Teledermatology and its Current Perspective

Efficacy of an Artificial Intelligence App (Aysa) in Dermatological Diagnosis: Cross-Sectional Analysis

BACKGROUND

Dermatology is an ideal specialty for artificial intelligence (AI)-driven image recognition to improve diagnostic accuracy and patient care. Lack of dermatologists in many parts of the world and the high frequency of cutaneous disorders and malignancies highlight the increasing need for AI-aided diagnosis. Although AI-based applications for the identification of dermatological conditions are widely available, research assessing their reliability and accuracy is lacking.

OBJECTIVE

The aim of this study was to analyze the efficacy of the Aysa AI app as a preliminary diagnostic tool for various dermatological conditions in a semiurban town in India.

METHODS

This observational cross-sectional study included patients over the age of 2 years who visited the dermatology clinic. Images of lesions from individuals with various skin disorders were uploaded to the app after obtaining informed consent. The app was used to make a patient profile, identify lesion morphology, plot the location on a human model, and answer questions regarding duration and symptoms. The app presented eight differential diagnoses, which were compared with the clinical diagnosis. The model's performance was evaluated using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and F1-score. Comparison of categorical variables was performed with the χ2 test and statistical significance was considered at P<.05.

RESULTS

A total of 700 patients were part of the study. A wide variety of skin conditions were grouped into 12 categories. The AI model had a mean top-1 sensitivity of 71% (95% CI 61.5%-74.3%), top-3 sensitivity of 86.1% (95% CI 83.4%-88.6%), and all-8 sensitivity of 95.1% (95% CI 93.3%-96.6%). The top-1 sensitivities for diagnosis of skin infestations, disorders of keratinization, other inflammatory conditions, and bacterial infections were 85.7%, 85.7%, 82.7%, and 81.8%, respectively. In the case of photodermatoses and malignant tumors, the top-1 sensitivities were 33.3% and 10%, respectively. Each category had a strong correlation between the clinical diagnosis and the probable diagnoses (P<.001).

CONCLUSIONS

The Aysa app showed promising results in identifying most dermatoses.

Ethical considerations for artificial intelligence in dermatology: a scoping review

The field of dermatology is experiencing the rapid deployment of artificial intelligence (AI), from mobile applications (apps) for skin cancer detection to large language models like ChatGPT that can answer generalist or specialist questions about skin diagnoses. With these new applications, ethical concerns have emerged. In this scoping review, we aimed to identify the applications of AI to the field of dermatology and to understand their ethical implications. We used a multifaceted search approach, searching PubMed, MEDLINE, Cochrane Library and Google Scholar for primary literature, following the PRISMA Extension for Scoping Reviews guidance. Our advanced query included terms related to dermatology, AI and ethical considerations. Our search yielded 202 papers. After initial screening, 68 studies were included. Thirty-two were related to clinical image analysis and raised ethical concerns for misdiagnosis, data security, privacy violations and replacement of dermatologist jobs. Seventeen discussed limited skin of colour representation in datasets leading to potential misdiagnosis in the general population. Nine articles about teledermatology raised ethical concerns, including the exacerbation of health disparities, lack of standardized regulations, informed consent for AI use and privacy challenges. Seven addressed inaccuracies in the responses of large language models. Seven examined attitudes toward and trust in AI, with most patients requesting supplemental assessment by a physician to ensure reliability and accountability. Benefits of AI integration into clinical practice include increased patient access, improved clinical decision-making, efficiency and many others. However, safeguards must be put in place to ensure the ethical application of AI.

The Past, the Present and the Future of Teledermatology: A Narrative Review

Teledermatology may be defined as the application of telemedicine to dermatology. According to published data, teledermatology is more widespread in Europe and North America, probably where resources for health care are greater than in other areas of the world. Indeed, teledermatology requires advanced technology to be efficient, as high image quality is necessary to allow the dermatologist to make correct diagnoses. Thanks to the recent advances in this field, teledermatology is become routinary in daily clinical practice. However, its use has been improved over time, overcoming several challenges. The aim of this narrative review is to retrace the almost 30-year history of teledermatology, to address the new challenges posed by advancing technologies such as artificial intelligence and the implications it may have on healthcare.

Descriptive and Concordance Data for Asynchronous Teledermatology Consultations for Dermatitis: A Retrospective Study

Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.

