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COVID-19 and the need for teledermatology and telemedicine

image24

Global Teledermatology

  

1. J Cutan Aesthet Surg. 2020 Apr-Jun;13(2):77-94. doi: 10.4103/JCAS.JCAS_83_20.

Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic.

Mysore V(1), Savitha AS(2), Venkataram A(1), Inamadar AC(3), Sanjeev A(4), 

Byalekere Chandrashekar S(5), Devaraj DK(6), Khunger N(7), Reddy RR(2), Rashi 

P(8), Salim T(9), Mutalik SD(10), Arsiwala S(11)(12)(13), Barua S(14), Gupta 

S(8), Sirur S(15), Shah S(16).

Author information:

(1)The Venkat Center for Skin ENT & Plastic Surgery, Bengaluru, India.

(2)Department of Dermatology, Sapthagiri Institute of Medical Sciences and 

Research Centre, Bangalore, India.

(3)Department of Dermatology, Sri B M Patil Medical College Hospital and 

Research Centre, BLDE University, Vijayapura, Karnataka, India.

(4)Skin & Laser Clinic, Hyderabad, Telangana, India.

(5)CUTIS Academy of Cutaneous Sciences, Bengaluru, Karnataka, India.

(6)Dr. Dinesh's Skin & Hair Clinic, Chennai, Tamil Nadu, India.

(7)Department of Dermatology, Vardhaman Mahavir Medical College, Safdarjang 

Hospital, New Delhi, India.

(8)Department of Dermatology and Venereology, All India Institute of Medical 

Sciences, New Delhi, India.

(9)Cutis Institute, Calicut, Kerala, India.

(10)Department of Dermatology, Maharashtra Medical Foundation, Pune, India.

(11)Renewderm Centre, Mumbai, Maharashtra, India.

(12)Saifee Hospital, Mumbai, Maharashtra, India.

(13)Prince Aly Khan Hospital, Mumbai, Maharashtra, India.

(14)Department of Dermatology, Assam Medical College & Hospital, Dibrugarh, 

Assam, India.

(15)Wockhardt Hospital and Apollo Spectra Hospital, Mumbai, India.

(16)Department of Dermatology, Ashwini Rural Medical College, Solapur, 

Maharashtra, India.

BACKGROUND: Amid the coronavirus disease 2019 (COVID-19) pandemic, 

dermatologists must be prepared to restructure their practice of procedural 

dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has 

presented several challenges and has ushered in several changes in practice such 

as teledermatology, with many physicians adopting virtual consultations and 

treatments. Performing procedures in the times of COVID-19 pandemic presents 

challenges such as risk of transmission to doctors and staff due to potential 

aerosolization, release of virus droplets during the procedures, and risk of 

virus transfer through the instruments both in the peri- and postoperative 

period. This can have several medical, administrative, and legal implications.

OBJECTIVES: This document aimed to outline best practices that can be followed 

in this scenario to perform cutaneous surgeries and procedures to ensure safer 

skin surgery.

RECOMMENDATIONS: Standard precautions include social distancing of at least 1 m, 

hand hygiene, appropriate use of personal protective equipment (PPE), safe 

injection practices, sterilization and disinfection of medical devices, 

environmental cleaning, and respiratory hygiene. It is generally advisable to 

see patients only by appointments. Each clinic should have a special area at 

entry for screening patients and providing sanitizers and masks. Procedures, 

which are of short duration, performed on nonfacial areas are considered as low 

risk and require donning surgical mask. Procedures involved with minimal 

invasiveness and bleeding, short duration procedures on the face such as 

injectables, chemical peels, and aerosol-generating procedures on nonfacial 

areas are considered moderate risk. These procedures need apron with head cover, 

N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency 

particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and 

plume-regenerating procedures (such as ablative lasers on the face), prolonged 

surgeries on head (such as hair transplantation), intraoral, and intranasal 

procedures are considered high risk. These procedures must be carried out with 

full body cover with surgical gown, head cover, N95 mask, face shield, double 

gloves, and smoke evacuator. Physicians should be aware of local epidemiological 

situation and adhere to the relevant guidelines issued by the relevant 

governmental agencies.

