COVID-19 and the need for teledermatology and telemedicine
Most Recent Teledermatology Updates
1. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021153. doi: 10.5826/dpc.1101a153.
eCollection 2021 Jan.
Impact of the COVID-19 Pandemic on Dermatology Practice Worldwide: Results of a
Survey Promoted by the International Dermoscopy Society (IDS).
Conforti C(1), Lallas A(2), Argenziano G(3), Dianzani C(4), Di Meo N(1),
Giuffrida R(5), Kittler H(6), Malvehy J(7), Marghoob AA(8), Soyer HP(9)(10),
Zalaudek I(1).
Author information:
(1)Department of Dermatology and Venereology, Dermatology Clinic, Maggiore
Hospital, University of Trieste, Italy.
(2)First Dermatology Department, Aristotle University of Thessaloniki, Greece.
(3)Department of Dermatology, University of Campania, Luigi Vanvitelli, Naples,
Italy.
(4)Dermatology Section, Plastic and Reconstructive Surgery Unit, Campus
Biomedico University, Rome, Italy.
(5)Department of Clinical and Experimental Medicine, Dermatology, University of
Messina, Italy.
(6)Department of Dermatology, Medical University of Vienna, Austria.
(7)Dermatology Department, Melanoma Unit, Hospital Clinic, University of
Barcelona, Spain.
(8)Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer
Center, New York, NY, USA.
(9)The University of Queensland Diamantina Institute, The University of
Queensland, Dermatology Research Centre, Brisbane, QLD, Australia.
(10)Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD
Australia.
INTRODUCTION: The International Dermoscopy Society (IDS) conducted an online
survey to investigate the impact of coronavirus disease 2019 (COVID-19) outbreak
on the daily practice of dermatologists working with skin cancer patients, to
collect data regarding the frequency of skin manifestations noticed by the
members, and to obtain information about the use of teledermatology during the
pandemic.
METHODS: All IDS members were asked to fill in a questionnaire, sent by email. A
questionnaire available in English was sent to all IDS members (≈16.0000
members) by email. The questionnaire was anonymous, with a compiling time of
less than 5 minutes. The survey was open for 30 days (from April 24, 2020 to May
24, 2020) and it could only be filled out once.
RESULTS: Overall, 678 dermatologists responded to the questionnaire; 334 members
stated that there has been a reduction of more than 75% in daily work activity
during the pandemic, 265 dermatologists worked fewer days per week, and 118
experienced telemedicine for the first time. Acrodermatitis was the most
frequently observed skin manifestation (n = 80) followed by urticarial rash (n =
69), morbilliform rash (n = 53) and purpuric manifestation (n = 40). In regard
to the role of teledermatology, 565 dermatologists reported an increased number
of teleconsultations, and the number of melanomas diagnosed during the pandemic
was practically 0 for 385 (56.78%) of respondents.
CONCLUSION: This survey highlights that the outbreak had a negative impact on
most dermatology services, with a significant reduction in consultation time
spent for chronic patients, and an increased risk of missed melanoma and
nonmelanoma skin cancer (NMSC) diagnosis. Moreover, our study confirms earlier
findings of a wide range of skin manifestations associated with COVID-19.
DOI: 10.5826/dpc.1101a153
PMCID: PMC7875667
PMID: 33614221
2. J Cutan Med Surg. 2021 Feb 16:1203475421993783. doi: 10.1177/1203475421993783.
Online ahead of print.
Medical Student and Resident Dermatology Education in Canada During the COVID-19
Pandemic.
Ladha MA(1), Lui H(2), Carroll J(3), Doiron P(3), Kirshen C(4), Wong A(2), Purdy
K(5).
Author information:
(1)2129 Division of Dermatology, Department of Medicine, University of Calgary,
Alberta, Canada.
(2)8166 Department of Dermatology and Skin Science, University of British
Columbia, Vancouver, Canada.
(3)79387989 Division of Dermatology, Department of Medicine, University of
Toronto, Canada.
(4)6363 Division of Dermatology, Department of Medicine, The Ottawa Hospital,
University of Ottawa, Canada.
(5)2338263688 Division of Dermatology, Department of Medicine, Dalhousie
University, Halifax, Canada.
The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical
distancing recommendations created major gaps in traditional dermatologic
undergraduate and postgraduate medical education delivery. Nevertheless, the
educational consequences of various public health restrictions have indirectly
set aside the inertia, resistance, and risk averse approach to pedagogical
change in medicine. In Canada, rapid collaboration and innovation in
dermatologic education has led to novel programs including the implementation of
a range of internet-facilitated group learning activities and a dramatic
expansion of digital telehealth and virtual care. Going forward, three key
issues arising from these developments will need to be addressed: the ongoing
assessment of these innovations for efficacy; sustaining the momentum and
creativity that has been achieved; and, determining which of these activities
are worth maintaining when traditional "tried and true" learning activities can
be resumed.
DOI: 10.1177/1203475421993783
PMID: 33593087
3. Clin Exp Dermatol. 2021 Feb 12. doi: 10.1111/ced.14606. Online ahead of print.
The "coloring wipes" phenomenon: a peculiar skin pigmentation induced by
ascorbic acid observed during lockdown.
Guglielmo A(1), Virdi A(1), Vincenzi C(1), Zanotti Russo M(2), Sechi A(1),
Patrizi A(1), Neri I(1).
Author information:
(1)Dermatology - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of
Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum,
University of Bologna, Italy, Bologna.
(2)Angel Consulting SAS, via S.Senatore, 14-20122, Milano, Italy.
During the SARS-CoV-2 pandemic, an outbreak of children with yellow-to-brown
pigmentation on the skin was observed. Because of the restrictions on movements
promulgated during the lockdown, most consultancies were performed using
teledermatology. Data concerning personal care products and topical substances
application were collected revealing the use of the same brand of wipes in all
the patients. A liquid chromatography-mass spectrometry analysis was performed
to compare the components of the wipes before and after the observation of the
pigmentation, in order to detect the responsible substance revealing a level
about ten fold higher of ascorbic acid and its oxidation products
(dehydroascorbic acid and L-threonic acid) in the wipes associated with the
pigmentation. The "coloring wipes" represented a peculiar but harmless
phenomenon that highlights the importance of a careful collection of personal
care products used by patients.
This article is protected by copyright. All rights reserved.
DOI: 10.1111/ced.14606
PMID: 33577095
4. Dermatology. 2021 Feb 10:1-6. doi: 10.1159/000514029. Online ahead of print.
Teledermatology in Times of COVID-19 Confinement: Comparing Patients' and
Physicians' Satisfaction by the Standardized Brest Teledermatology
Questionnaire.
Fluhr JW(1)(2)(3), Gueguen A(4), Legoupil D(5)(4), Brenaut E(5)(4), Abasq
C(5)(4), Araújo H(5), Misery L(5)(4).
Author information:
(1)Univ Brest, LIEN, Brest, France, joachim.fluhr@gmx.net.
(2)Department of Dermatology, CHRU Brest, Brest, France, joachim.fluhr@gmx.net.
(3)Department of Dermatology, Charité - Universitätsmedizin, Berlin, Germany,
(4)Department of Dermatology, CHRU Brest, Brest, France.
(5)Univ Brest, LIEN, Brest, France.
The French government imposed the first COVID-19 pandemic lockdown from March 17
until May 11, 2020. Only emergency cases and teledermatology (TD) were allowed
in outpatient settings. A standardized questionnaire was developed to compare
the satisfaction level of patients and their treating physicians. Our main
question was whether the patients would perceive TD as a valid alternative for
direct physical face-to-face consultation. Eighty-two patients and their 4
treating dermatologists from one dermatology department participated in the
study (43 females, 39 males) with a mean age of 46.6 years (SD ±23.9). The
reason for TD was a chronic disease in the majority (87.8%), and mainly as a
follow-up (96.3%). Regarding satisfaction, almost all categories rated around 9
on a 0-10 verbal analogue scale. The same level of global satisfaction could be
seen between the patients and the physicians as well as for the quality of the
patient-physician relation and whether all questions could be addressed during
the TC. Physicians showed significantly higher scores than patients only for the
category of "length" of the consultation. Gender, age, as well as distance
between the clinic and home of the patient were not influencing factors for
satisfaction. Regarding the technical parameters, the evaluation was mostly
comparable for patients and physicians, but overall lower than the relational
satisfaction parameters, especially for image quality. Patients were
significantly more motivated to continue the TD after the lockdown than their
treating dermatologists. We see an interest for implementing TD in specialized
centers with chronic patients coming from remote places for regular follow-ups.
TD cannot replace in-person patient-physician interaction, but was helpful
during the lockdown. As a result, TD might become part of dermatology training
to prepare for future lockdown situations.
© 2021 The Author(s) Published by S. Karger AG, Basel.
DOI: 10.1159/000514029
PMID: 33567427
5. J Drugs Dermatol. 2021 Feb 1;20(2):178-183. doi: 10.36849/JDD.2021.5714.
Patient Perceptions and Satisfaction With Teledermatology During the COVID-19
Pandemic: A Survey-Based Study.
Yeroushalmi S, Millan SH, Nelson K, Sparks A, Friedman AJ.
BACKGROUND: The COVID-19 pandemic has drastically changed the practice of
dermatology as social distancing guidelines have led to a shift from in-office
care to virtual telehealth (teledermatology). We aimed to determine patient
satisfaction, perceived barriers, as well as indications for teledermatology
appointments during the COVID-19 pandemic.
METHODS: A survey was sent out via SurveyMonkey's online platform to patients of
the George Washington Medical Faculty Associates' Dermatology department who
attended telehealth appointments during the COVID-19 pandemic.
RESULTS: Out of 894 invitations sent, 168 patients completed our survey.The most
common reasons for making a telehealth appointment were for a new rash (11.6%),
eczema (9.8%), and psoriasis (9.1%). The most common reasons respondents liked
telehealth were because of time efficiency (81.1%), not requiring transportation
(74.2%), and maintaining social distancing (73.6%). The most common reasons
respondents did not like telehealth were due to lack of physical touch (26.8%)
and feeling they received an inadequate assessment (15.7%). Very few patients
reported that they were unlikely to undertake another telehealth visit (9.94%)
or recommend a telehealth visit to others (6.92%).
CONCLUSION: Dermatology patients likely perceive telehealth visits as a
convenient and safe method for quality care during the COVID-19 pandemic. The
lack of physical touch, inability to provide close inspection and/or procedural
intervention can be frustrating for patients and therefore meaningful selection
of appropriate cases for telehealth visits can optimize the patient experience.
Overall, telemedicine represents an effective and safe vehicle for delivering
care especially during a global pandemic. J Drugs Dermatol. 2021;20(2):178-183.
doi:10.36849/JDD.2021.5714.
DOI: 10.36849/JDD.2021.5714
PMID: 33538563 [Indexed for MEDLINE]
6. JMIR Med Inform. 2021 Jan 27;9(1):e23454. doi: 10.2196/23454.
Assessing the International Transferability of a Machine Learning Model for
Detecting Medication Error in the General Internal Medicine Clinic: Multicenter
Preliminary Validation Study.
Chin YPH(1)(2), Song W(3), Lien CE(4), Yoon CH(1), Wang WC(5), Liu J(6), Nguyen
PA(2)(7), Feng YT(2), Zhou L(8), Li YCJ(#)(9)(10), Bates DW(#)(8)(11).
Author information:
(1)Department of Biomedical Informatics, Harvard Medical School, Boston, MA,
United States.
(2)College of Medical Science and Technology, Graduate Institute of Biomedical
Informatics, Taipei Medical University, Taipei City, Taiwan.
(3)Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States.
(4)Doctor of Public Health Program, Harvard TH Chan School of Public Health,
Boston, MA, United States.
(5)Department of Epidemiology, Harvard TH Chan School of Public Health, Boston,
MA, United States.
(6)Department of Emergency Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States.
