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Teledermatology beyond Covid-19

The first major report on teledermatology was developed at Logan Airport in Boston, MA in the late 1960s and early 1970s. At Logan, a two-way interactive black and white television was used to connect patients at the airport clinic to dermatologists located at a university dermatology department of Massuchussets Hospital.(fig.1)

The term ‘teledermatology’ was used for the first time by Perednia and Brown in 1995, who reported the results of a teledermatology project carried out in remote rural areas of Oregon (USA).

Many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, and like radiology and pathology, dermatology as well, is particularly suited for this care system as skin disorders are a visual specialty. Advances in telecommunications technology have made it possible to deliver high-quality skin care when patient and provider are separated by both time and space. Most recently, mobile devices that connect users through cellular data networks have enabled teledermatologists to instantly communicate with primary care providers throughout the world with high resolution images.

Even in regions where dermatologic expertise is readily accessible, teledermatology may serve as an alternative that streamlines health care delivery by triaging chief complaints and reducing unnecessary in-person visits. In addition, many patients in developing countries have no access to dermatologic expertise, rendering it possible for teledermatologists to make a significant contribution to patient health outcomes. Teledermatology also offers educational benefits to primary care providers and dermatologists.

Through teledermatology, diagnostic images of skin disorders with accompanying clinical information can be reviewed remotely by teledermatologists via several modalities, such as photographic clinical images, live video teleconferencing or hybrid solutions (asynchronous, synchronous. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve and it is progressing fast during and beyond the Covid pandemic as telemedicine consultations sky-rocketed.

A systematic review summarising studies published on teledermatology during the Covid-19 pandemic, based on a Medline search for articles from 2020 in English and German, found that the use of teledermatology during the pandemic should be employed to improve the use and acceptance of teledermatology by patients and dermatologists. 1

Two surveys among dermatologists from the USA and India showed that more than 80 % offered teledermatology. Among German dermatologists, 17.5 % of 480 respondents offered online video consultation, 11.3 % offline consultation (store and forward) and 10.0 % both. Five cohort studies on teledermatology during the pandemic were identified. Three of them investigated teledermatology in chronic dermatoses (acne, inflammatory skin diseases), one dealt with the care of oncological patients with dermatological complications, and one analyzed teleconsultation in suspected COVID‐19 cases. In all studies, teledermatology largely reduced the number of personal consultations. 1

The results also indicate that limitations of personal dermatological care of patients with skin diseases during the COVID‐19 pandemic can be at least partially mitigated by expanding teledermatology.

Despite most of the articles agreeing on the benefits of Teledermatology , it is important to highlight the difficulties and limitations of this approach. For example, if image quality was poor, that can negatively impact on usefulness of teledermatology. It would be appropriate and important to explain to patients some tips like:

  • Ensuring good lighting, 

  • Utilising a solid and non-reflective background and,

  • If possible, a ruler could be placed next to the lesion specially if it was a mole.

  • For videoconferencig , making sure that internet connection is stable with sufficient bandwidth before commencing a session.

  • Sitting in front of the camera that is in focus and stable with sufficient lighting.

Another limitation is the lack of access to a dermoscope when evaluating pigmented lesions. Hair-bearing areas and mucosal surfaces are areas that can also be difficult to visualise well. 

Finally, skin concerns that could involve procedures, skin biopsy or medical injection cannot be done by telemedicine (yet!) . Telemedicine can help guide the decision for a subsequent face-to-face consultation.

In my opinion, clinicians and healthcare providers will likely be employing a hybrid strategy of telemedicine and face-to-face visits in order to achieve high quality modern medical care for patients.

1- Teledermatology in the times of COVID‐19 – a systematic review


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