Copyright: © 2020 Journal of Cutaneous and Aesthetic Surgery.

DOI: 10.4103/JCAS.JCAS_83_20

PMCID: PMC7394118

PMID: 32792769

Conflict of interest statement: There are no conflicts of interest.


2. Arch Dermatol Res. 2020 Aug 12. doi: 10.1007/s00403-020-02119-5. Online ahead of 

print.

Patient education in Mohs surgery: a review and critical evaluation of 

techniques.

Patel P(1), Malik K(2), Khachemoune A(3)(4).

Author information:

(1)Division of Dermatology, Department of Medicine, Montefiore Medical Center, 

Albert Einstein College of Medicine, Bronx, New York, USA.

(2)Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, 

USA.

(3)Department of Dermatology, SUNY Downstate, Brooklyn, New York, USA. 

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 

implemented. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/dth.14161

PMID: 32770716


7. J Ultrasound Med. 2020 Aug 7. doi: 10.1002/jum.15409. Online ahead of print.

Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology: A 

Prospective Multicenter Validation Study.

Alfageme F(1), Minguela E(2), Martínez C(1), Salgüero I(1), Calvo A(3), León 

F(4), Álvarez L(4), de Vicente O(5), Panadero FJ(6), Salguero OL(7), Roustán 

G(1).

Author information:

(1)Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, 

Madrid, Spain.

(2)Centro de Salud Valle de la Oliva Majadahonda, Madrid, Spain.

(3)Centro de Salud de Galapagar, Madrid, Spain.

(4)Centro de Salud San Juan de la Cruz, Pozuelo de Alarcón, Spain.

(5)Centro de Salud La Marazuela, Las Rozas, Spain.

(6)Centro de Salud Villanueva de la Cañada, Madrid, Spain.

(7)Centro de Salud Cerro del Aire Majadahonda, Madrid, Spain.

OBJECTIVES: This study aimed to validate dermatologic ultrasound as a 

complementary teledermatologic imaging modality in primary and tertiary care 

centers.

METHODS: Six primary care centers and 1 tertiary care dermatology department 

collaborated in the program. Images were sent through the institutional 

teledermatologic platform to the tertiary care dermatology department. At the 

reference hospital, ultrasound images and clinical data were received and 

registered by a physician trained in dermatologic ultrasound. An in-person 

consultation was scheduled to confirm the teleultrasound diagnosis. The time of 

response by the tertiary center, quality and size of the teledermatologic image, 

and concordance with the in-person diagnosis were assessed for each dermatologic 

lesion.

RESULTS: A total of 147 teleultrasound consultations with 143 patients (93 women 

and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and 

January 2019. Nine teleultrasound consultations (6.1%) were not valid. 

Discordance between teleultrasound and the in-person diagnosis was evident in 6 

of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), 

followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), 

and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 

100%), although 2 cases of benign lesions were telediagnosed as malignant 

(specificity, 97.8%). The positive and negative predictive values of a 

teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, 

respectively.

CONCLUSIONS: Asynchronous primary care teleultrasound combined with dermatologic 

ultrasound training at tertiary centers is an effective teledermatologic 

modality.

© 2020 American Institute of Ultrasound in Medicine.

DOI: 10.1002/jum.15409

PMID: 32767579


8. Dermatol Ther. 2020 Aug 6:e14149. doi: 10.1111/dth.14149. Online ahead of print.

COVID-19: An Opportunity to Build Dermatology's Digital Future.

Puri P(1)(2), Comfere N(2)(3), Pittelkow MR(2)(4), Bezalel SA(2)(3), Murphree 

DH(2)(5).

Author information:

(1)Mayo Clinic Alix School of Medicine, Scottsdale, AZ.