(7)International Center for Health Information Technology, Taipei Medical
University, Taipei City, Taiwan.
(8)Division of General Internal Medicine and Primary Care, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States.
(9)Graduate Institute of Biomedical Informatics, College of Medical Science and
Technology, Taipei Medical University, Taipei City, Taiwan.
(10)Department of Dermatology, Taipei Municipal Wan Fang Hospital, Taipei City,
Taiwan.
(11)Clinical and Quality Analysis, Information Systems, Partners HealthCare,
Somerville, MA, United States.
(#)Contributed equally
BACKGROUND: Although most current medication error prevention systems are
rule-based, these systems may result in alert fatigue because of poor accuracy.
Previously, we had developed a machine learning (ML) model based on Taiwan's
local databases (TLD) to address this issue. However, the international
transferability of this model is unclear.
OBJECTIVE: This study examines the international transferability of a machine
learning model for detecting medication errors and whether the federated
learning approach could further improve the accuracy of the model.
METHODS: The study cohort included 667,572 outpatient prescriptions from 2 large
US academic medical centers. Our ML model was applied to build the original
model (O model), the local model (L model), and the hybrid model (H model). The
O model was built using the data of 1.34 billion outpatient prescriptions from
TLD. A validation set with 8.98% (60,000/667,572) of the prescriptions was first
randomly sampled, and the remaining 91.02% (607,572/667,572) of the
prescriptions served as the local training set for the L model. With a federated
learning approach, the H model used the association values with a higher
frequency of co-occurrence among the O and L models. A testing set with 600
prescriptions was classified as substantiated and unsubstantiated by 2
independent physician reviewers and was then used to assess model performance.
RESULTS: The interrater agreement was significant in terms of classifying
prescriptions as substantiated and unsubstantiated (κ=0.91; 95% CI 0.88 to
0.95). With thresholds ranging from 0.5 to 1.5, the alert accuracy ranged from
75%-78% for the O model, 76%-78% for the L model, and 79%-85% for the H model.
CONCLUSIONS: Our ML model has good international transferability among US
hospital data. Using the federated learning approach with local hospital data
could further improve the accuracy of the model.
©Yen Po Harvey Chin, Wenyu Song, Chia En Lien, Chang Ho Yoon, Wei-Chen Wang,
Jennifer Liu, Phung Anh Nguyen, Yi Ting Feng, Li Zhou, Yu Chuan Jack Li, David
Westfall Bates. Originally published in JMIR Medical Informatics
(http://medinform.jmir.org), 27.01.2021.
DOI: 10.2196/23454
PMCID: PMC7875695
PMID: 33502331
Conflict of interest statement: Conflicts of Interest: YL and YC are cofounders
of DermAI Co, which provides AI-based teledermatology service and AESOP
Technology, which makes software to reduce medication error rates. DB consults
for EarlySense, which makes patient safety monitoring systems. DB receives cash
compensation from CDI (Negev), Ltd, which is a not-for-profit incubator for
health IT startups. DB receives equity from ValeraHealth, which makes software
to help patients with chronic diseases. DB receives equity from Clew, which
makes software to support clinical decision-making in intensive care. DB
receives equity from MDClone, which takes clinical data and produces
deidentified versions of it. DB receives minor equity from AESOP, which makes
software to reduce medication error rates. DB receives research funding from IBM
Watson Health. Other authors have declared no potential conflict of interest.
7. Medicina (B Aires). 2020;80 Suppl 6:18-24.
[Teledermatology during de COVID-19 pandemic in a public hospital].
[Article in Spanish; Abstract available in Spanish from the publisher]
Debernardi ME(1), Bordón MP(2), Campastri A(2), Chequim A(2), Cilio AM(2), Fava
MV(2), Kuperman Wilder L(2), Bendjuia G(2).
Author information:
(1)División Dermatología, Hospital General de Agudos José María Ramos Mejía,
Buenos Aires, Argentina. E-mail: emiliadebernardi@gmail.com.
(2)División Dermatología, Hospital General de Agudos José María Ramos Mejía,
Buenos Aires, Argentina.
Telemedicine refers to the use of information and communication technologies to
provide health care. Dermatology is particularly suited for this virtual
modality. The COVID-19 pandemic significantly increased the use of telemedicine
worldwide which has demonstrated to be useful in promoting social distancing and
in avoiding the overload of the healthcare system. This is an observational
study about the use of teledermatology during the pandemic in the area of
connective tissue diseases in a public hospital in Buenos Aires City. The main
objective was to assess if teledermatology is useful to resolve patient's
consultation and thus to avoid the referral to the hospital. There were 120
teledermatological consultations included, from which 93.3% were made by women.
The average age was 38.4 years. The 57.5% of the consultations were from
patients of the outskirts of Buenos Aires and 33.3% from Buenos Aires City. The
47.5% of consultations were from patients with no medical insurance. Of the
total, 17 (14.2%) required referral to a health center. Most of the
consultations were follow-up's and in a lower percentage, due to reactivation of
the underlying disease or another reason. Patients who completed the survey
reported not having difficulties and were able to resolve their consultations
through virtual care. Doctors involved in this study were totally satisfied with
the experience and they felt that teledermatology was a valid resource to
continue with their medical training and would choose to use it in the near
future.
PMID: 33481728 [Indexed for MEDLINE]
8. Trans R Soc Trop Med Hyg. 2021 Jan 21:traa199. doi: 10.1093/trstmh/traa199.
Online ahead of print.
Mycetoma and the Community Dermatology Program, Mexico.
Roberto E(1), Guadalupe CL(1), Guadalupe EC(2), Hay R(3).
Author information:
(1)Dermatología Comunitaria México-Centro Dermatológico "Ramón Ruiz Maldonado",
Acapulco, Guerrero, Mexico.
(2)Instituto Estatal de Cancerología Arturo Beltrán Leyva", Acapulco, Guerrero,
Mexico.
(3)International Foundation for Dermatology, London, UK.
The Community Dermatology Program established in the state of Guerrero, Mexico for almost 30 y provides an adaptable method of detecting and monitoring skin neglected tropical diseases such as mycetoma, which is endemic in the state. The
program utilises general and thematic teaching elements combined with distance learning through teledermatology, direct patient consultations and close
collaboration with community teams. Using this approach, a picture of mycetoma in Guerrero has emerged, with a focal hot spot located in the southern part of the state in the Costa Chica region. Although in much of Mexico Nocardia infections dominate, in this area there are also substantial numbers of cases of eumycetoma. This combined approach provides a means of early case detection and long-term surveillance through targeted use of a small specialist team.
© The Author(s) 2021. Published by Oxford University Press on behalf of Royal
Society of Tropical Medicine and Hygiene.
DOI: 10.1093/trstmh/traa199
PMID: 33479763
9. Am J Manag Care. 2021 Jan;27(1):30-32. doi: 10.37765/ajmc.2021.88574.
Access to consultative dermatologic care via physician-to-physician asynchronous
outpatient teledermatology.
Mizes A, Vainder C, Howerter SS, Hu A, Liu A, Harris A, Moorhead A, Falo LD Jr,
English JC 3rd(1).
Author information:
(1)Department of Dermatology, University of Pittsburgh Medical Center, 9000
Brooktree Rd, Ste 200, Wexford, PA 15090. Email: engljc@upmc.edu.
OBJECTIVES: To determine whether physician-to-physician outpatient asynchronous
store-and-forward teledermatology can be a portal for patient access to
consultative dermatologic care and decrease primary care physician referrals to
dermatology.
STUDY DESIGN: Retrospective study.
METHODS: Reviewed outpatient teledermatology consults completed within a shared
Epic electronic health record at the University of Pittsburgh Medical Center
(UPMC) Health System between August 4, 2013, and December 19, 2019. Study data
were reviewed for consult response time and triage percentage. Patient and
physician experiences were collected by satisfaction surveys.
RESULTS: This study reviewed 1581 teledermatology consults that originated from
UPMC primary care provider (PCP) appointments. The average response time for a
completed consult was 1 hour, 13 minutes for same-day consult submissions. The
majority of consults, 63%, were completed online, whereas only 37% of patients
were recommended for an in-person referral visit to the dermatology clinic.
Surveyed patients (81%) and PCPs (90%) responded positively to their
teledermatology experience.
CONCLUSIONS: Physician-to-physician outpatient asynchronous teledermatology
consults can provide a model for rapid consultation and decreased primary care
referral to dermatology.
DOI: 10.37765/ajmc.2021.88574
PMID: 33471459
10. J Telemed Telecare. 2021 Jan 18:1357633X20987423. doi: 10.1177/1357633X20987423.
Online ahead of print.
The utility of teledermatology in the evaluation of skin lesions.
Clarke EL(1), Reichenberg JS(2), Ahmed AM(2), Keeling B(2), Custer J(3), Rathouz
PJ(3), Jambusaria-Pahlajani A(2).
Author information:
(1)Dell Medical School at the University of Texas at Austin, USA.
(2)Division of Dermatology, Dell Medical School at the University of Texas at
Austin, USA.
(3)Department of Population Health, Dell Medical School at the University of
Texas at Austin, USA.
INTRODUCTION: Past studies have shown mixed results about the accuracy of
store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The
objective of this study is to determine the accuracy of SAF teledermatology in
the diagnosis of skin lesions and biopsy decision compared to in-person clinical
evaluation.
METHODS: Histories and photographs of skin lesions gathered at clinic visits
were sent as SAF consults to teledermatologists, whose diagnoses and biopsy
decisions were recorded and compared statistically to the clinic data.Results
and Discussion: We enrolled 206 patients with 308 lesions in the study. The
study population was composed of 50% males (n = 104), and most patients were
white (n = 179, 87%) and not Hispanic/Latino (n = 167, 81%). There was good
concordance for biopsy decision between the clinic dermatologist (CD) and
teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly
differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and
specificity of teledermatology based on biopsy decision was 0.71 and 0.85,
respectively. Overall concordance in first diagnosis between the CD and TD was
good (κ = 0.60). While there was no difference between CD and TD in proportion
of correct diagnoses compared to histopathology, two skin cancers presentations
were missed by TD. Study limitations included sample size, enrolment bias and
differing amounts of teledermatologist case experience. Teledermatology has good
concordance in diagnosis and biopsy decision when compared to clinic
dermatology. Teledermatology may be utilized in the evaluation of skin lesions
to expand access to dermatologic care.
DOI: 10.1177/1357633X20987423
PMID: 33461401
11. J Dtsch Dermatol Ges. 2020 Aug;18(8):841-845. doi: 10.1111/ddg.14180. Epub 2020
Jul 27.
Teledermatology in the times of COVID-19 - a systematic review.
Elsner P(1).
Author information:
(1)Department of Dermatology, University Hospital Jena, Germany.
The COVID-19 pandemic restricts the care of dermatological patients in many
ways. Teledermatology such as video consultation or "store-and-forward"
teledermatology could at least partly compensate for this. This systematic
review summarizes all published studies on teledermatology during the COVID-19
pandemic. It is based on a MEDLINE search for articles from 2020 in English and
German. 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. The results indicate that
the limitations of personal dermatological care of patients with skin diseases
during the COVID-19 pandemic can be at least partially compensated by an
extension of teledermatology. Findings from the use of teledermatology during
the pandemic should be employed to improve the use and acceptance of
teledermatology by patients and dermatologists.
© 2020 The Authors. Journal der Deutschen Dermatologischen Gesellschaft
published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische
Gesellschaft.
DOI: 10.1111/ddg.14180
PMID: 33448667 [Indexed for MEDLINE]
12. EClinicalMedicine. 2020 Nov 21;29-30:100641. doi: 10.1016/j.eclinm.2020.100641.
eCollection 2020 Dec.
Teledermatology reduces dermatology referrals and improves access to
specialists.
Giavina-Bianchi M(1), Santos AP(1), Cordioli E(1).
Author information:
(1)Department of Telemedicine, Hospital Israelita Albert Einstein, Av. Albert
Einstein, 627, 3 andar, 05652-000 São Paulo, SP, Brazil.