[Acceptance of Teledermatology: Results of a Survey of General Practitioners and Dermatologists in Saxony (Germany)]

AIM OF THE STUDY

The aim of this study was to investigate acceptance and intention to use teledermatological application by means of a survey of general practitioners and dermatologists in Saxony (Germany). Considering the demographic development in Saxony and the low regional density of medical specialists, this federal state is particularly well suited for conducting a survey dealing with telemedicine.

METHODS

Based on a stratified random selection, 108 physicians were interviewed via self-administered postal or online questionnaire (60 general practitioners and 48 dermatologists, response rate: 23.5%). The theory of acceptance and use of technology (UTAUT) was applied to teledermatology. Four central hypotheses were deduced and tested with logistic regressions.

RESULTS

The tested hypotheses postulating relationships between performance expectancy, effort expectancy, social influence and facilitating conditions and the intention to use teledermatology were partly confirmed. In addition, teledermatology was shown to have potential among Saxon general practitioners, as 9.5% of their patients came to the medical office for treatment of skin diseases; 78% of general practitioners offered skin cancer screenings.

CONCLUSION

The population structure and the low density of medical specialists in Saxony would be favourable prerequisites for the implementation of teledermatology. Survey results failed to show any reservations of general practitioners and dermatologists towards teledermatology.

Explainable Image Quality Assessments in Teledermatological Photography

Background and Objectives: Image quality is a crucial factor in the effectiveness and efficiency of teledermatological consultations. However, up to 50% of images sent by patients have quality issues, thus increasing the time to diagnosis and treatment. An automated, easily deployable, explainable method for assessing image quality is necessary to improve the current teledermatological consultation flow. We introduce ImageQX, a convolutional neural network for image quality assessment with a learning mechanism for identifying the most common poor image quality explanations: bad framing, bad lighting, blur, low resolution, and distance issues. Methods: ImageQX was trained on 26,635 photographs and validated on 9,874 photographs, each annotated with image quality labels and poor image quality explanations by up to 12 board-certified dermatologists. The photographic images were taken between 2017 and 2019 using a mobile skin disease tracking application accessible worldwide. Results: Our method achieves expert-level performance for both image quality assessment and poor image quality explanation. For image quality assessment, ImageQX obtains a macro F1-score of 0.73 ± 0.01, which places it within standard deviation of the pairwise inter-rater F1-score of 0.77 ± 0.07. For poor image quality explanations, our method obtains F1-scores of between 0.37 ± 0.01 and 0.70 ± 0.01, similar to the inter-rater pairwise F1-score of between 0.24 ± 0.15 and 0.83 ± 0.06. Moreover, with a size of only 15 MB, ImageQX is easily deployable on mobile devices. Conclusion: With an image quality detection performance similar to that of dermatologists, incorporating ImageQX into the teledermatology flow can enable a better, faster flow for remote consultations.

Human-Machine Collaboration in Diagnostics: Exploring the Synergy in Clinical Imaging with Artificial Intelligence

Advancements in artificial intelligence (AI), thanks to IT developments during the COVID-19 pandemic, have revolutionized the field of diagnostics, particularly in clinical imaging [...].

Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient's destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems.

Cutaneous larva migrans: A case report diagnosed using teledermatology

Teledermatology is a branch of dermatology that transmits medical data over several miles using telecommunications technologies. It involves the diagnosis of skin lesions using digital photographs and related patient data, and it can be especially helpful for patients in remote areas who might not have convenient access to dermatologists. Cutaneous larva migrans (CLM) is a zoonotic parasitic disease found in tropical and subtropical areas that are sunny and hot; however, cases of allocated resources have been disclosed in Saudi Arabia. There is little information about the frequency of CLM as a work-related illness among employees who are exposed to potentially polluted soil or have close contact with pets. In this paper, we present an ancestral case of CLM in Saudi Arabia, explaining the hazards of CLM infection. CLM may pose a challenge for physicians in non-endemic areas regarding assessment, therapeutic interventions, and protection, especially at work. The holistic strategy to CLM assessment, which includes the participation of numerous science competencies (e.g., veterinarians, dermatologists, and occupational physicians), may contribute to a better understanding of the expansion of human CLM and related risk factors, lowering the chance of infection.

