Teledermatology is the skin branch of telemedicine, which is the use of telecommunication technology to relay audio, visual, and data information. Teledermatology can be a valuable tool for patients and doctors, especially for patients in rural areas that may not have easy access to a dermatologist. Teledermatology can be used to determine which patients need additional follow-up by a dermatology clinic, to diagnose skin conditions like skin cancer, and to manage care for chronic skin conditions.1
There are two modalities for teledermatology: store-and-forward and live-interactive.
Store-and-forward is the sending (or forwarding) of digital images and patient information to a distant site provider; or the sending of information back to the patient.
Live-interactive is the patient sending images or interacting live directly with the dermatologist.2
The benefits of teledermatology
Teledermatology offers several benefits, including:
Reducing healthcare costs: telemedicine reduces emergency room visits, which significantly reduces healthcare costs. Teledermatology can also provide quality care to patients at a lower cost.
Increasing access to medical care: teledermatology enables virtual consultations with a dermatologist regardless of a patient’s geographic location.
Aiding patient compliance: teledermatology can improve patient compliance with recommended treatment and referral plans.2
The challenges of teledermatology
Teledermatology is an exciting field of medicine, and the number of practices offering these services is growing. However, there are some challenges. One of the critical factors is the quality of the images sent by patients. If the pictures aren’t of sufficient quality, including the lighting and focus of the image, the dermatologist doesn’t have the necessary information to provide a healthcare recommendation. Also, some healthcare plans aren’t yet equipped to reimburse for telemedicine services. Another challenge is the efficiency of the technology platform used by the dermatologist, which can impact both the doctor’s office and the patient.3
Patient satisfaction with teledermatology
Despite the challenges and the relative newness of the technology, studies have found that patients are very satisfied with teledermatology. One meta-analysis that evaluated 40 studies of telemedicine found that 96% of the studies that evaluated store-and-forward demonstrated patient satisfaction, and 89% of the studies that evaluated live-interactive demonstrated patient satisfaction. The physicians also showed a high satisfaction with the technology (82% satisfaction with store-and-forward and 100% with live-interactive).4
The use of teledermatology in skin cancer
In skin cancer, early detection is critical, and teledermatology offers an alternative to the average wait time to see a dermatologist of 33.9 days. The use of teledermatology in skin cancer can provide immediate skin cancer screening.5
However, accuracy of diagnosis is also of critical importance in skin cancer. A recent meta-analysis reviewed 21 studies to determine how accurate teledermatology is in skin cancer diagnosis compared with face-to-face (FTF) diagnosis. The researchers found that while the accuracy for FTF remains higher (between 67%-85% for FTF and between 51%-85% for teledermatology), some studies have shown a high accuracy in diagnoses from teledermatology. The researchers concluded that while additional studies are needed, teledermatology does consistently reduce wait times for assessment and provides a service with high patient satisfaction.6
An exciting tool for skin care
Telemedicine, including teledermatology, has the potential to revolutionize the delivery of health care. Using technology for dermatology is especially useful due to the visual nature of skin conditions. While teledermatology will never replace in-person visits, it can provide another tool for people needing expert care for their skin conditions.
Warshaw E, Greer N, Hillman Y, et al. Teledermatology for Diagnosis and Management of Skin Conditions: A Systematic Review of the Evidence [Internet]. Washington (DC): Department of Veterans Affairs (US); 2010 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK49157/
American Academy of Dermatology. Accessed online on 9/5/17 at https://www.aad.org/practicecenter/managing-a-practice/teledermatology.
Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists.PLoS One. 2011;6(12):e28687. doi: 10.1371/journal.pone.0028687. Epub 2011 Dec 14
Mounessa JS, Chapman S, Braunberger T, et al. A systematic review of satisfaction with teledermatology. Journal of Telemedicine and Telecare. First published date: March-28-2017. doi: 10.1177/1357633X17696587.
Walocko FM, Tejasvi T. Teledermatology applications in skin cancer diagnosis. Dermatol Clin. 2017;35:559-563. doi: http://dx.doi.org/10.1016/j.det.2017.06.002.
Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the Diagnosis and Management of Skin CancerA Systematic Review . JAMA Dermatol. 2017;153(3):319–327. doi:10.1001/jamadermatol.2016.4361.