BACKGROUND: Teledermatology may be used for triage in primary care to address
skin conditions, improving access and reducing time to treat the most severe or
surgical cases. We aimed to evaluate the proportion of individuals who could be
assessed in primary care using teledermatology, and how this affected the
waiting time for an in-person dermatologist appointment.
METHODS: A cross-sectional retrospective study, involving 30,976 individuals and
55,624 skin lesions, was performed from July 2017 to July 2018 We assessed the
frequency of diagnoses and referrals to biopsy, to in-person dermatologists, or
to primary care, and compared the waiting time for an in-person dermatologist
appointment before and after the teledermatology implementation.
FINDINGS: 53% of the patients were managed with the primary care physician, 43%
were referred to in-person dermatologists and 4% directly to biopsy, leading to
a reduction of 78% in the waiting time for in-person appointments when compared
to the previous period. The most frequent diseases were: melanocytic nevus,
seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis,
solar lentigo, melasma, xerosis, and epidermoid cyst, with significant
differences according to sex, age and referrals. The most frequent treatment
prescribed was emollient.
INTERPRETATION: The use of teledermatology as a triage tool significantly
reduced the waiting time for in-person visits, improving health care access and
utilizing public resources wisely. Knowledge of sex, age, diagnoses and
treatment of common skin conditions can enable public policies for the
prevention and orientation of the population, as it can be used to train general
physicians to address such cases.
FUNDING: None.
© 2020 The Authors.
DOI: 10.1016/j.eclinm.2020.100641
PMCID: PMC7788431
PMID: 33437950
Conflict of interest statement: The authors have nothing to disclose.
13. Ann Fam Med. 2021 Jan-Feb;19(1):24-29. doi: 10.1370/afm.2608.
Diagnostic Agreement Between Telemedicine on Social Networks and Teledermatology
Centers.
Serhrouchni S(1), Malmartel A(2).
Author information:
(1)Department of General Medicine, University of Paris, Paris, France.
(2)Department of General Medicine, University of Paris, Paris, France
alexandre.malmartel@u-paris.fr.
PURPOSE: With increasing delays in obtaining a dermatological consultation,
general practitioners (GPs) are using social networks for telemedicine to obtain
advice on dermatological images. The objective was to analyze diagnostic
agreement between telemedicine on social networks (Twitter and MedPics) and
standard teledermatology services (TDS).
METHODS: This retrospective observational study included images published on
Twitter and MedPics by GPs in 2016. The contextualized images were evaluated by
2 teledermatology services in Paris, France and an expert committee. Diagnoses
obtained from telemedicine on social networks, TDS, and the expert committee
were collected for each image. The agreement between the diagnoses made on
social networks and by TDS was measured using Cohen κ statistic. The number of
correct diagnoses obtained using social networks and TDS as determined by
agreement with the expert's diagnoses were compared with χ 2 tests.
RESULTS: Two hundred and seventy health professionals responded to the 60
selected images from social networks. The main diagnoses, according to the
experts were: purpura (8.3%), eczema (6.7%), mycosis (6.7%), and viral
infections (6.7%). Diagnostic agreement between telemedicine on social networks
and TDS was moderate over the entire set of images (κ = 0.55; 95% CI, 0.42-0.68)
and good for images containing dermatologist's answers (κ = 0.63; 95% CI,
0.45-0.85). The number of correct diagnoses was not statistically different
between telemedicine on social networks and TDS on all images (60% vs 55%; P =
.28) but was higher on social networks when a dermatologist answered (65% vs
55%; P <.01).
CONCLUSIONS: Diagnostic agreement using social network images showed that use of
this telemedicine tool could be a reliable means to alleviate the difficulties
of accessing dermatology consultations although data safety probably needs to be
improved.
© 2021 Annals of Family Medicine, Inc.
DOI: 10.1370/afm.2608
PMCID: PMC7800733
PMID: 33431387
14. Dermatol Online J. 2020 Dec 15;26(12):13030/qt1fs0m0tp.
Teledermatology application use in the COVID-19 era.
Pulsipher KJ, Presley CL, Rundle CW, Rietcheck HR, Millitelo M, Dellavalle
RP(1).
Author information:
(1)Department of Dermatology, University of Colorado School of Medicine, Aurora,
CO Department of Epidemiology, Colorado School of Public Health, University of
Colorado Anschutz Medical Campus, Aurora, CO Dermatology Service, U.S.
Department of Veteran Affairs, Eastern Colorado Health Care System, Denver, CO.
Robert.Dellavalle@cuanschutz.edu.
Owing to the COVID-19 outbreak, the use of telemedicine applications has
increased throughout the United States. Using an algorithm to analyze mobile
application rankings, we were able to examine how applications with telemedicine
services have increased in prevalence and rank pre- and post- COVID-19.
Telemedicine apps saw an increase of 210.92 ranked positions on average. Within
US telehealth, skin conditions have become the fifth most common diagnosis.
Widespread use of teledermatology has been well-accepted. Dermatologists and
patients report high satisfaction using teledermatology during COVID-19 and
intend to continue using these services in the future. COVID-19 has assisted in
reducing physician concerns previously preventing some dermatologists from
utilizing teledermatology in their services. Additionally, the geographical and
socioeconomic barriers preventing some patients from receiving dermatologic care
have been minimized through the use of teledermatology. Addressing these
obstacles for dermatologic care improves healthcare equity.
PMID: 33423415 [Indexed for MEDLINE]
15. Dermatol Ther. 2021 Jan 9:e14766. doi: 10.1111/dth.14766. Online ahead of print.
The clinical utility of teledermoscopy in the era of telemedicine.
Uppal SK(1), Beer J(2), Hadeler E(3), Gitlow H(4), Nouri K(5).
Author information:
(1)Albany Medical College, Albany, New York, USA.
(2)Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania, USA.
(3)Miller School of Medicine, University of Miami, Miami, Florida, USA.
(4)Miami Herbert Business School, University of Miami, Miami, Florida, USA.
(5)Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller
School of Medicine, University of Miami, Miami, Florida, USA.
Teledermoscopy is a novel diagnostic tool for the prevention, diagnosis, and
treatment of skin disease when direct visualization of lesions is difficult. It
is an economically viable option that can complement telehealth visits and that
providers can utilize to identify melanocytic lesions and optimize care with
diagnostic accuracy comparable to face-to-face (FTF) diagnosis. Teledermoscopy
is invaluable in monitoring chronic conditions that require frequent follow-up
and treatment optimization. Inclusion of clinical and dermoscopic images has
been shown to improve the diagnostic accuracy of teledermatology services,
thereby reducing healthcare costs. Teledermoscopy is also non-discriminatory, as
diagnostic accuracy is similar in lighter and darker skin types. It has been
shown to improve patient access to specialty services and reduce the number of
"no-shows" at FTF clinics and length of surgery waiting times. Mobile
teledermoscopy is user-friendly, feasible, and economically viable, as
inexpensive mobile dermatoscopes have emerged on the market to reduce consumer
out-of-pocket costs. Research is limited on teledermoscopy's utility in
diagnosing pre-cancerous and cancerous skin lesions in adults, particularly
complex pigmented lesions. Further research is recommended to investigate the
role of dermoscopic expertise and artificial intelligence on the evaluation of
teledermoscopic images.
© 2021 Wiley Periodicals LLC.
DOI: 10.1111/dth.14766
PMID: 33421232
16. Dermatol Ther. 2021 Jan 6:e14741. doi: 10.1111/dth.14741. Online ahead of print.
Investigating the factors enabling the accurate implementation of the
patient-assisted teledermatology model during the pandemic in Turkey: A pilot
study.
Turan Ç(1), Utlu Z(1).
Author information:
(1)Department of Dermatology and Venereology, the Republic of Turkey, Health
Sciences University Erzurum Regional Training and Research Hospital, Erzurum,
Turkey.
We aim to investigate the factors enabling the accurate implementation of the
patient-assisted teledermatology model during the pandemic in our country. This
single-center, a prospective-survey study was enrolled consecutively 468
patients aged 13 years and older. The patients were asked about their attitudes
towards teledermatology. After the dermatological examinations, the diagnosis
and management of the diseases, and classification of diseases according to
lesion locations were recorded. The physician's and the patient's opinions on
whether it was possible to manage properly the current medical condition through
teledermatology were recorded. The patients stated that 81.2% have been keen to
use teledermatology for any complaints during the pandemic. 53.7% of the
patients who are positive to use teledermatology expressed that they would never
use this method unless it is fully reimbursed. Although it was thought that
49.8% of the current complaints according to the patients and 56.6% to the
dermatologists could be resolved appropriately by teledermatology, for 24.8%
either the patient's or the physician's opinion was contrary. Being woman,
high-income level, and the presence of facial dermatosis favorably affected the
patients' and physicians' evaluations regarding the suitability of the complaint
to teledermatology. Factors such as low education level, insufficient technical
skills to be examined alone, and the necessity of undressing for examination
caused patients to consider teledermatology unsuitable for their current
complaints. Priority should be given to the development of an appropriate
reimbursement system and reducing potential medicolegal risks to encourage
patients to participate in high-quality teledermatology.
© 2021 Wiley Periodicals LLC.
DOI: 10.1111/dth.14741
PMID: 33404147
17. Arch Dermatol Res. 2021 Jan 5:1-4. doi: 10.1007/s00403-020-02170-2. Online ahead
of print.
Evaluation of patient attitudes towards the technical experience of synchronous
teledermatology in the era of COVID-19.
Pearlman RL(1), Le PB(1), Brodell RT(1), Nahar VK(2)(3).
Author information:
(1)Department of Dermatology, School of Medicine, University of Mississippi
Medical Center, 2500 North State Street, L216, Jackson, MS, 39216, USA.
(2)Department of Dermatology, School of Medicine, University of Mississippi
Medical Center, 2500 North State Street, L216, Jackson, MS, 39216, USA.
(3)Department of Preventive Medicine, School of Medicine/John D. Bower School of
Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
Teledermatology has become critical for maintaining patient access to
dermatologic services since the eruption of the COVID-19 pandemic. This survey
of first-time synchronous teledermatology patients (n = 100) seen by providers
of the University of Mississippi Medical Center during Spring 2020 was designed
to learn more about patient experiences associated with the technical challenges
of synchronous teledermatology. Our patient population had considerable
experience with various social media including Facebook (82%) and hardware
platforms, such as Apple devices (66%). We found that the majority of patients
were satisfied (88.9%) with their synchronous teledermatology encounter and
81.8% of patients did not experience a technical difficulty with their consult.
About 15% of patients lost connection with their provider during their
consultation. Furthermore, about 30% of patients rated "showing their skin" to
their provider as "hardest" on a ten scale. However, about 34% of patients sent
"store-and-forward"-type images to supplement their encounter. Despite
overwhelming satisfaction with synchronous teledermatology, a majority prefer an
in-person consultation for their next visit (68.7%). Synchronous teledermatology
offers a critical service to patients to expand access to specialty
consultation. It is well-received by patients despite technical barriers,
especially during a global health crisis.
DOI: 10.1007/s00403-020-02170-2
PMCID: PMC7785034
PMID: 33403572
Conflict of interest statement: Robert T. Brodell discloses the following
potential conflicts of interest: Multicenter Clinical Trials: Corona psoriasis
biologic registry and Novartis Principal Investigator. Editorial Boards:
American Medical Student Research Journal; Archives of Dermatological Research;
Practice Update Dermatology; Practical Dermatology; Practical Dermatology;
Journal of the Mississippi State Medical Society; SKIN: The Journal of Cutaneous
Medicine; and, Journal of the American Academy of Dermatology. Advisory Boards:
Bracco Diagnostics, Inc. (Gadolinium-based Contrast Agent Litigation) and
Chairperson of REGN3500 AD independent monitoring committee (iDMC) (Sanofi
Genzyme/Regeneron). Ross L. Pearlman, Phuong B. Le, and Vinayak K. Nahar have no
conflicts of interest.