Serial Dependence in Dermatological Judgments

Serial Dependence is a ubiquitous visual phenomenon in which sequentially viewed images appear more similar than they actually are, thus facilitating an efficient and stable perceptual experience in human observers. Although serial dependence is adaptive and beneficial in the naturally autocorrelated visual world, a smoothing perceptual experience, it might turn maladaptive in artificial circumstances, such as medical image perception tasks, where visual stimuli are randomly sequenced. Here, we analyzed 758,139 skin cancer diagnostic records from an online app, and we quantified the semantic similarity between sequential dermatology images using a computer vision model as well as human raters. We then tested whether serial dependence in perception occurs in dermatological judgments as a function of image similarity. We found significant serial dependence in perceptual discrimination judgments of lesion malignancy. Moreover, the serial dependence was tuned to the similarity in the images, and it decayed over time. The results indicate that relatively realistic store-and-forward dermatology judgments may be biased by serial dependence. These findings help in understanding one potential source of systematic bias and errors in medical image perception tasks and hint at useful approaches that could alleviate the errors due to serial dependence.

The Artificial Intelligence in Teledermatology: A Narrative Review on Opportunities, Perspectives, and Bottlenecks

Artificial intelligence (AI) is recently seeing significant advances in teledermatology (TD), also thanks to the developments that have taken place during the COVID-19 pandemic. In the last two years, there was an important development of studies that focused on opportunities, perspectives, and problems in this field. The topic is very important because the telemedicine and AI applied to dermatology have the opportunity to improve both the quality of healthcare for citizens and the workflow of healthcare professionals. This study conducted an overview on the opportunities, the perspectives, and the problems related to the integration of TD with AI. The methodology of this review, following a standardized checklist, was based on: (I) a search of PubMed and Scopus and (II) an eligibility assessment, using parameters with five levels of score. The outcome highlighted that applications of this integration have been identified in various skin pathologies and in quality control, both in eHealth and mHealth. Many of these applications are based on Apps used by citizens in mHealth for self-care with new opportunities but also open questions. A generalized enthusiasm has been registered regarding the opportunities and general perspectives on improving the quality of care, optimizing the healthcare processes, minimizing costs, reducing the stress in the healthcare facilities, and in making citizens, now at the center, more satisfied. However, critical issues have emerged related to: (a) the need to improve the process of diffusion of the Apps in the hands of citizens, with better design, validation, standardization, and cybersecurity; (b) the need for better attention paid to medico-legal and ethical issues; and (c) the need for the stabilization of international and national regulations. Targeted agreement initiatives, such as position statements, guidelines, and/or consensus initiatives, are needed to ensure a better result for all, along with the design of both specific plans and shared workflows.

Teledermatology for Common Inflammatory Skin Conditions: The Medicine of the Future?

BACKGROUND

The COVID-19 pandemic period revolutionized daily clinical practice. Several strategies were adopted by clinicians to avoid reducing treatment for diseases without the risk of spreading the infection. Among the adopted strategies, telemedicine played a key role. In this scenario, several tools were used, including e-mails, phone calls, video calls, support groups, and messages. Fortunately, the COVID-19 pandemic period seems to be at an end. However, the use of teledermatology appears to be an excellent strategy for the future as well. Indeed, several patients may benefit from teledermatology.

OBJECTIVE

In this manuscript, we aim to investigate the use of telemedicine in the dermatological field to point out how this tool may become the mainstay of future medicine. Only the use of teledermatology with common inflammatory skin conditions have been reported herein.

MATERIALS AND METHODS

Investigated manuscripts included metanalyses, reviews, letters to the editor, real-life studies, case series, and reports. Manuscripts were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines.

RESULTS

A total of 121 records were identified from the analyzed databases. However, only 110 articles were assessed for eligibility. Finally, 92 articles were selected at the end of the literature research for our review.

CONCLUSIONS

Teledermatology should be considered as a viable option for the dermatologist for the future. We believe that the pandemic has strengthened this service, and this will allow for ever better development in the future. Guidelines regarding the use of teledermatology are required as well as additional improvements for the future.

Psoriasis in teledermatology: analysis of the 2016‒2020 period in Santa Catarina

BACKGROUND

Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care.

OBJECTIVE

To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC).

METHODS

Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05).

RESULTS

During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001).

STUDY LIMITATIONS

The TD service is available only for the public health network and analysis for a limited period (five years).

CONCLUSIONS

Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level.

