by age group for an expanded U-healthcare skin health service. Of the total participant cohort, 141 (37.7%) expected that a U-healthcare dermatology service would provide diagnosis and monitoring tailored to each patient. Additionally, 80 respondents (21.4%) said that these services could potentially facilitate a systematic and accurate assessment of their own skin health status. Meanwhile, 77 respondents (20.6%) suggested that dermatology services could be provided quickly and efficiently and tailored to individual needs.

ICT-customized skin diagnosis as a preferred dermatology service

Table 2 indicates the preferred areas of ICT dermatology healthcare by age group. Of the total respondents, 164 people expressed interest in using ICT for beauty care, 100 people showed interest in kinesitherapy management, and 91 people reported using ICT to receive skin diagnosis and prescription for chronic skin diseases. In addition, the proportion of respondents who preferred the customized skin diagnosis service was the highest among all age groups, and there was no statistically significant difference between age groups.

Demand and perception of U-healthcare services among person who protect skin health management

Table 3 shows participants’ willingness to use U-healthcare skin services to maintain skin health by age group. Of the participants, 253 (67.6%) expressed an intention to use the U-healthcare skin service, 84 (22.5%) said that it would be difficult to use digital devices for dermatology care, and 37 (9.9%) indicated they would not use the U-healthcare skin service. The most frequent response among all age groups was intention to use the U-healthcare skin service. The rate of indifference to U-healthcare skin service was lowest in the 65–70-year-old age group. However, for respondents aged 70 years and older, the percentages expressing interest and disinterest were nearly equal. These differences between age groups were statistically significant (χ²=18.31, P<0.05). These results indicate there is demand for digital dermatology care, but potential patients may be deterred from using digital dermatology care due to difficulties using the technology.

Discussion

Main findings

This research study is the first report to highlight the growing demand for and potential use of dermatology U-healthcare as population aging becomes more prominent globally. After the 4th Industrial Revolution, the importance of U-healthcare is emerging, and a perception survey on this was conducted. The customized industry will further increase in this topic in the future, and as a result, the interest of academia and the cosmetics industry will increase. Given its importance to future human security, this trend is likely to continue in the future.

What is already known about this topic, and what does this study add?

Aging remains a consistent focus of healthcare research and policy, and its interpretation and management are key aspects of modern medicine. Despite our growing understanding of the cellular processes involved, the conceptualization of aging as a disease poses certain challenges. The notion of aging and age-related diseases being inevitable or natural life outcomes is still prevalent in the literature (19-22). Notably, the aging process exerts a significant impact on skin health, particularly during menopause. This stage is marked by a drop in estrogen levels, which has been associated with key structural and functional characteristics of skin such as strength, firmness, and elasticity; lower levels can lead to detrimental effects on the extracellular matrix. Empirical evidence and histological analysis substantiate a relationship between structural changes in the dermis and altered skin function. Conditions such as senile xerostomia, skin malignancies, and skin damage tend to be more prevalent in older individuals (23-29). As life expectancy increases globally, research into the health of aging skin has become a priority, given its importance to overall health care. These findings (Tables 1-3) demonstrate the considerable potential for the growth of the U-healthcare skin health service market leveraging future IoT technology. Also, these findings showed that even a comprehensive telemedicine system has limitations in the diagnostic accuracy of skin lesions (23-27). More recent research, conducted after the onset of the Fourth Industrial Revolution, aligns with these findings. Projections indicate that by 2030, the proportion of the population aged 65 years and over will reach 20%. This demographic trend suggests an impending increase in long-term care facility admissions. Concurrently, an upsurge has been observed in the incidence of skin diseases, resulting in over 27 million annual visits to dermatologists and more than 5 million new cases of skin cancer, primarily among older adults. Store-and-forward tele dermatology assists older adults in overcoming mobility-related obstacles and garners high satisfaction levels among patients; demand for this type of service is likely to grow, given the shortage of dermatologists. In 2020, however, the number of requests declined, and response completion times increased due to the coronavirus disease-19 (COVID-19) pandemic. During this period, doctors in long-term care facilities appeared to prioritize concerns related to COVID-19 over other health issues (29-35). Interestingly, remote dermatologists have shown appreciation for the quality of information provided by geriatricians. Skin cancer has emerged as the most frequent cause for store-and-forward tele dermatology requests in long-term care facilities, reinforcing store-and-forward tele dermatology as an ideal model for point-of-care diagnoses in remote dermatology. Furthermore, as skin diseases are prevalent among older adults, geriatricians generally have more experience with these conditions than their peers in other specialties (36-39). A study that compared the health-related quality of life of patients using tele dermatology services in hospitals with those receiving face-to-face dermatology services found that tele dermatology serves as an effective diagnostic and follow-up tool, and the health-related quality of life of patients in both groups was found to be higher than baseline levels. Importantly, both the general and specific health-related quality of life perceived by tele dermatology patients were consistently higher than those of the face-to-face dermatology group (40). It is not just telemedicine capabilities that are needed; a study among women aged between 40 and 60 years in Seoul Korea that investigated the awareness and developmental potential of customized cosmetics in mobile shopping suggested that a user-friendly mobile app designed specifically for older adults who may have difficulties using technology is a pressing need (41,42). U-healthcare can obtain a variety of information by applying information and communication technology to the healthcare industry. AI technology is being developed in the cosmetics industry, such as skin research, cosmetics, and personalization services in the field of aging. It is possible to quantitatively evaluate skin aging through facial images. Therefore, an AI-based system to diagnose this is being developed (43). Accordingly, the AI skin health diagnosis service is conducted using a skin diagnosis deep learning algorithm. You can check the user’s overall skin to check for skin aging, including wrinkles, redness, elasticity, damage, and pigmentation. It is possible to recommend an optimized solution to prevent skin aging. It is believed that customized provision for preventing skin aging will be possible for everyone (13,15,44). This study confirms that there are various possibilities for use in the field of dermatology. Here’s how U-healthcare can be applied to dermatology (10-12). First, skin health monitoring will be possible. They can monitor their skin health through U-healthcare, which sends photos of your skin condition through the app. This allows a doctor or dermatologist to consult and provide advice remotely. Second, it will be possible to prevent and manage skin diseases. AI and U-healthcare can be used to enhance skin disease prevention and provide information on how to maintain skin health. Patients can quickly acquire this information to obtain information about skin care and continuously manage their skin health. Skin diagnosis and treatment: AI and U-healthcare allows you to detect early symptoms of skin diseases and consult with a doctor to determine diagnosis and treatment. Additionally, even after skin disease treatment, you can monitor and manage your condition through U-healthcare. Third, skin-related information and expert consultation will be available immediately. Skin-related information, tips on skin health, product recommendations, etc. can be provided through the AI and U-healthcare app or platform. You can have a remote consultation with a dermatologist through U-healthcare. Patients will be able to ask questions about their skin concerns and receive answers from experts (10-12,45-47).