18. Pediatr Dermatol. 2020 Dec 27. doi: 10.1111/pde.14489. Online ahead of print.
Disparities in telemedicine access for Spanish-speaking patients during the
COVID-19 crisis.
Blundell AR(1)(2), Kroshinsky D(1), Hawryluk EB(1), Das S(1).
Author information:
(1)Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
(2)San Juan Bautista School of Medicine, Caguas, Puerto Rico.
The rapid rise of telemedicine during the COVID-19 pandemic raised the prospect
of worsening health care disparities for vulnerable populations. We
retrospectively compared pediatric teledermatology visits scheduled during the
pandemic (03/17/2020-07/31/2020) with in-person appointments scheduled during
the same period in 2019 and found that Spanish-speaking patients had
significantly fewer scheduled appointments in 2020 (9% vs 5%, P < .001). Among
the telemedicine cohort, Spanish-speaking patients were less likely to have an
email address documented within the electronic medical record and less likely to
have activated an online patient portal account prior to their visit during the
pandemic (45% vs 62%, P = .017, and 23% vs 66%, P < .001, respectively). Our
findings suggest that email connectedness may represent a bottleneck in
telemedicine access for Spanish-speaking pediatric dermatology patients.
© 2020 Wiley Periodicals LLC.
DOI: 10.1111/pde.14489
PMID: 33368668
19. Dermatol Ther. 2021 Jan;34(1):e14694. doi: 10.1111/dth.14694. Epub 2020 Dec 29.
Tetracyclines in COVID-19 patients quarantined at home: Literature evidence
supporting real-world data from a multicenter observational study targeting
inflammatory and infectious dermatoses.
Gironi LC(1), Damiani G(2)(3), Zavattaro E(1), Pacifico A(4), Santus P(5),
Pigatto PDM(2)(3), Cremona O(6), Savoia P(7).
Author information:
(1)AOU Maggiore della Carità, Novara, Italy.
(2)Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
(3)Department of Biomedical, Surgical, and Dental Sciences, University of Milan,
Milan, Italy.
(4)San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
(5)Pneumology Unit, ASST - Luigi Sacco University Hospital - University of
Milan, Milan, Italy.
(6)Università Vita Salute San Raffaele, Milan, Italy.
(7)Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.
Tetracyclines (TetraC) are widely used in dermatology for both inflammatory and
infectious dermatoses; recently both in vivo and in vitro studies started to
suggest also a potential antiviral effect. During COVID-19 outbreak, several
dermatological patients contracted SARS-CoV-2 experiencing only mild symptoms,
but no protocol were approved. A multicenter prospective observational study
that enrolled COVID-19 patients visited with teledermatology and undergoing
TetraC was performed. About 38 adult outpatients (M/F: 20/18, age 42.6 years
[21-67]) were enrolled. During the TetraC treatment, symptoms resolved in all
patients within 10 days. Remarkably, ageusia and anosmia disappeared in the
first week of TetraC treatment. TetraC seem a promising drug to treat COVID-19
outpatients with mild symptoms.
© 2020 Wiley Periodicals LLC.
DOI: 10.1111/dth.14694
PMCID: PMC7883087
PMID: 33354849
Conflict of interest statement: The authors declare no conflicts of interest.
Global Teledermatology
1. J Cutan Aesthet Surg. 2020 Apr-Jun;13(2):77-94. doi: 10.4103/JCAS.JCAS_83_20.
Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic.
Mysore V(1), Savitha AS(2), Venkataram A(1), Inamadar AC(3), Sanjeev A(4),
Byalekere Chandrashekar S(5), Devaraj DK(6), Khunger N(7), Reddy RR(2), Rashi
P(8), Salim T(9), Mutalik SD(10), Arsiwala S(11)(12)(13), Barua S(14), Gupta
S(8), Sirur S(15), Shah S(16).
Author information:
(1)The Venkat Center for Skin ENT & Plastic Surgery, Bengaluru, India.
(2)Department of Dermatology, Sapthagiri Institute of Medical Sciences and
Research Centre, Bangalore, India.
(3)Department of Dermatology, Sri B M Patil Medical College Hospital and
Research Centre, BLDE University, Vijayapura, Karnataka, India.
(4)Skin & Laser Clinic, Hyderabad, Telangana, India.
(5)CUTIS Academy of Cutaneous Sciences, Bengaluru, Karnataka, India.
(6)Dr. Dinesh's Skin & Hair Clinic, Chennai, Tamil Nadu, India.
(7)Department of Dermatology, Vardhaman Mahavir Medical College, Safdarjang
Hospital, New Delhi, India.
(8)Department of Dermatology and Venereology, All India Institute of Medical
Sciences, New Delhi, India.
(9)Cutis Institute, Calicut, Kerala, India.
(10)Department of Dermatology, Maharashtra Medical Foundation, Pune, India.
(11)Renewderm Centre, Mumbai, Maharashtra, India.
(12)Saifee Hospital, Mumbai, Maharashtra, India.
(13)Prince Aly Khan Hospital, Mumbai, Maharashtra, India.
(14)Department of Dermatology, Assam Medical College & Hospital, Dibrugarh,
Assam, India.
(15)Wockhardt Hospital and Apollo Spectra Hospital, Mumbai, India.
(16)Department of Dermatology, Ashwini Rural Medical College, Solapur,
Maharashtra, India.
BACKGROUND: Amid the coronavirus disease 2019 (COVID-19) pandemic,
dermatologists must be prepared to restructure their practice of procedural
dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has
presented several challenges and has ushered in several changes in practice such
as teledermatology, with many physicians adopting virtual consultations and
treatments. Performing procedures in the times of COVID-19 pandemic presents
challenges such as risk of transmission to doctors and staff due to potential
aerosolization, release of virus droplets during the procedures, and risk of
virus transfer through the instruments both in the peri- and postoperative
period. This can have several medical, administrative, and legal implications.
OBJECTIVES: This document aimed to outline best practices that can be followed
in this scenario to perform cutaneous surgeries and procedures to ensure safer
skin surgery.
RECOMMENDATIONS: Standard precautions include social distancing of at least 1 m,
hand hygiene, appropriate use of personal protective equipment (PPE), safe
injection practices, sterilization and disinfection of medical devices,
environmental cleaning, and respiratory hygiene. It is generally advisable to
see patients only by appointments. Each clinic should have a special area at
entry for screening patients and providing sanitizers and masks. Procedures,
which are of short duration, performed on nonfacial areas are considered as low
risk and require donning surgical mask. Procedures involved with minimal
invasiveness and bleeding, short duration procedures on the face such as
injectables, chemical peels, and aerosol-generating procedures on nonfacial
areas are considered moderate risk. These procedures need apron with head cover,
N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency
particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and
plume-regenerating procedures (such as ablative lasers on the face), prolonged
surgeries on head (such as hair transplantation), intraoral, and intranasal
procedures are considered high risk. These procedures must be carried out with
full body cover with surgical gown, head cover, N95 mask, face shield, double
gloves, and smoke evacuator. Physicians should be aware of local epidemiological
situation and adhere to the relevant guidelines issued by the relevant
governmental agencies.
Copyright: © 2020 Journal of Cutaneous and Aesthetic Surgery.
DOI: 10.4103/JCAS.JCAS_83_20
PMCID: PMC7394118
PMID: 32792769
Conflict of interest statement: There are no conflicts of interest.
2. Arch Dermatol Res. 2020 Aug 12. doi: 10.1007/s00403-020-02119-5. Online ahead of
print.
Patient education in Mohs surgery: a review and critical evaluation of
techniques.
Patel P(1), Malik K(2), Khachemoune A(3)(4).
Author information:
(1)Division of Dermatology, Department of Medicine, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, New York, USA.
(2)Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York,
USA.
(3)Department of Dermatology, SUNY Downstate, Brooklyn, New York, USA.
(4)Dermatology Service, Veterans Affairs Hospital, SUNY Downstate, 800 Poly
Place Brooklyn, New York, 11209, USA. amorkh@gmail.com.
BACKGROUND: Traditional in-person discussion alone is often used for
preoperative education in Mohs micrographic surgery (MMS). The appropriate use
of more modern education techniques is not well defined in the MMS literature.
OBJECTIVE: The authors aim to evaluate patient education techniques for MMS,
address education in special populations, and highlight opportunities for
improvement.
METHODS AND MATERIALS: We performed a PubMed literature search with keywords
"Mohs" and "education", "teaching", "understanding", "explanation",
"preoperative", or "consent" with no restriction on publication time frame due
to literature scarcity.
RESULTS: Teledermatology consultation, MMS videos, 3D models, pamphlets/online
materials, and shared medical appointments appear to be effective techniques
(GRADE B). Analogies are also anecdotally helpful when integrated into
traditional verbal education (GRADE C). The role of preoperative educational
phone calls is more controversial (GRADE C).
CONCLUSION: Regardless of the education technique utilized, no singular
technique entirely replaces the traditional in-person discussion. Having access
to multiple modalities can be beneficial for patients, allowing them options to
choose their preferred method(s) of education. MMS is a difficult topic to
conceptualize, and further research into educational techniques is needed to
provide clear guidelines for Mohs surgeons.
DOI: 10.1007/s00403-020-02119-5
PMID: 32785836
3. J Dermatolog Treat. 2020 Aug 12:1-7. doi: 10.1080/09546634.2020.1809625. Online
ahead of print.
Psychological teleconsultations in patients suffering from chronic skin diseases
during the COVID-19 era: a service to improve patients' quality of life.
Marasca C(1), De Rosa A(1), Fabbrocini G(1), Cantelli M(1), Patrì A(1),
Vastarella M(1), Gallo L(1), di Vico F(1), Poggi S(1), Ruggiero A(1).
Author information:
(1)Department of Clinical Medicine and Surgery, Section of Dermatology,
University of Naples Federico II, Naples, Italy.
The COVID-19 era represented an important stressful event affecting population
in many different ways, with important negative impact on social, working and
relational life. Indeed, the home-isolation in addition to the high-level of
distress given by fear of infection, has significantly resulted in a large
number of psychological-consequences. Moreover, in order to guarantee a
continuity of care, different measures have been applied among hospitals such as
the implementation of teledermatology services. For these reasons, we
implemented at our Dermatological-Clinic psychological video-consultations
through our teledermatology-services. Herein we report our experience of 23
psychological-video-consultations, which led to achieve a significant reduction
of DLQI (from 4.4 ± 3.9 at baseline to 1.6 ± 2.5 at week-4) in patients
suffering from chronic skin conditions during the COVID-19 era.
DOI: 10.1080/09546634.2020.1809625
PMID: 32783664
4. J Am Acad Dermatol. 2020 Aug 8:S0190-9622(20)32373-2. doi:
10.1016/j.jaad.2020.08.016. Online ahead of print.
Telemedicine and the battle for health equity: Translating temporary regulatory
orders into sustained policy change.
Kassamali B(1), Haddadi NS(2), Rashighi M(2), Cavanaugh-Hussey M(3), LaChance
A(4).
Author information:
(1)Harvard Medical School, Boston, Massachusetts; Department of Dermatology,
Brigham and Women's Hospital, Boston, Massachusetts.
(2)Department of Dermatology, University of Massachusetts School of Medicine,
Worchester, Massachusetts.
(3)Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts; Harvard Medical School, Boston, Massachusetts.
(4)Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic
address: alachance@bwh.harvard.edu.
DOI: 10.1016/j.jaad.2020.08.016
PMCID: PMC7414778
PMID: 32781185
5. J Am Acad Dermatol. 2020 Aug 6:S0190-9622(20)32356-2. doi:
10.1016/j.jaad.2020.07.119. Online ahead of print.
'Drop dermoscopy' for teledermatology.
Kaliyadan F(1), Jayasree P(2), Ashique KT(3).