Limited Access to Dermatology Specialty Care: Barriers and Teledermatology

INTRODUCTION

Access to dermatology specialty care is limited in the underserved population. Barrier identification and exploring the potential role of teledermatology are the first steps to address this problem.

OBJECTIVES

Identify the barriers to dermatologist care for the diagnosis and treatment of melanoma and non-melanoma skin cancers in the underserved population. Additionally explored was the potential role of teledermatology to provide dermatology care access in the underserved population.

METHODS

A quantitative descriptive study was conducted via an online survey instrument. The survey's barriers portion was adapted from the 1998 Ohio Family Health Survey (OFHS). The survey's teledermatology portion was adapted from the McFarland Teledermatology Provider and Imaging Technician Satisfaction Survey. The participants were practicing dermatologists and members of Georgia, Missouri, Oklahoma, and Wisconsin dermatology associations. Thirty-eight responded to demographic questions, of which twenty-two responded to the survey items.

RESULTS

The top three barriers ranked as the most concerning were "continually uninsured" (n = 8; 36.40%), "resides in a medically underserved county" (n = 5; 22.70%), and "family under federal poverty level" (n = 7; 33.30%). Teledermatology as a potential role for access to care was supported by convenient delivery of healthcare (n = 6; 72.70%), an addition to regular patient care (n = 20; 90.90%), and increase to patient care access (n = 18; 81.80%).

CONCLUSION

Barrier identification and teledermatology access to provide care to the underserved population is supported. Further teledermatology research is necessary to address the logistics regarding how to initiate and deliver teledermatology to the underserved.

The Role of Teledermatology During the COVID-19 Pandemic: A Narrative Review

Teledermatology represented one of the most important and useful tools during the COVID-19 pandemic era. Indeed, due to the severe restriction, and to reduce the spread of the infection, different measures were applied among different countries and hospitals to ensure a continuity of care for patients. In this scenario, teledermatology played a central role, especially in the management of patients suffering from chronic inflammatory skin diseases. The aim of this narrative review is to describe the role of teledermatology during the COVID-19 pandemic to analyze main strengths and limitations of this tool, as well as to provide future perspectives in clinical applications.

Deep learning for dermatologists: Part II. Current applications

Because of a convergence of the availability of large data sets, graphics-specific computer hardware, and important theoretical advancements, artificial intelligence has recently contributed to dramatic progress in medicine. One type of artificial intelligence known as deep learning has been particularly impactful for medical image analysis. Deep learning applications have shown promising results in dermatology and other specialties, including radiology, cardiology, and ophthalmology. The modern clinician will benefit from an understanding of the basic features of deep learning to effectively use new applications and to better gauge their utility and limitations. In this second article of a 2-part series, we review the existing and emerging clinical applications of deep learning in dermatology and discuss future opportunities and limitations. Part 1 of this series offered an introduction to the basic concepts of deep learning to facilitate effective communication between clinicians and technical experts.

Using teledermatology to prevent and diagnose skin cancer in the rural United States

ABSTRACT

In the United States, skin cancer is a prevalent and sometimes preventable form of cancer that causes a significant disease burden in rural and urban communities. Studies have shown, however, that rural residents are less likely to engage in primary prevention behaviors against skin cancer, and rural populations have higher skin cancer incidence and mortality than urban residents. Teledermatology can be used to address disparities in both skin cancer diagnosis and health education to improve dermatology outcomes in rural communities. This article reviews teledermatology formats, barriers, and benefits to encourage integration of teledermatology modalities into clinical practice.

Concordance and Accuracy of Teledermatology Using Mobile Phones in the Outpatient Clinic of Jose R Reyes Memorial Medical Center: Cross-sectional Study

BACKGROUND

Dermatologists rely on visual findings; thus, teledermatology is uniquely compatible to providing dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data are sent to a distant health provider for later review, may be a potential bridge in seeking dermatologic care.

OBJECTIVE

This study aimed to determine the agreement between face-to-face consultations and teledermatologic consultations through the store-and-forward approach using mobile phones and its accuracy compared to a histopathologic diagnosis.

METHODS

The study design was a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard smartphone (iPhone 6s Plus), and a 4-mm skin punch biopsy was taken on each patient-the gold standard to which the study result was compared to. The photographs were sent to 3 consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan.