Limitations of this study

Our limitation of this study is that, despite numerous studies around the world on population aging, further research is needed on mobile apps that ensure sustainable safety (28,48). Therefore, to expand the scope of this study, future research on customized dermatological skin care for middle-aged people in the 4th Industrial Revolution and development of various user-friendly applications are recommended. In addition, U-healthcare has a lot of potential to be utilized in the field of dermatology, but research on it is insufficient (45-48). Attention must be paid to safety and personal information protection, and collaboration with medical experts is necessary. In addition, the fact that the survey questions were structured in a short answer scale format rather than a Likert scale appears to be the biggest limitation of this study. Therefore, it appears that follow-up research is needed. Further developments in the dermatology field are expected in healthcare in the future.

Conclusions

This study sought to identify the demand for and development potential of dermatological telehealth by identifying perceptions of dermatology AI and U-healthcare among people aged 50 years or older in Korea who were not familiar with digital devices amid the rapid progress of the Fourth Industrial Revolution. High expectations for the strengthening effect of U-healthcare’s skin health service by age group and the need for individual skin diagnosis and monitoring services were confirmed. In addition, participants believed they would be able to monitor their own skin health status and expected to receive customized skin care and dermatology services tailored to their individual needs systematically and accurately. This study indicates strong demand and development potential for dermatology AI and U-healthcare services for middle-aged and older adults in Korea. This finding reflects consumer demand for sustainable and safe methods to delay skin aging among an aging population. Research on telemedicine technology and the development of mobile apps that can be used easily by middle-aged and older adults are essential to the continuous improvement and development of dermatology.

Acknowledgments

Funding: None.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://jmai.amegroups.com/article/view/10.21037/jmai-24-161/rc

Peer Review File: Available at https://jmai.amegroups.com/article/view/10.21037/jmai-24-161/prf

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jmai.amegroups.com/article/view/10.21037/jmai-24-161/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Ethical Standards of Dongguk University and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Providing questionnaires to voluntarily participating workers is not perceived as a hazardous activity that needs special screening. The study was not a clinical trial, and the data are robustly anonymized and informed consent and thus did not require ethics committee approval. All participants signed an informed consent form and could cancel their participation at any time during the study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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