Author information:
(1)European Board Dermatovenereology, FRCP (London) Faculty of Dermatology,
College of medicine, King Faisal University, Saudi Arabia. Electronic address:
(2)Consultant Dermatologist, Medical Trust Hospital, Cochin, Kerala, India.
(3)Medical Director & Senior Consultant Dermatologist Amanza Health Care,
Perinthalmanna, 679322. Kerala. India College of medicine, King Faisal
University, Al-Ahsa ,Saudi Arabia.
DOI: 10.1016/j.jaad.2020.07.119
PMCID: PMC7410012
PMID: 32771542
6. Dermatol Ther. 2020 Aug 8:e14161. doi: 10.1111/dth.14161. Online ahead of print.
Mental Distress in Dermatologists During COVID-19 Pandemic: Assessment and Risk
Factors in A Global, Cross-Sectional Study.
Bhargava S(1), Sarkar R(2), Kroumpouzos G(3)(4)(5).
Author information:
(1)Department of Dermatology, R.D. Gardi Medical College, Ujjain, India.
(2)Department of Dermatology, Lady Hardinge Medical College, New Delhi, India.
(3)Department of Dermatology, Alpert Medical School of Brown University,
Providence, RI, USA.
(4)Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
(5)GK Dermatology, PC, South Weymouth, MA, USA.
BACKGROUND: There is a sparsity of data regarding the mental health status of
dermatologists during COVID-19 pandemic.
OBJECTIVES: Evaluate the effects of pandemic on mental health of dermatologists
on a large scale and identify risk factors for mental distress.
METHODS: 733 dermatologists were included in this cross-sectional, web-based
survey.
RESULTS: Mental distress was reported by 77.2% of responders. Considerable
percentages of participants experienced stress (73.9%), irritation (33.7%),
insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the
amount of pandemic information they were receiving. Mental distress was
significantly associated with practice years, volume of patients seen per week
before pandemic, personal protective equipment availability at hospital (P=.001
for each), practice location (continent) (P <.001), and participant's assessment
that the healthcare system was not equipped for the pandemic (P=.003). Stress
was associated with hospital service (P=.003), and depression with being
overwhelmed with the amount of pandemic information received (P=.004). In a
logistic model, teledermatology use was the most powerful predictor of mental
distress (OR, 1.57 [95% CI, 1.07-2.32]).
CONCLUSIONS: Mental distress was common among dermatologists during this
pandemic. Teledermatology use was the most powerful predictor of mental
distress. Preventative strategies and psychosocial interventions should be
implemented. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
DOI: 10.1111/dth.14161
PMID: 32770716
7. J Ultrasound Med. 2020 Aug 7. doi: 10.1002/jum.15409. Online ahead of print.
Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology: A
Prospective Multicenter Validation Study.
Alfageme F(1), Minguela E(2), Martínez C(1), Salgüero I(1), Calvo A(3), León
F(4), Álvarez L(4), de Vicente O(5), Panadero FJ(6), Salguero OL(7), Roustán
G(1).
Author information:
(1)Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda,
Madrid, Spain.
(2)Centro de Salud Valle de la Oliva Majadahonda, Madrid, Spain.
(3)Centro de Salud de Galapagar, Madrid, Spain.
(4)Centro de Salud San Juan de la Cruz, Pozuelo de Alarcón, Spain.
(5)Centro de Salud La Marazuela, Las Rozas, Spain.
(6)Centro de Salud Villanueva de la Cañada, Madrid, Spain.
(7)Centro de Salud Cerro del Aire Majadahonda, Madrid, Spain.
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.
© 2020 American Institute of Ultrasound in Medicine.
DOI: 10.1002/jum.15409
PMID: 32767579
8. Dermatol Ther. 2020 Aug 6:e14149. doi: 10.1111/dth.14149. Online ahead of print.
COVID-19: An Opportunity to Build Dermatology's Digital Future.
Puri P(1)(2), Comfere N(2)(3), Pittelkow MR(2)(4), Bezalel SA(2)(3), Murphree
DH(2)(5).
Author information:
(1)Mayo Clinic Alix School of Medicine, Scottsdale, AZ.
(2)Mayo Clinic Office of Artificial Intelligence in Dermatology.
(3)Department of Dermatology, Mayo Clinic, Rochester, MN.
(4)Depatment of Dermatology, Mayo Clinic, Scottsdale, AZ.
(5)Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
DOI: 10.1111/dth.14149
PMID: 32767453
9. Hautarzt. 2020 Aug 6:1-5. doi: 10.1007/s00105-020-04664-6. Online ahead of
print.
[Artificial intelligence to support telemedicine in Africa].
[Article in German]
Greis C(1), Maul LV(2), Hsu C(2), Djamei V(3), Schmid-Grendelmeier P(3),
Navarini AA(2).
Author information:
(1)Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091,
Zürich, Schweiz. christian.greis@usz.ch.
(2)Klinik für Dermatologie, Universitätsspital Basel, Basel, Schweiz.
(3)Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091,
Zürich, Schweiz.
Telemedicine has been used in the daily routine of dermatologists for decades.
The potential advantages are especially obvious in African countries having
limited medical care, long geographical distances, and a meanwhile relatively
well-developed telecommunication sector. National and international working
groups support the establishment of teledermatological projects and in recent
years have increasingly been using artificial intelligence (AI)-based
technologies to support the local physicians. Ethnic variations represent
a challenge in the development of automated algorithms. To further improve the
accuracy of the systems and to be able to globalize, it is important to increase
the amount of available clinical data. This can only be achieved with the active
participation of local health care providers as well as the dermatological
community and must always be in the interest of the individual patient.
Telemedizin findet seit Jahrzehnten Anwendung im Alltag von Dermatologen.
Insbesondere in afrikanischen Ländern mit begrenzter medizinischer Versorgung,
zu überbrückenden geografischen Distanzen und einem zwischenzeitlich relativ gut
ausgebauten Telekommunikationssektor liegen die Vorteile auf der Hand. Nationale
und internationale Arbeitsgruppen unterstützen den Aufbau von
teledermatologischen Projekten und bedienen sich in den letzten Jahren zunehmend
KI(künstliche Intelligenz)-gestützter Technologien, um Ärzte vor Ort zu
unterstützen. Vor diesem Hintergrund stellen ethnische Variationen eine
besondere Herausforderung in der Entwicklung automatisierter Algorithmen dar. Um
die Genauigkeit der Systeme weiter zu verbessern und globalisieren zu können,
ist es wichtig, die Zahl der verfügbaren klinischen Daten zu erhöhen. Dies kann
nur mit der aktiven Beteiligung der lokalen Gesundheitsversorger sowie der
dermatologischen Gemeinschaft gelingen und muss stets im Interesse des einzelnen
Patienten erfolgen.
DOI: 10.1007/s00105-020-04664-6
PMCID: PMC7407433
PMID: 32761386
10. Contact Dermatitis. 2020 Aug 4. doi: 10.1111/cod.13683. Online ahead of print.
Teledermatology and hygiene practices during the COVID-19 pandemic.
Cristaudo A(1), Pigliacelli F(1), Pacifico A(1), Damiani G(2), Iacovelli P(1),
Morrone A(1).
Author information:
(1)San Gallicano Dermatological Institute IRCCS, Rome, Italy.
(2)Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences,
IRCCS Galeazzi, Orthopaedic Institute, University of Milan, 20126, Milan, Italy.
DOI: 10.1111/cod.13683
PMID: 32754901
Telemedicine and Teledermatology
1. JMIR Public Health Surveill. 2020 Apr 2;6(2):e18810. doi: 10.2196/18810.
Global Telemedicine Implementation and Integration Within Health Systems to
Fight the COVID-19 Pandemic: A Call to Action.
Ohannessian R(1), Duong TA(2)(3), Odone A(4)(5)(6).
Author information:
(1)Télémédecine 360, TLM360, Paris, France.
(2)Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.
(3)Chaire Avenir Sante numérique, équipe 8 IMRB, Inserm, Créteil, France.
(4)School of Public Health, Faculty of Medicine, University Vita-Salute San
Raffaele, Milan, Italy.
(5)Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute,
Milan, Italy.
(6)Digital Health Section, European Public Health Association, Milan, Italy.
On March 11, 2020, the World Health Organization declared the coronavirus
disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported
in more than 203 countries as of 31 March. The response strategy included early
diagnosis, patient isolation, symptomatic monitoring of contacts as well as
suspected and confirmed cases, and public health quarantine. In this context,
telemedicine, particularly video consultations, has been promoted and scaled up
to reduce the risk of transmission, especially in the United Kingdom and the
United States of America. Based on a literature review, the first conceptual
framework for telemedicine implementation during outbreaks was published in
2015. An updated framework for telemedicine in the COVID-19 pandemic has been
defined. This framework could be applied at a large scale to improve the
national public health response. Most countries, however, lack a regulatory
framework to authorize, integrate, and reimburse telemedicine services,
including in emergency and outbreak situations. In this context, Italy does not
include telemedicine in the essential levels of care granted to all citizens
within the National Health Service, while France authorized, reimbursed, and
actively promoted the use of telemedicine. Several challenges remain for the
global use and integration of telemedicine into the public health response to
COVID-19 and future outbreaks. All stakeholders are encouraged to address the
challenges and collaborate to promote the safe and evidence-based use of
telemedicine during the current pandemic and future outbreaks. For countries
without integrated telemedicine in their national health care system, the
COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for
supporting wide adoption of telemedicine.
©Robin Ohannessian, Tu Anh Duong, Anna Odone. Originally published in JMIR
Public Health and Surveillance (http://publichealth.jmir.org), 02.04.2020.
DOI: 10.2196/18810
PMCID: PMC7124951
PMID: 32238336 [Indexed for MEDLINE]
Conflict of interest statement: Conflicts of Interest: None declared.
2. Med Leg J. 2020 Jun 3:25817220926926. doi: 10.1177/0025817220926926. Online
ahead of print.
Telemedicine during Covid-19 pandemic: Advantage or critical issue?
Perrone G(1), Zerbo S(1), Bilotta C(1), Malta G(1), Argo A(1).
Author information:
(1)Department of Health Promotion, Maternal and Child Care, "G. D'Alessandro",
Legal Medicine Section, University of Palermo, Palermo, Italy.
Telemedicine offers a support to traditional medicine, delivering clinical
services when distance is a critical factor. Although this tool does not replace
a medical examination, during Covid-19 pandemic, it reduces the spread of
infection and avoids the need for a patient's visit. It is useful in the
management of chronic disorders or for patients undergoing palliative treatment.
The University Hospital of Palermo has applied this in cases of chronic illness
caring for patients who cannot stop their treatment, such as Department of
Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal
Medicine of Palermo, in particular, is also using telemedicine to manage
medico-legal sudden natural death investigations and dealing with the Public
Prosecutor's office of Palermo. Even after the Covid-19 emergency, telemedicine
will be essential to streamline outpatient visits, while at the same time
limiting costs, with significant benefits for the Italian National Public Health
Service budget. In conclusion, telemedicine can offer a valuable support to the
doctor's activity by streamlining and facilitating their work. In this sense,
the Covid-19 pandemic represents a positive input for the acceleration and
enhancement of these tools.
DOI: 10.1177/0025817220926926
PMID: 32490720
3. J Coll Physicians Surg Pak. 2020 Apr;30(4):349-350. doi:
10.29271/jcpsp.2020.04.349.
Telemedicine in the Time of COVID-19 Pandemic.
Gondal KM(1), Shaukat S(2).
Author information:
(1)Department of Surgery, King Edward Medical University, Lahore, Pakistan.
(2)Department of Dermatology, Unit - I, King Edward Medical University, Lahore,
Pakistan.
Null.
DOI: 10.29271/jcpsp.2020.04.349
PMID: 32513349 [Indexed for MEDLINE]
4. J Dermatolog Treat. 2020 May 13:1-2. doi: 10.1080/09546634.2020.1762844. Online
ahead of print.