RESULTS

A total of 60 patients were included, with a median age of 41 years. There was moderate-to-almost perfect agreement in terms of final diagnosis between the face-to-face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (κ=0.84; P<.001). Among the 3 dermatologists, there was moderate-to-almost perfect agreement as well. Agreement between pairs of teledermatologists ranged from 0.45 to 0.84. The 3 teledermatologists had moderate-to-substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (κ=0.77; P<.001). Overall, there was a moderate agreement in the diagnosis of patients across raters.

CONCLUSIONS

Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate-to-substantial agreement in diagnoses from a face-to-face consultation and store-and-forward teledermatology.

Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID-19 pandemic: A pilot programme

BACKGROUND

Elderly patients in senior communities faced high barriers to care during the COVID-19 pandemic, including increased vulnerability to COVID-19, long quarantines for clinic visits, and difficulties with telemedicine adoption.

OBJECTIVE

To pilot a new model of dermatologic care to overcome barriers for senior living communities during the COVID-19 pandemic and assess patient satisfaction.

METHODS

From 16 November 2020 to 9 July 2021, this quality improvement programme combined in-residence full body imaging with real-time outlier lesion identification and virtual teledermatology. Residents from the Sequoias Portola Valley Senior Living Retirement Community (Portola Valley, California) voluntarily enroled in the Stanford Skin Scan Programme. Non-physician clinical staff with a recent negative COVID-19 test travelled on-site to obtain in-residence full body photographs using a mobile app-based system on an iPad called SkinIO that leverages deep learning to analyse patient images and suggest suspicious, outlier lesions for dermoscopic photos. A single dermatologist reviewed photographs with the patient and provided recommendations via a video visit. Objective measures included follow-up course and number of skin cancers detected. Subjective findings were obtained through patient experience surveys.

RESULTS

Twenty-seven individuals participated, three skin cancers were identified, with 11 individuals scheduled for a follow up in-person visit and four individuals starting home treatment. Overall, 88% of patients were satisfied with the Skin Scan programme, with 77% likely to recommend the programme to others. 92% of patients agreed that the Skin Scan photographs were representative of their skin. In the context of the COVID-19 pandemic, 100% of patients felt the process was safer or comparable to an in-person visit. Despite overall appreciation for the programme, 31% of patients reported that they would prefer to see dermatologist in-person after the pandemic.

CONCLUSIONS

This programme offers a framework for how a hybrid skin scan programme may provide high utility for individuals with barriers to accessing in-person clinics.

Usefulness of Smartphones in Dermatology: A US-Based Review

(1) Background: As smartphones have become more widely used, they have become an appealing tool for health-related functions. For dermatology alone, hundreds of applications (apps) are available to download for both patients and providers. (2) Methods: The Google Play Store and Apple App Store were searched from the United States using dermatology-related terms. Apps were categorized based on description, and the number of reviews, download cost, target audience, and use of AI were recorded. The top apps from each category by number of reviews were reported. Additionally, literature on the benefits and limitations of using smartphones for dermatology were reviewed. (3) Results: A total of 632 apps were included in the study: 395 (62.5%) were marketed towards patients, 203 (32.1%) towards providers, and 34 (5.4%) towards both; 265 (41.9%) were available only on the Google Play Store, 146 (23.1%) only on the Apple App Store, and 221 (35.0%) were available on both; and 595 (94.1%) were free to download and 37 (5.9%) had a cost to download, ranging from USD 0.99 to USD 349.99 (median USD 37.49). A total of 99 apps (15.7%) reported the use of artificial intelligence. (4) Conclusions: Although there are many benefits of using smartphones for dermatology, lack of regulation and high-quality evidence supporting the efficacy and accuracy of apps hinders their potential.

Patient perception and satisfaction with a smartphone-based teledermatology service initiated during the COVID-19 pandemic at a tertiary care hospital in North India

BACKGROUND

Telemedicine is being increasingly used to provide healthcare to patients, particularly during the COVID-19 pandemic.

AIMS

The study aimed to study patient perception and satisfaction with a smartphone-based hybrid teledermatology service initiated during the COVID-19 pandemic.

METHODS

This was a cross-sectional telephonic survey including patients ≥18 years of age who had received a teledermatology consultation. After noting the demographic, clinical and teleconsultation details, patients were administered the Telemedicine Satisfaction Questionnaire and an additional 6-item questionnaire. Patients were also asked to give qualitative feedback and suggestions for improvement using a semi-structured interview guide.