(2)Mayo Clinic Office of Artificial Intelligence in Dermatology.

(3)Department of Dermatology, Mayo Clinic, Rochester, MN.

(4)Depatment of Dermatology, Mayo Clinic, Scottsdale, AZ.

(5)Department of Health Sciences Research, Mayo Clinic, Rochester, MN.

DOI: 10.1111/dth.14149

PMID: 32767453


9. Hautarzt. 2020 Aug 6:1-5. doi: 10.1007/s00105-020-04664-6. Online ahead of 

print.

[Artificial intelligence to support telemedicine in Africa].

[Article in German]

Greis C(1), Maul LV(2), Hsu C(2), Djamei V(3), Schmid-Grendelmeier P(3), 

Navarini AA(2).

Author information:

(1)Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091, 

Zürich, Schweiz. christian.greis@usz.ch.

(2)Klinik für Dermatologie, Universitätsspital Basel, Basel, Schweiz.

(3)Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091, 

Zürich, Schweiz.

Telemedicine has been used in the daily routine of dermatologists for decades. 

The potential advantages are especially obvious in African countries having 

limited medical care, long geographical distances, and a meanwhile relatively 

well-developed telecommunication sector. National and international working 

groups support the establishment of teledermatological projects and in recent 

years have increasingly been using artificial intelligence (AI)-based 

technologies to support the local physicians. Ethnic variations represent 

a challenge in the development of automated algorithms. To further improve the 

accuracy of the systems and to be able to globalize, it is important to increase 

the amount of available clinical data. This can only be achieved with the active 

participation of local health care providers as well as the dermatological 

community and must always be in the interest of the individual patient.

Telemedizin findet seit Jahrzehnten Anwendung im Alltag von Dermatologen. 

Insbesondere in afrikanischen Ländern mit begrenzter medizinischer Versorgung, 

zu überbrückenden geografischen Distanzen und einem zwischenzeitlich relativ gut 

ausgebauten Telekommunikationssektor liegen die Vorteile auf der Hand. Nationale 

und internationale Arbeitsgruppen unterstützen den Aufbau von 

teledermatologischen Projekten und bedienen sich in den letzten Jahren zunehmend 

KI(künstliche Intelligenz)-gestützter Technologien, um Ärzte vor Ort zu 

unterstützen. Vor diesem Hintergrund stellen ethnische Variationen eine 

besondere Herausforderung in der Entwicklung automatisierter Algorithmen dar. Um 

die Genauigkeit der Systeme weiter zu verbessern und globalisieren zu können, 

ist es wichtig, die Zahl der verfügbaren klinischen Daten zu erhöhen. Dies kann 

nur mit der aktiven Beteiligung der lokalen Gesundheitsversorger sowie der 

dermatologischen Gemeinschaft gelingen und muss stets im Interesse des einzelnen 

Patienten erfolgen.

DOI: 10.1007/s00105-020-04664-6

PMCID: PMC7407433

PMID: 32761386


10. Contact Dermatitis. 2020 Aug 4. doi: 10.1111/cod.13683. Online ahead of print.

Teledermatology and hygiene practices during the COVID-19 pandemic.

Cristaudo A(1), Pigliacelli F(1), Pacifico A(1), Damiani G(2), Iacovelli P(1), 

Morrone A(1).

Author information:

(1)San Gallicano Dermatological Institute IRCCS, Rome, Italy.

(2)Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, 

IRCCS Galeazzi, Orthopaedic Institute, University of Milan, 20126, Milan, Italy.

DOI: 10.1111/cod.13683

PMID: 32754901

Telemedicine and Teledermatology

1. JMIR Public Health Surveill. 2020 Apr 2;6(2):e18810. doi: 10.2196/18810.

Global Telemedicine Implementation and Integration Within Health Systems to 

Fight the COVID-19 Pandemic: A Call to Action.

Ohannessian R(1), Duong TA(2)(3), Odone A(4)(5)(6).