The danger of neglecting melanoma during the COVID-19 pandemic.
Gomolin T(1), Cline A(2), Handler MZ(2).
Author information:
(1)New York Medical College School of Medicine, Valhalla, NY, USA.
(2)Department of Dermatology, Metropolitan Hospital, New York, NY, USA.
Due to the COVID-19 pandemic, planned medical and surgical activities are being
postponed. For the dermatology community, this interruption to the healthcare
system can lead to delays in the diagnosis and treatment of melanoma. Neglecting
melanoma during this crisis can result in increased mortality, morbidity and
healthcare costs. With the COVID-19 pandemic evolving and no clear solutions in
sight, it is time for the prospective evaluation of teledermatology. However,
dermatologists should be cautious and continue seeing patients with pigmented
lesions in person due to the necessity of early surgical intervention.
DOI: 10.1080/09546634.2020.1762844
PMID: 32347761
5. J Eur Acad Dermatol Venereol. 2020 May 18:10.1111/jdv.16636. doi:
10.1111/jdv.16636. Online ahead of print.
Chilblain acral lesions in the COVID-19 era. Are they marker of infection in
asymptomatic patients?
Ramondetta A(1), Panzone M(1), Dapavo P(1), Ortoncelli M(1), Giura MT(1),
Licciardello M(1), Rozzo G(1), Siliquini N(1), Fierro MT(1), Ribero S(1).
Author information:
(1)Dermatology Clinic, University of Turin, Turin, Italy.
During these months in which the COVID‐19 emergency is waning, the activity of
dermatologists has changes substantially. Since the beginning of March 2020, in
the Dermatology Clinic at the University Hospital in Turin (Italy) the
outpatient access has been significantly reduced and telemedicine has been
useful whenever possible, by putting the patient in contact directly with
dermatologists or mediated by the general practitioners.
DOI: 10.1111/jdv.16636
PMCID: PMC7276754
PMID: 32421876
6. Pediatr Dermatol. 2020 Apr 16:10.1111/pde.14196. doi: 10.1111/pde.14196. Online
ahead of print.
Management of infantile hemangiomas during the COVID pandemic.
Frieden IJ(1), Püttgen KB(2), Drolet BA(3), Garzon MC(3), Chamlin SL(4), Pope
E(5), Mancini AJ(4), Lauren CT(6), Mathes EF(1), Siegel DH(7), Gupta D(8),
Haggstrom AN(9), Tollefson MM(10), Baselga E(11), Morel KD(6), Shah SD(1),
Holland KE(7), Adams DM(12), Horii KA(13), Newell BD(13), Powell J(14), McCuaig
CC(14), Nopper AJ(13), Metry DW(15), Maguiness S(16); Hemangioma Investigator
Group.
Author information:
(1)University of California San Francisco, San Francisco, California, USA.
(2)Intermountain Healthcare, Salt Lake City, Utah, USA.
(3)School of Medicine and Public Health, University of Wisconsin, Madison,
Wisconsin, USA.
(4)Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University
Feinberg School of Medicine, Chicago, Illinois, USA.
(5)The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
(6)Columbia University Vagelos College of Physicians and Surgeons, New York, New
York, USA.
(7)Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
(8)Seattle Children's Hospital, University of Washington School of Medicine,
Seattle, Washington, USA.
(9)Indiana University, Indianapolis, Indiana, USA.
(10)Mayo Clinic, Rochester, Minnesota, USA.
(11)Hospital Sant Joan de Deu, Barcelona, Spain.
(12)Harvard Medical School, Boston, Massachusetts, USA.
(13)University of Missouri - Kansas City, Kansas City, Missouri, USA.
(14)Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine
University Hospital Centre, University of Montreal, Montreal, QC, Canada.
(15)Baylor College of Medicine, Houston, Texas, USA.
(16)University of Minnesota, Minneapolis, Minnesota, USA.
The COVID-19 pandemic has caused significant shifts in patient care including a
steep decline in ambulatory visits and a marked increase in the use of
telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk
stratification to determine which infants need treatment and which can be
managed with continued observation. For those requiring treatment, prompt
initiation decreases morbidity and improves long-term outcomes. The Hemangioma
Investigator Group has created consensus recommendations for management of IH
via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice
guidelines, and relevant, up-to-date publications regarding initiation and
monitoring of beta-blocker therapy were used to inform the recommendations.
Clinical decision-making guidelines about when telehealth is an appropriate
alternative to in-office visits, including medication initiation, dosage
changes, and ongoing evaluation, are included. The importance of communication
with caregivers in the context of telemedicine is discussed, and online
resources for both hemangioma education and propranolol therapy are provided.
© 2020 Wiley Periodicals, LLC.
DOI: 10.1111/pde.14196
PMCID: PMC7262142
PMID: 32298480
Conflict of interest statement: Ilona J. Frieden is a member of Venthera Medical
Advisory Board; Other: Pfizer (Data Safety Monitoring Board and investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01) Beth A.
Drolet reports an investigator‐initiated trial funded by Pierre Fabre, Venthera
consultant and medical advisory, and founder of Peds Derm Development, LLC and
investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and
Pharmacokinetics of Topical Timolol in Infants With Infantile Hemangioma (IH)
(TIM01). Maria C. Garzon MD is an investigaror NCT02913612 Pediatric Trials
Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants
With Infantile Hemangioma (IH) (TIM01). Sarah L. Chamlin MD is an investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01). Other:
Sarah L. Chamlin MD is a consultant in Regeneron and Sanofi. Elena Pope MD
investigator in Pierre Fabre. Dawn H. Siegel MD is reviewer in ArQule (expert
reviewer) and investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy,
Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile
Hemangioma (IH) (TIM01). Deepti Gupta MD has no conflicts of interest to
declare. Anita N. Haggstrom MD is investigator NCT02913612 Pediatric Trials
Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants
With Infantile Hemangioma (IH) (TIM01), Anthony J. Mancini MD is an investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Megha M.
Tollefson MD is an investigator NCT02913612 Pediatric Trials Network‐NIH
Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants With
Infantile Hemangioma (IH) (TIM01), Christine T. Lauren MD is an investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Erin F.
Mathes MD is an investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy,
Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile
Hemangioma (IH) (TIM01). Eulalia Baselga MD is a consultant and advisory board
member in Pierre Fabre, Venthera co‐founder and medical advisor. Kristen E.
Holland MD is an investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy,
Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile
Hemangioma (IH) (TIM01); Other: Kristen E. Holland MD is an investigator and
consultant in Pfizer, consultant in Regeneron, and investigator in Celgene and
Sanofi. Denise M. Adams MD is an advisory board member in Venthera and Novartis.
Katherine B. Püttgen MD is an investigator NCT02913612 Pediatric Trials
Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants
With Infantile Hemangioma (IH) (TIM01), Kimberly A. Horii MD is an investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Kimberly
D. Morel MD, is an investigator NCT02913612 Pediatric Trials Network‐NIH
Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants With
Infantile Hemangioma (IH) (TIM01), Kimberly A. Horii MD is an investigator
NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics
of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Brandon D.
Newell MD, Catherine C. McCuaig, Amy J. Nopper MD, Denise W. Metry MD, Sheilagh
Maguiness and Sonal D. Shah MD have no conflicts of interest to declare. Julie
Powell MD is a member of advisory board and speaker in Pierre‐Fabre Dermatology.
7. Dermatol Ther. 2020 Apr 29:e13472. doi: 10.1111/dth.13472. Online ahead of
print.
Changing paradigms of dermatology practice in developing nations in the shadow
of COVID-19: Lessons learnt from the pandemic.
Kumar S(1)(2), Bishnoi A(2), Vinay K(2).
Author information:
(1)Department of Dermatology, Venereology and Leprosy, All India Institute of
Medical Sciences, Rishikesh, India.
(2)Department of Dermatology, Venereology and Leprology, Postgraduate Institute
of Medical Education and Research, Chandigarh, India.
At present, routine dermatology practices stay mostly disrupted worldwide owing
to the ongoing COVID-19 pandemic. However, dermatology services need to be
resumed in future and dermatologists especially in developing countries face a
mammoth task of devising plans to tackle the upcoming surge of patients while
still maintaining the precautions to avoid risk of infection to health care
workers and our patients. Teledermatology practice is a viable alternative and
there is need of starting functioning teledermatology centers at primary health
care centers and training health care workers in telemedicine. Several steps
like increasing the working hours of outpatient clinics, posting dermatologists
and health staffs in shifts, encouraging online registration and payment,
providing time slots to patients should be taken to prevent overcrowding at
outpatient departments in hospitals of developing countries like India where the
usual patient turnover during summers maybe around 600 to 800 per day. Once
diagnosed by the dermatologist, a subsequent meticulous use of teledermatology
can limit the number of follow-up visits. To avoid student gatherings, the
undergraduate and postgraduate teaching schedule should be replaced by online or
virtual teaching in form of webinars and video conferencing. Above all, intense
upgradation of health care infrastructure, recruitment, training of new health
care staffs on mass level and huge investment in health care sector is required
in all the developing countries.
© 2020 Wiley Periodicals LLC.
DOI: 10.1111/dth.13472
PMCID: PMC7261977
PMID: 32347612
Conflict of interest statement: The authors declare no conflicts of interest.
Teledermatology
1. J Dermatolog Treat. 2020 May 4:1-9. doi: 10.1080/09546634.2020.1762843. [Epub
ahead of print]
Inpatient Teledermatology During the COVID-19 Pandemic.
Rismiller K(1), Cartron AM(2), Trinidad JCL(1).
Author information:
(1)Division of Dermatology, Department of Internal Medicine, The Ohio State
University Wexner Medical Center, Columbus, Ohio, USA.
(2)Department of Dermatology, University of Maryland School of Medicine,
Baltimore, MD, USA.
DOI: 10.1080/09546634.2020.1762843
PMID: 32364809
2. J Am Acad Dermatol. 2020 May 4. pii: S0190-9622(20)30776-3. doi:
10.1016/j.jaad.2020.04.154. [Epub ahead of print]
The COVID-19 crisis: A unique opportunity to expand dermatology to underserved
populations.
Ashrafzadeh S(1), Nambudiri VE(2).
Author information:
(1)Harvard Medical School, Boston, Massachusetts, USA; Department of Dermatology,
Brigham and Women's Hospital, Boston, Massachusetts, USA.
(2)Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, USA. Electronic address: vnambudiri@bwh.harvard.edu.
DOI: 10.1016/j.jaad.2020.04.154
PMCID: PMC7198179
PMID: 32380217
3. Australas J Dermatol. 2020 May 3. doi: 10.1111/ajd.13301. [Epub ahead of print]
Practice guidelines for teledermatology in Australia.
Abbott LM(1)(2), Miller R(1), Janda M(3), Bennett H(1), Taylor M(4), Arnold C(1),
Shumack S(1), Soyer HP(5), Caffery LJ(5).
Author information:
(1)The Australasian College of Dermatologists, Sydney, New South Wales,
Australia.
(2)Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.
(3)Centre for Health Services Research, The University of Queensland, St Lucia,
Queensland, Australia.
(4)Centre for Online Health, Centre for Health Services Research, The University
of Queensland, St Lucia, Queensland, Australia.
(5)The University of Queensland Diamantina Institute, Woolloongabba, Queensland,
Australia.
Despite the potential of teledermatology to increase access to dermatology
services and improve patient care, it is not widely practised in Australia. In an
effort to increase uptake of teledermatology by Australian dermatologists and
support best practice, guidelines for teledermatology for the Australian context
have been developed by The University of Queensland's Centre for Online Health in
collaboration with The Australasian College of Dermatologists' E-Health
Committee. The guidelines are presented in two sections: 1. Guidelines and 2.
Notes to support their application in practice, when feasible and appropriate.