RESULTS

We interviewed 201 subjects. The most common diagnoses were pemphigus (27, 13.4%), superficial fungal infections (24, 11.8%), psoriasis (22, 10.9%) and dermatitis (21, 10.4%). The overall mean Telemedicine Satisfaction Questionnaire score was 4.20± 0.71. One hundred seventy-one (85.1%) patients responded that they would use teledermatology services again, while 168 (83.6%) reported satisfaction with the quality of services. A majority of the patients were largely satisfied with the various components involved, though some concerns were raised about the care perceived as not at par with physical consultations, difficulty in procuring medicines, lack of confidence in photographic diagnoses and the lack of a personal touch. Patients with urticaria (P=0.020), those who were advised a change in treatment (P=0.029) and those with improvement in their skin disease (P=0.026) were more likely to be satisfied.

LIMITATIONS

Our study was conducted during the COVID-19 pandemic when patient acceptability was likely to be higher. Only follow-up patients were included in the study.

CONCLUSION

Patient satisfaction levels were generally high with teledermatology. Addressing lacunae that negatively impact patient perception and satisfaction will help in greater acceptance of teledermatology services.

Teledermatologie: Fluch oder Segen?

Teledermatologische Dienste haben sich insbesondere während der COVID-19-Pandemie als Alternative zu „Echt“visiten verbreitet. Der Mangel an Dermatologen und die Möglichkeit einer präzisen Diagnose auch bei unterversorgten Regionen macht diese Alternative für alle Beteiligten besonders attraktiv. Trotzdem ist der Bedarf an Schulungen des Personals und der Anwender hoch. Ebenfalls können Implementierungs-, Instandhaltungs- und Wartungskosten der notwendigen Ausrüstung und die Heterogenität der unterschiedlichen Anbieter nachteilig für Patient und Arzt sein. In diesem Artikel werden wesentliche Vorteile und Nachteile der Teledermatologie zusammengefasst.

The Use of Teledermatology in Medical Education

Certain aspects of medical education have transitioned to virtual platforms since the start of the COVID-19 pandemic. This commentary explores advantages and barriers to teledermatology in medical education, which has the potential to reach an extensive pool of learners and preceptors but may be limited by logistical and security considerations of a virtual platform. Dermatology in particular lends itself to an online platform as a highly visual specialty, although clinical exam would be highly dependent on quality of images captured. With teledermatology, learners can begin developing an approach to delivering care remotely, and becoming accustomed to virtual platforms.

Chronic Wound Telemedicine Models Before and During the COVID-19 Pandemic: A Scoping Review

GENERAL PURPOSE

To present the results of a scoping review exploring chronic wound care telemedicine before and during the pandemic, including the characteristics of the models implemented.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Identify the characteristics of the studies the authors examined for their scoping review of chronic wound care telemedicine.2. Choose the electronic methods commonly used for wound care telemedicine in the studies the authors examined.3. Recognize the implications for the patients who participated in chronic wound care telemedicine in the studies the authors examined.

ABSTRACT

OBJECTIVETo explore different chronic wound telemedicine models and identify current research on this topic.METHODSThe authors searched the MEDLINE and EMBASE databases on August 10, 2021 and identified 58 articles included in the analysis.RESULTSIncluded studies were published between 1999 and 2021, with more than half of the studies published between 2015 to 2019 (25.9%, n = 15/58) and 2020 to 2021 (25.9%, n = 15/58). There were 57 models identified, of which 87.7% (n = 50/57) used a blended model of care. Image assessment was the most common element in blended care (66.0%, n = 33/50), followed by video consultation (46.0%, n = 23/50), text (44.0%, n = 22/50), and telephone consultation (22.0%, n = 11/50). Purely virtual care was used in 12.3% (n = 7/57) of models, 85.7% (n = 6/7) of which were implemented during the COVID-19 pandemic. Most studies conducted a quantitative analysis (62.1%, n = 36/58); 20.7% (n = 12/58) conducted a qualitative analysis, and 17.2% (n = 10/58) conducted both. The most frequently assessed results were wound outcomes (53.4%, n = 31/58) and patient opinions (25.9%, n = 15/58).CONCLUSIONSChronic wound care-related telemedicine has common elements: image assessment, video and telephone consultation, and text-based information that can be combined in a variety of ways with unique implementation barriers. Blended care models are more common than purely virtual alternatives. Heterogeneity among outcomes and reporting methods make the results difficult to synthesize.