Author information:

(1)Télémédecine 360, TLM360, Paris, France.

(2)Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.

(3)Chaire Avenir Sante numérique, équipe 8 IMRB, Inserm, Créteil, France.

(4)School of Public Health, Faculty of Medicine, University Vita-Salute San 

Raffaele, Milan, Italy.

(5)Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, 

Milan, Italy.

(6)Digital Health Section, European Public Health Association, Milan, Italy.

On March 11, 2020, the World Health Organization declared the coronavirus 

disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported 

in more than 203 countries as of 31 March. The response strategy included early 

diagnosis, patient isolation, symptomatic monitoring of contacts as well as 

suspected and confirmed cases, and public health quarantine. In this context, 

telemedicine, particularly video consultations, has been promoted and scaled up 

to reduce the risk of transmission, especially in the United Kingdom and the 

United States of America. Based on a literature review, the first conceptual 

framework for telemedicine implementation during outbreaks was published in 

2015. An updated framework for telemedicine in the COVID-19 pandemic has been 

defined. This framework could be applied at a large scale to improve the 

national public health response. Most countries, however, lack a regulatory 

framework to authorize, integrate, and reimburse telemedicine services, 

including in emergency and outbreak situations. In this context, Italy does not 

include telemedicine in the essential levels of care granted to all citizens 

within the National Health Service, while France authorized, reimbursed, and 

actively promoted the use of telemedicine. Several challenges remain for the 

global use and integration of telemedicine into the public health response to 

COVID-19 and future outbreaks. All stakeholders are encouraged to address the 

challenges and collaborate to promote the safe and evidence-based use of 

telemedicine during the current pandemic and future outbreaks. For countries 

without integrated telemedicine in their national health care system, the 

COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for 

supporting wide adoption of telemedicine.

©Robin Ohannessian, Tu Anh Duong, Anna Odone. Originally published in JMIR 

Public Health and Surveillance (http://publichealth.jmir.org), 02.04.2020.

DOI: 10.2196/18810

PMCID: PMC7124951

PMID: 32238336 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.

2. Med Leg J. 2020 Jun 3:25817220926926. doi: 10.1177/0025817220926926. Online 

ahead of print.

Telemedicine during Covid-19 pandemic: Advantage or critical issue?

Perrone G(1), Zerbo S(1), Bilotta C(1), Malta G(1), Argo A(1).

Author information:

(1)Department of Health Promotion, Maternal and Child Care, "G. D'Alessandro", 

Legal Medicine Section, University of Palermo, Palermo, Italy.

Telemedicine offers a support to traditional medicine, delivering clinical 

services when distance is a critical factor. Although this tool does not replace 

a medical examination, during Covid-19 pandemic, it reduces the spread of 

infection and avoids the need for a patient's visit. It is useful in the 

management of chronic disorders or for patients undergoing palliative treatment. 

The University Hospital of Palermo has applied this in cases of chronic illness 

caring for patients who cannot stop their treatment, such as Department of 

Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal 

Medicine of Palermo, in particular, is also using telemedicine to manage 

medico-legal sudden natural death investigations and dealing with the Public 

Prosecutor's office of Palermo. Even after the Covid-19 emergency, telemedicine 

will be essential to streamline outpatient visits, while at the same time 

limiting costs, with significant benefits for the Italian National Public Health 

Service budget. In conclusion, telemedicine can offer a valuable support to the 

doctor's activity by streamlining and facilitating their work. In this sense, 

the Covid-19 pandemic represents a positive input for the acceleration and 

enhancement of these tools.

DOI: 10.1177/0025817220926926

PMID: 32490720

3. J Coll Physicians Surg Pak. 2020 Apr;30(4):349-350. doi: 

10.29271/jcpsp.2020.04.349.

Telemedicine in the Time of COVID-19 Pandemic.

Gondal KM(1), Shaukat S(2).

Author information:

(1)Department of Surgery, King Edward Medical University, Lahore, Pakistan.