Content was last updated March 2020 and includes modalities of teledermatology;
patient selection and consent; imaging; quality and safety; privacy and security;
communication; and documentation and retention of clinical images. The guidelines
educate dermatologists about the benefits and limitations of telehealth while
articulating how to enhance patient care and reduce risk when practicing
teledermatology.
© 2020 The Authors. Australasian Journal of Dermatology published by John Wiley &
Sons Australia, Ltd on behalf of Australasian College of Dermatologists.
DOI: 10.1111/ajd.13301
PMID: 32363572
4. Int J Med Inform. 2020 Mar 13;139:104118. doi: 10.1016/j.ijmedinf.2020.104118.
[Epub ahead of print]
Teleoncology for children with cancer: A scoping review on applications and
outcomes.
Kermani F(1), Orooji A(2), Sheikhtaheri A(3).
Author information:
(1)Department of Health Information Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
(2)School of Medicine, North Khorasan University of Medical Science (NKUMS),
North Khorasan, Iran.
(3)Health Management and Economics Research Center, Department of Health
Information Management, School of Health Management and Information Sciences,
Iran University of Medical Sciences, Tehran, Iran. Electronic address:
BACKGROUND AND OBJECTIVES: Teleoncology can be used to reduce the limitations due
to the lack of access to specialists, inadequate resources and training, and
reducing unnecessary travels and arising of the costs. The purpose of this study
was to review the literatures to identify and classify the areas of application
and outcomes of using teleoncology in diagnosis, management, and treatment of
children with cancer.
METHODS: This scoping review of the published literatures was conducted by
searching the Web of Science, PubMed/Medline, Scopus, and Cochrane Library
databases in October 2019. Studies investigated telemedicine in diagnosis,
management, and treatment of cancer in children were also included. We identified
and classified different applications and the reported outcomes of this
technology.
RESULTS: In this study, 1834 articles were retrieved, and after removing the
unrelated and duplicated articles, 20 articles were reviewed ultimately. We found
that, teleoncology services were provided to the patients with cancer, their
parents, and nurses in various clinical fields such as telepathology, telemental
care (telepsychology), teleneurology, teledermatology, telehematology, and
teleophthalmology. The findings also showed that, the outcomes of using
telemedicine in children with cancer can be classified into six general
categories (five primary and 14 secondary outcomes). Primary outcomes including
diagnosis accuracy, reduced costs as well as mortality and secondary outcomes
consist of improved relationship and training, better care management,
satisfaction, and workload.
CONCLUSION: The use of telemedicine for children with cancer is growing, and
there is a tendency for using this technology for families and clinical staff.
Providing teleoncology services to children with cancer may improve diagnosis
accuracy and reduce the cost and mortality rate. Also, better care management,
appropriate relationships and training, increased satisfaction, and decreased
workload may be achieved.
Copyright © 2020 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.ijmedinf.2020.104118
PMID: 32353751
5. Telemed J E Health. 2020 Apr 27. doi: 10.1089/tmj.2020.0013. [Epub ahead of
print]
Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM
Framework.
Peracca SB(1), Jackson GL(2)(3), Lamkin RP(4), Mohr DC(4)(5), Zhao M(4), Lachica
O(1), Prentice JC(4)(6), Grenga AM(7), Gifford A(4), Chapman JG(2), Weinstock
MA(7)(8)(9), Oh DH(1)(8)(10).
Author information:
(1)Dermatology Service, San Francisco Veterans Affairs Health Care System, San
Francisco, California, USA.
(2)Center of Innovation to Accelerate Discovery and Practice Transformation
(ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
(3)Department of Population Health Sciences and Division of General Internal
Medicine, Department of Medicine, Duke University, North Carolina, USA.
(4)Center for Healthcare Organization and Implementation Research (CHOIR),
Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.
(5)Department of Health Law, Policy and Management, School of Public Health,
Boston University, Boston, Massachusetts, USA.
(6)Department of Psychiatry, School of Medicine, Boston University,
Massachusetts, USA.
(7)Providence VA Medical Center, Providence, Rhode Island.
(8)Office of Connected Care, Veterans Health Administration, Washington, District
of Columbia, USA.
(9)Dermatoepidemiology Unit, Departments of Dermatology and Epidemiology, Brown
University, Providence, Rhode Island, USA.
(10)Department of Dermatology, University of California at San Francisco, San
Francisco, California, USA.
Introduction: Few systematic evaluations of implementing teledermatology programs
in large health care systems exist. We conducted a longitudinal evaluation of a
U.S. Department of Veterans Affairs (VA) initiative to expand asynchronous
consultative teledermatology services for rural veterans. Methods: The reach,
effectiveness, adoption, implementation, and maintenance framework guided the
evaluation, which included analysis of quantitative VA administrative data as
well as an online survey completed by participating facilities. The first 2 years
of the program were compared with the year before the start of funding. Results:
Sixteen hub facilities expanded teledermatology's reach over the 2-year period,
increasing the number of referral spoke sites, unique patients served, and
teledermatology encounters. Effectiveness was reflected as teledermatology
constituted an increasing fraction of dermatology activity and served more
remotely located patients. Adoption through defined stages of implementation
progressed as facilities engaged in a variety of strategies to enhance
teledermatology implementation, and facilitators and barriers were identified.
Program maintenance was assessed by Program Sustainability Index scores, which
reflected the importance of executive support, and ongoing concerns about
staffing and longitudinal funding. Discussion: Enabling hubs to create solutions
that best fit their needs and culture likely increased reach and effectiveness.
Important facilitators included organizational leadership and encouraging
communication between stakeholders before and during the intervention.
Conclusions: A systematic analysis of teledermatology implementation to serve
rural sites in VA documented a high degree of implementation and sustainability
as well as areas for improvement.
DOI: 10.1089/tmj.2020.0013
PMID: 32343924
6. PLoS One. 2020 Apr 27;15(4):e0232131. doi: 10.1371/journal.pone.0232131.
eCollection 2020.
Teledermatology in Norway using a mobile phone app.
Rizvi SMH(1)(2), Schopf T(3), Sangha A(2), Ulvin K(2), Gjersvik P(4).
Author information:
(1)Department of Dermatology, Oslo University Hospital, Oslo, Norway.
(2)Askin AS, Oslo, Norway.
(3)National Centre for e-Health Research, University Hospital Northern Norway,
Tromsø, Norway.
(4)Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Rashes, ulcers and skin lesions are well suited for telemedicine. We have
developed a smartphone app, the first of its kind in Norway, where a referring
physician can write a short medical history and take clinical and dermatoscopic
photographs with a smartphone, which is then sent to and evaluated by a
dermatologist. In the period from June 1st, 2017, to September 1st, 2019,
clinical information and photographs of rash and skin lesions from 171 patients
were sent by 40 primary care and nursing home physicians via the smartphone app
to four dermatologists for diagnosis and therapeutic advice. A wide range of
dermatological conditions were diagnosed, most commonly chronic ulcers (17%),
eczema (15%) and pigmented lesions (13%). Assessed later by a dermatologist,
referral for regular consultations with a specialist was avoided in 119 patients
(70%). Sixteen patients (9%) were recommended a regular consultation with a
dermatologist; information for prioritization in the specialist healthcare
service was then provided. In 36 patients (21%), further measures by the
referring physician were recommended. Our experience indicates that many ordinary
consultations on rash, ulcers and skin lesions in the specialist healthcare
services can be avoided when using the smartphone app.
DOI: 10.1371/journal.pone.0232131
PMCID: PMC7185702
PMID: 32339203
Conflict of interest statement: SMHR, AS and KU founded and are shareholders in
Askin AS (www.askin.no) of which TS is a partner. PG has no conflict of interest.
The commercial affiliation does not alter our adherence to PLOS ONE policies on
sharing data and materials.
7. J Am Acad Dermatol. 2020 Apr 22. pii: S0190-9622(20)30696-4. doi:
10.1016/j.jaad.2020.04.080. [Epub ahead of print]
Teledermatology in the Wake of COVID-19: Advantages and Challenges to Continued
Care in a Time of Disarray.
Gupta R(1), Ibraheim MK(2), Doan HQ(3).
Author information:
(1)School of Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic
address: rohit.gupta@bcm.edu.
(2)The University of Texas McGovern Medical School, Houston, TX, USA.
(3)Department of Dermatology, Division of Internal Medicine, The University of
Texas MD Anderson Cancer Center, Houston, TX, USA.
DOI: 10.1016/j.jaad.2020.04.080
PMCID: PMC7175895
PMID: 32334056
8. J Med Internet Res. 2020 Apr 21;22(4):e16700. doi: 10.2196/16700.
Benefits of Teledermatology for Geriatric Patients: Population-Based
Cross-Sectional Study.
G Bianchi M(#)(1), Santos A(#)(1), Cordioli E(#)(1).
Author information:
(1)Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
(#)Contributed equally
BACKGROUND: Teledermatology is a health care tool that has been increasingly used
around the world, mostly because dermatology has an emphasis on visual diagnosis.
Many studies have shown that access to specialized care improves using
teledermatology, which provides accurate diagnosis and reduces the time taken for
treatment, with high patient satisfaction. As the population around the world
grows old, there will be even more demand for dermatologists in years to come. It
is essential to know which are the most prevalent skin conditions in the primary
care population and if they can be addressed through teledermatology.
OBJECTIVE: Our main goal was to evaluate the proportion of lesions in individuals
aged 60 years and older that could be managed using teledermatology in
conjunction with primary care physicians. Second, we aimed to assess the most
frequent skin lesions, the most common treatments provided to patients, and the
distribution and causes of referrals made by the teledermatologists.
METHODS: This was a retrospective cohort study from July 2017 to July 2018 in São
Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented
with 12,770 skin lesions. Teledermatologists had three options to refer patients:
(1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3)
back to the primary care physician with the most probable diagnosis and
treatment.
RESULTS: Teledermatology managed 66.66% (8408/12614) of dermatoses with the
primary care physician without the need for an in-presence visit; 27.10%
(3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to
biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo,
onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid
cyst, xerosis, leucoderma, and wart, with significant differences between sexes.
Malignant tumors increased with age and were the leading cause for biopsies,
while infectious skin conditions and pigmentary disorders decreased. Emollient
was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases.
CONCLUSIONS: Teledermatology helped to treat 67% of the dermatoses of older
individuals, addressing cases of minor complexity quickly and conveniently
together with the primary care physician, thus optimizing dermatological
appointments for the most severe, surgical, or complex diseases. Teledermatology
does not aim to replace a face-to-face visit with the dermatologist; however, it
might help to democratize dermatological treatment access for patients and
decrease health care expenses.
©Mara G Bianchi, Andre Santos, Eduardo Cordioli. Originally published in the
Journal of Medical Internet Research (http://www.jmir.org), 21.04.2020.
DOI: 10.2196/16700
PMCID: PMC7201316
PMID: 32314966
9. Mil Med. 2020 Apr 20. pii: usz479. doi: 10.1093/milmed/usz479. [Epub ahead of
print]
Synchronous Teledermoscopy in Military Treatment Facilities.
Day WG(1), Shrivastava V(2), Roman JW(2).
Author information:
(1)Internal Medicine Intern, Naval Medical Center Portsmouth, 620 John Paul Jones
Cir, Portsmouth, VA 23708.
(2)Department of Dermatology, Naval Medical Center Portsmouth, 620 John Paul
Jones Cir, Portsmouth, VA 23708.
Sustained demand for dermatologic care throughout military medicine, in
conjunction with increasing dermatologic provider shortages, has led to increase
use of teledermatology in military treatment facilities (MTFs). Initially used to
aid in the differentiation of suspicious melanocytic lesions, dermoscopy has
found increasing clinical utility in an expanding realm of general dermatologic
conditions. We demonstrate the use of synchronous teledermoscopy within a remote
MTF by repurposing webcam technology already available at most MTFs. Two patients
were seen in clinic at a remote naval primary care clinic with limited
subspecialties. Once written consent was retrieved, an on-site dermatologist
evaluated each patient and performed a history and skin exam with dermoscopy.