Teledermatology in the time of COVID-19

AIMS

The enormous spread of the novel Corona virus disease (COVID-19) represents a challenge to dermatological practice. Accumulating evidence has suggested a possible role of teledermatology in facing this challenge. In this article, we aimed to give a general overview of teledermatology in terms of models of practice, modes of delivery, advantages, limitations, ethical considerations and legislative challenges as well as discussing, using examples from literature, how dermatological practice can benefit from teledermatology during the time of the COVID-19 pandemic.

DISCUSSION AND CONCLUSION

Teledermatology could be an accessible, accurate and cost-effective substitute for conventional face-to-face dermatological consultations during the COVID-19 pandemic. However, teledermatology practice needs updated legislation and guidelines. More efforts should be done to encourage dermatologists, especially in underserved communities, to provide teledermatology services. Ethical issues and data security related to teledermatology have to be considered.

Economic assessment of teledermatology in the state of Santa Catarina - Brazil

OBJECTIVES

In locations with poor public dermatology services, teledermatology emerges as a viable way to fill this need. Thus, the aim was to estimate how much could be saved with the use of teledermatology in the state of Santa Catarina, Brazil, from 2015 to 2018.

STUDY DESIGN

Observational study of the analytical type with a cross-sectional design and collection of secondary data in electronic media.

METHODS

A total of 95,828 teledermatology test protocols from the period were evaluated. The amount that would be necessary to refer all the patients of the several regions of the state for evaluation by General Dermatology (secondary network) was estimated, as it occurred before the deployment of teledermatology, considering the cost of displacement, consultation with a specialist, cost aid and opportunity cost of patients and companions. This amount was compared with the amount effectively spent on the screening deployment via teledermatology.

RESULTS

There was a minimum savings of $1,170,550.82 during the period, with an average cost savings of $21.94 per protocol not forwarded to the secondary network. The greater the distance and time spent to evaluate the patient by a specialist, the greater the savings.

CONCLUSIONS

Teledermatology provides savings in public resources, reduces the number of patient referrals, and improves the dermatological assistance provided to the population of Santa Catarina. This is a relevant and efficient health technology.

Perspectives on the Future Development of Mobile Applications for Dermatology Clinical Research

The COVID-19 pandemic significantly impacted clinical research in dermatology and practices around the country transitioned to teledermatology amid physical distancing requirements. Despite their growing use in teledermatology and clinical care, dermatology applications have not been studied extensively in the research space. The use of mobile applications has the potential to improve the experience of study subjects and physicians and increase the pool of individuals willing to participate in research beyond the pandemic. We discuss the various pros and cons of mobile apps, as well as the necessary components they require to successfully conduct research.

Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology: A Prospective Multicenter Validation Study

OBJECTIVES

This study aimed to validate dermatologic ultrasound as a complementary teledermatologic imaging modality in primary and tertiary care centers.

METHODS

Six primary care centers and 1 tertiary care dermatology department collaborated in the program. Images were sent through the institutional teledermatologic platform to the tertiary care dermatology department. At the reference hospital, ultrasound images and clinical data were received and registered by a physician trained in dermatologic ultrasound. An in-person consultation was scheduled to confirm the teleultrasound diagnosis. The time of response by the tertiary center, quality and size of the teledermatologic image, and concordance with the in-person diagnosis were assessed for each dermatologic lesion.

RESULTS

A total of 147 teleultrasound consultations with 143 patients (93 women and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and January 2019. Nine teleultrasound consultations (6.1%) were not valid. Discordance between teleultrasound and the in-person diagnosis was evident in 6 of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 100%), although 2 cases of benign lesions were telediagnosed as malignant (specificity, 97.8%). The positive and negative predictive values of a teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, respectively.

CONCLUSIONS

Asynchronous primary care teleultrasound combined with dermatologic ultrasound training at tertiary centers is an effective teledermatologic modality.

