Teledermatology

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.

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,

joachim.fluhr@gmx.net.

(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.

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.

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.

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.

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.

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.

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.

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.

naharvinayak@gmail.com.

(3)Department of Preventive Medicine, School of Medicine/John D. Bower School of

Population Health, University of Mississippi Medical Center, Jackson, MS, USA.

naharvinayak@gmail.com.

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.

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.

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.

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.

amorkh@gmail.com.

(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:

ferozkal@hotmail.com.

(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

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.

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.

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.

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.

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:

sheikhtaheri.a@iums.ac.ir.

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.

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.

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.

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.

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.

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.

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.

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.

DOI: 10.1111/jdv.16275

PMID: 32031277