Synchronous consultations were conducted with the Global Med Cart (GlobalMed(R)
Clinical Access Station with TotalExam(R) 3 HDUSB camera), and Cisco webcam video
jabber (Cisco TelePresence PrecisionHD USB Camera part number TTC8-03). The
patients then underwent individual synchronous teledermatology consultations with
an off-site U.S. Navy dermatologist located in the continental United States. The
methodology for the consultation involved the use of a standard dermatoscope and
jabber webcam. Two synchronous teledermatology consultations were completed
successfully on patients in MTFs with limited subspecialty capabilities. Both
cases, with two lesions of concern per case, had 100% concordance between the
on-site and teleconsulted dermatologist. Through observing inter-rater agreements
between the on-site and remote dermatologists, this small study demonstrates a
novel application of technology readily available at most MTFs.
© The Author(s) 2020. Published by Oxford University Press on behalf of the
Association of Military Surgeons of the United States. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.
DOI: 10.1093/milmed/usz479
PMID: 32307547
10. J Am Acad Dermatol. 2020 Apr 16. pii: S0190-9622(20)30661-7. doi:
10.1016/j.jaad.2020.04.048. [Epub ahead of print]
Teledermatology in the Era of COVID-19: Experience of an Academic Department of
Dermatology.
Perkins S(1), Cohen JM(2), Nelson CA(2), Bunick CG(2).
Author information:
(1)Department of Dermatology, Yale University, New Haven, CT, 06520. Electronic
address: sara.perkins@yale.edu.
(2)Department of Dermatology, Yale University, New Haven, CT, 06520.
DOI: 10.1016/j.jaad.2020.04.048
PMCID: PMC7162755
PMID: 32305442
11. Clin Exp Dermatol. 2020 Apr 18. doi: 10.1111/ced.14245. [Epub ahead of print]
Telemedicine and support groups in order to improve the adherence to treatment
and health related quality of life in patients affected by inflammatory skin
conditions during COVID-19 emergency.
Marasca C(1), Ruggiero A(1), Fontanella G(1), Ferrillo M(1), Fabbrocini G(1),
Villani A(1).
Author information:
(1)Section of Dermatology, Department of Clinical Medicine and Surgery,
University of Naples Federico II, Napoli, Italy.
We have read with great interest the article by Deepak et al. which reported the
measures applied during the COVID-19 emergency in order to answer to the request
of consultations. Particularly they described the growing importance that
telemedicine is having during this emergency, focusing on the use of mobile
technology (particularly the use of WhatsApp) as a method to communicate via text
messages, voice messages, photos and videos, which is rapidly expanding within
the field of telemedicine.
This article is protected by copyright. All rights reserved.
DOI: 10.1111/ced.14245
PMID: 32304587
12. Clin Exp Dermatol. 2020 Apr 17. doi: 10.1111/ced.14244. [Epub ahead of print]
Secure communication conduits during COVID19 lockdown.
Black SM(1), Ali FR(2).
Author information:
(1)Medical Sciences Division, University of Oxford, Oxford, UK.
(2)Vernova Healthcare Community Interest Company, Macclesfield, UK.
We commend Deepak and colleagues in highlighting the virtues of instant messaging
tools such as WhatsApp during the COVID-19 crisis1 . Whilst WhatsApp's advantages
include being highly intuitive, widely used and accessible, there are concerns
among clinicians about its use, as well as that of other commercially available
communications apps. These include the loss of anonymity to patients, the need to
reveal their personal telephone number as well questions over privacy and data
security.
This article is protected by copyright. All rights reserved.
DOI: 10.1111/ced.14244
PMID: 32302418
13. Dermatol Online J. 2019 Nov 15;25(11). pii: 13030/qt6xh9p2nn.
Implementation of a patient-assisted teledermatology model in the Veteran Health
Administration.
Fortugno AP, Dellavalle RP(1).
Author information:
(1)Department of Dermatology, University of Colorado School of Medicine, Aurora,
CO Dermatology Service, U.S. Department of Veterans Affairs, Eastern Colorado
Health Care System, Aurora, CO Department of Epidemiology, Colorado School of
Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
Owing to the inherently visual nature of the field of dermatology, advances in
imaging and communication technology have resulted in wide-spread application of
teledermatology since its introduction in the mid-1990s. In the last 20 years,
studies have repetitively shown that teledermatology provides effective and
efficient quality care for patients. It also increases access to underserved
patients and reduces traveling costs, wait times, and unnecessary referrals. In
this letter the authors seek to analyze implementation of a direct patient to
dermatologist model in a Veteran Health Administration (VHA) patient population,
referred to as patient-assisted teledermatology. This population is largely over
the age of 65 and a significant portion are either without internet or have the
minimum technology necessary to participate in the studied model. Owing to these
observations and personal experiences, the authors found the implementation
process of a patient-assisted model to be challenging in this population.
PMID: 32045144 [Indexed for MEDLINE]
14. JAAD Case Rep. 2020 Jan 30;6(2):141-143. doi: 10.1016/j.jdcr.2019.11.006.
eCollection 2020 Feb.
A suspected hedgehog dermatosis diagnosed via store and forward teledermatology.
Said JT(1), Stavert R(2).
Author information:
(1)Harvard Medical School, Boston, Massachusetts.
(2)Department of Dermatology, Cambridge Health Alliance, Harvard Medical School,
Boston, Massachusetts.
DOI: 10.1016/j.jdcr.2019.11.006
PMCID: PMC7000437
PMID: 32042872
15. J Am Acad Dermatol. 2020 Feb 5. pii: S0190-9622(20)30151-1. doi:
10.1016/j.jaad.2020.01.065. [Epub ahead of print]
Clinical effectiveness and cost-effectiveness of teledermatology: Where are we
now, and what are the barriers to adoption?
Wang RH(1), Barbieri JS(2), Nguyen HP(3), Stavert R(4), Forman HP(5), Bolognia
JL(6), Kovarik CL(7); Group for Research of Policy Dynamics in Dermatology.
Author information:
(1)University of Pennsylvania Perelman School of Medicine, Philadelphia,
Pennsylvania.
(2)Department of Dermatology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania. Electronic address:
john.barbieri@pennmedicine.upenn.edu.
(3)Department of Dermatology, Emory University School of Medicine, Atlanta,
Georgia.
(4)Department of Dermatology, Beth Israel Deaconess Medical Center, Boston,
Massachusetts.
(5)Department of Public Health (Health Policy), Economics, and Management, Yale
University, New Haven, Connecticut.
(6)Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
(7)Department of Dermatology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania.
There has been rapid growth in teledermatology over the past decade, and
teledermatology services are increasingly being used to support patient care
across a variety of care settings. Teledermatology has the potential to increase
access to high-quality dermatologic care while maintaining clinical efficacy and
cost-effectiveness. Recent expansions in telemedicine reimbursement from the
Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will
play an increasingly prominent role in patient care. Therefore, it is important
that dermatologists be well informed of both the promises of teledermatology and
the potential practice challenges a continuously evolving mode of care delivery
brings. In this article, we will review the evidence on the clinical and
cost-effectiveness of teledermatology and we will discuss system-level and
practice-level barriers to successful teledermatology implementation as well as
potential implications for dermatologists.
Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc.
All rights reserved.
DOI: 10.1016/j.jaad.2020.01.065
PMID: 32035106
16. Clin Exp Dermatol. 2020 Feb 7. doi: 10.1111/ced.14191. [Epub ahead of print]
Patient satisfaction with a new skin cancer teledermatology service.
Nicholson P(1), Macedo C(1), Fuller C(1), Thomas L(1).
Author information:
(1)Dermatology Department, Chelsea and Westminster Hospital NHS Foundation Trust,
London, UK.
BACKGROUND: Rising numbers of two-week-wait (2WW) skin cancer referrals have
caused increasing pressure on UK dermatology departments. Initiatives to address
this include teledermatology. Previous studies have indicated good patient
acceptability but most have focused on general dermatology rather than skin
cancer referrals, and have taken place in rural settings, where teledermatology
may be preferable.
AIM: To evaluate patient satisfaction of teledermatology 2WW services in a
London-based tertiary National Health Service (NHS) setting.
METHODS: A literature search was performed and a patient satisfaction survey was
designed to evaluate: (i) ease of completing a questionnaire about the skin
lesion; (ii) lifestyle impact; (iii) preferences regarding electronic data
collection and communication of results; and (iv) confidence in the service. A
five-point Likert scale was used to assess responses. The study took place over a
20-week period.
RESULTS: Over half (51%; n = 31 of 60 patients) were female; 78% (47) were aged
≤ 55 years and 65% (39) were Caucasian. Over 80% (49) would recommend the
service, and the majority felt confident with the teledermatology model. Overall,
patients would be happy to complete electronic questionnaires and receive results
electronically, with younger patients being more amenable to this. Patients with
better health status, those of younger age and those with less frequent visits to
a dermatologist were more accepting of teledermatology.
CONCLUSION: To our knowledge, this is the first comprehensive study evaluating
patient satisfaction with teledermatology specifically for 2WW referrals in an
NHS setting. As skin cancer referrals increase, dermatology departments must
adjust. Patient involvement and feedback is paramount in implementing and
expanding teledermatology services.
© 2020 British Association of Dermatologists.
DOI: 10.1111/ced.14191
PMID: 32031275
17. J Eur Acad Dermatol Venereol. 2020 Feb 7. doi: 10.1111/jdv.16275. [Epub ahead of
print]
Diagnostic accuracy and interobserver concordance: teledermoscopy of 600
suspicious skin lesions in Southern Denmark.
Vestergaard T(1)(2), Prasad SC(1), Schuster A(1), Laurinaviciene R(1), Andersen
MK(3), Bygum A(1).
Author information:
(1)Department of Dermatology and Allergy Centre, Odense University Hospital,
Odense, Denmark.
(2)OPEN, Odense Patient data Explorative Network, Odense University Hospital,
Odense, Denmark.
(3)Audit Project Odense, Research Unit of General Practice, University of
Southern Denmark, Odense, Denmark.
BACKGROUND: Skin cancer incidences are increasing and early diagnosis, especially
of malignant melanoma, is crucial. Teledermatology including teledermoscopy (TDS)
can be used to triage referrals of suspicious skin lesions, however, this is not
currently recommended in Denmark.
OBJECTIVES: To evaluate diagnostic accuracy, sensitivity, specificity and
interobserver concordance of TDS, and to evaluate the number of incidental
lesions potentially missed by TDS.
METHODS: Fifty general practices were invited to send images of suspicious skin
lesions for evaluation using smartphone TDS. Simultaneously, the patient was
referred for a face-to-face (FTF) consultation. Images for TDS were independently
evaluated by two dermatologists; a third dermatologist performed the FTF
consultation. Diagnosis, management plan and level of diagnostic confidence were
noted. For TDS photo quality was rated, and for FTF any incidental findings were
described.
RESULTS: Six hundred lesions in 519 patients were included. The diagnostic
accuracy was significantly higher on FTF evaluation than on TDS (P < 0.01).
However, this was associated with a significant difference in specificity
(P ≤ 0.012) whereas no significant difference was found in sensitivity. The
concordance between FTF and TDS, and the interobserver concordance of two TDS
evaluations was moderate to substantial (AC1 = 0.57-0.71). Incidental melanomas
were found in 0.6% of patients on FTF evaluation, adding an extra 13% of
melanomas. However, on TDS these patients' photographed lesions all warranted FTF
follow-up, where these melanomas would have been identified.
CONCLUSION: In this large prospective study, no significant difference in
sensitivity was observed between FTF and TDS, but specificity was lower on TDS
than FTF. Taking management plans into account, we would, however, potentially
have dismissed 2 of 23 melanomas, if only TDS had been used for assessment. One
of these was a melanoma located on the scalp, an anatomic region less suitable
for TDS.
© 2020 European Academy of Dermatology and Venereology.
DOI: 10.1111/jdv.16275
PMID: 32031277