The Increasing Scope of Teledermatology in Nepal

Teledermatology is a rising subspecialty that uses information and communications technologies to diagnose, prevent, treat, and educate skin health. It is an innovative means for delivering quality dermatological care. It embraces the potentials for revolutionizing dermatologic consultation to remote locations in Nepal, where service by dermatologists is almost impossible. By adopting advances in telecommunication, wider and faster coverage of the internet and smartphones, computers, laptops, and high-resolution cameras, the era of teledermatology is changing even in lower-income countries like Nepal. It has emerged as a boon in skin healthcare to rural and even urban care in the recent coronavirus pandemic but would never replace traditional consultations. The challenges faced by teledermatology are lack of technical expertise and proper implementation of guidelines, diagnostic limitations, and various medico-legal aspects. This article presents a brief review of teledermatology in Nepal.

Impact of COVID-19 Pandemic on Dermatology Practice in India

Background:

COVID-19 pandemic has disrupted healthcare systems throughout the globe. It has affected dermatology practice to a great extent. Since most of the consultations (except emergencies) in dermatology are deferred as a precautionary measure, dermatologists have taken the route of virtual appointments in order to continue treating patients in the present lockdown state. However, the concept of telemedicine is quite new for doctors as well as for patients in India.

Material and Methods:

An online questionnaire was circulated among Indian dermatologists which included participant demographics, changes in their practice and teaching during COVID-19, use of virtual or e-health technologies, and attitudes/opinions on their experiences. We also wanted to understand doctor perspectives on their own roles, wellness, and hospital responses to the pandemic.

Results:

A total of 260 responses from qualified dermatologists of different parts of India were received between 1^st and 8^th April 2020 and were analyzed. Two-thirds of the respondents were within 10 years of starting practice. Virtual consultations have increased by almost three-fold during the pandemic, which is a major change noticed in the practice when we compare before and during the pandemic. Earlier the focus of teledermatology (TD) was mainly for follow-up care (85%), whereas during the pandemic, both new and follow-up patients were provided virtual consultations. The number of patients coming to them for a consultation has drastically reduced. Only 2% of the responders are still performing minor procedures with proper care. Almost two-thirds do not have systems in place to train their residents and fellows due to the disruptions caused by the pandemic. The rest of them have started to take the virtual route of teaching through webinars, virtual rounds, and providing access to online journals to continue their teaching. Only 18.6% of dermatologists at work were provided with personal protective equipment. TD has opened new doors to virtual consultation and it was evident that 54.4% of doctors are willing to continue it in the future even after the pandemic is over.

Conclusion:

TD platforms hold great promise to improve access to high-quality dermatologic care in the future. Results from this survey of Indian dermatologists suggest that TD is the future of dermatology as it will be accessed by patients in remote areas and it is a cost-effective move for the patients.

Teledermatology: current indications and considerations for future use

Telemedicine is one of the most consequential technologies in modern healthcare. In certain situations, it allows for the delivery of care with high quality and minimal difficulty. This is particularly true in dermatology, in which many dermatological conditions can be treated remotely. The burden on dermatology patients has been greatly reduced for certain pathologies due to telemedicine. Health care providers also achieve improved job satisfaction following the convenience of meeting their patients. This paper details select dermatological conditions, and subsequently divides them into those treatable by telemedicine appointments, and those requiring face to face appointments.

Definitions, survey methods, and findings of patient satisfaction studies in teledermatology: a systematic review

Remote consultations likely will grow in importance if the COVID-19 pandemic continues. This review analyzes which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys and concluded patients respond to the different modalities of teledermatology. Using PubMed and Cochrane databases, we reviewed studies from April 5th, 2010 to April 5th, 2020 that included the search terms patient satisfaction and teledermatology. All studies that included patient satisfaction as an outcome were included, but studies not published in English were excluded. We examined domains of satisfaction, survey method, study characteristics (including patient population, country, age, study design and evidence score), findings and statistical comparisons. We thoroughly reviewed 23 studies. Definitions of satisfaction varied, but all concluded patients were satisfied with the live-interactive and store-and-forward modalities. The studies reveal that store-and-forward is appropriate for clinicians with established patients who require regular follow-up. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring, and post-procedural follow-up. Only four studies conducted statistical analyses. One of those studies compared patient preference for each modality of teledermatology with face-to-face dermatology. While this study reported high satisfaction with each mode of teledermatology, patients still preferred face-to-face. Favorable responses to remote diagnostic capabilities suggest that these offerings improve preference for teledermatology. With only one study evaluating preference between each modality and face-to-face dermatology, more studies should address the discrepancy. Surveys that cover all domains of satisfaction may improve assessments and identify where gaps in preference exist.