The main added value of teledermatology is to ensure a wider access to specialist skin care (“Telemedicine is a way of moving patient’s information rather than patients”[1]).
Developed in Portland, Oregon in 1995 by the dermatologists Perednia and Brown as an application of telemedicine, recently teledermatology is experiencing a remarkable growth due to a large availability of smartphones, computers and other Internet connected devices, their portability, affordable cost and efficiency.
From a technological perspective three models of teledermatology could be implemented:
- Store and forward method.
- Real time videoconferencing.
- A hybrid of the above.
The greatest benefit of the “store and forward” approach is the separation between the time of the acquisition of the image and the time of its assessment by the dermatologist; it avoids any interference with the daily workflow. Store & forward does not need for high-speed Internet connection; on the contrary high resolution and quality of the images are important features.
The real time video conferencing method has the advantage of a direct connection and interaction between the patient and the clinician but the availability of patient and physician at the same time is needed; in addition, video conferencing is highly dependent on the Internet connection and could be expensive because of technical issues.
Application on teledermatology
Among the applications:
- Remote provision of clinical services including diagnosis directly to the patient (primary teledermatology).
- Consultation among healthcare providers e.g. collaboration between a referrer and a specialist (secondary teledermatology).
- second opinion between two or more specialists (tertiary teledermatology).
- Monitoring of the patient’s health conditions and of the evolution of suspicious lesions (follow up).
- Triage (prioritization of patients and assessment of the need for in-person visits).
- Remote access to educational resources.
The fig. 1 shows how the interaction between the patient and the dermatologist could be:
- Direct through the use by the patient of his/her smartphone together with an app.
- Mediated by a medical professional (e.g. the GP or the nurse in a pharmacy).
Typically, in the first case the images are photos of the involved lesion(s); only in few cases the patients have available a smartphone add-on allowing to take dermoscopic images. On the contrary in the “mediated interaction” a dermatoscope is typically used for the acquisition of the images.
Covid-19 and the teledermatology
A recent survey[2] among dermatologists (434 respondents of 49 countries, mainly from Europe (85%)) reported that during the pandemic the users of teledermatology (TD) increased to 87%; before the pandemic they represented the 54% of the total number of interviewed dermatologists but only the 19% of them with a regular use.
Today - according to the survey - only 12% of the dermatologists are against the use of TD; they judge it inadequate to make a diagnosis.
[1] E. Tensen,. P. van der Heijden, M. W. M. Jaspers, L. Witkamp - Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems - Current Dermatology Reports - June 2016, Volume 5, Issue 2, pp 96–104.
1 P. Pala et al. – Teledermatology: idea, benefits and risks of modern age – A systematic review based on melanoma – Postepy Dermatol Alergol 2020 April; 37 (2):159-167; dpo: 10.5114/ada.2020.94834
[2] E. Moscarella, X P. Pasquali, E. Cinotti, L. Tognetti, G. Argenziano, P. Rubegni - A survey on teledermatology use and doctors’ perception in times of COVID-19 – a letter published in the Journal of European Academy of Dermatology and Venereology - JEADV 2020, 34, e755–e853.