(2)Department of Dermatology, Unit - I, King Edward Medical University, Lahore, 

Pakistan.

Null.

DOI: 10.29271/jcpsp.2020.04.349

PMID: 32513349 [Indexed for MEDLINE]

4. J Dermatolog Treat. 2020 May 13:1-2. doi: 10.1080/09546634.2020.1762844. Online 

ahead of print.

The danger of neglecting melanoma during the COVID-19 pandemic.

Gomolin T(1), Cline A(2), Handler MZ(2).

Author information:

(1)New York Medical College School of Medicine, Valhalla, NY, USA.

(2)Department of Dermatology, Metropolitan Hospital, New York, NY, USA.

Due to the COVID-19 pandemic, planned medical and surgical activities are being 

postponed. For the dermatology community, this interruption to the healthcare 

system can lead to delays in the diagnosis and treatment of melanoma. Neglecting 

melanoma during this crisis can result in increased mortality, morbidity and 

healthcare costs. With the COVID-19 pandemic evolving and no clear solutions in 

sight, it is time for the prospective evaluation of teledermatology. However, 

dermatologists should be cautious and continue seeing patients with pigmented 

lesions in person due to the necessity of early surgical intervention.

DOI: 10.1080/09546634.2020.1762844

PMID: 32347761

5. J Eur Acad Dermatol Venereol. 2020 May 18:10.1111/jdv.16636. doi: 

10.1111/jdv.16636. Online ahead of print.

Chilblain acral lesions in the COVID-19 era. Are they marker of infection in 

asymptomatic patients?

Ramondetta A(1), Panzone M(1), Dapavo P(1), Ortoncelli M(1), Giura MT(1), 

Licciardello M(1), Rozzo G(1), Siliquini N(1), Fierro MT(1), Ribero S(1).

Author information:

(1)Dermatology Clinic, University of Turin, Turin, Italy.

During these months in which the COVID‐19 emergency is waning, the activity of 

dermatologists has changes substantially. Since the beginning of March 2020, in 

the Dermatology Clinic at the University Hospital in Turin (Italy) the 

outpatient access has been significantly reduced and telemedicine has been 

useful whenever possible, by putting the patient in contact directly with 

dermatologists or mediated by the general practitioners.

DOI: 10.1111/jdv.16636

PMCID: PMC7276754

PMID: 32421876

6. Pediatr Dermatol. 2020 Apr 16:10.1111/pde.14196. doi: 10.1111/pde.14196. Online 

ahead of print.

Management of infantile hemangiomas during the COVID pandemic.

Frieden IJ(1), Püttgen KB(2), Drolet BA(3), Garzon MC(3), Chamlin SL(4), Pope 

E(5), Mancini AJ(4), Lauren CT(6), Mathes EF(1), Siegel DH(7), Gupta D(8), 

Haggstrom AN(9), Tollefson MM(10), Baselga E(11), Morel KD(6), Shah SD(1), 

Holland KE(7), Adams DM(12), Horii KA(13), Newell BD(13), Powell J(14), McCuaig 

CC(14), Nopper AJ(13), Metry DW(15), Maguiness S(16); Hemangioma Investigator 

Group.

Author information:

(1)University of California San Francisco, San Francisco, California, USA.

(2)Intermountain Healthcare, Salt Lake City, Utah, USA.

(3)School of Medicine and Public Health, University of Wisconsin, Madison, 

Wisconsin, USA.

(4)Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University 

Feinberg School of Medicine, Chicago, Illinois, USA.

(5)The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

(6)Columbia University Vagelos College of Physicians and Surgeons, New York, New 

York, USA.

(7)Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

(8)Seattle Children's Hospital, University of Washington School of Medicine, 

Seattle, Washington, USA.

(9)Indiana University, Indianapolis, Indiana, USA.

(10)Mayo Clinic, Rochester, Minnesota, USA.

(11)Hospital Sant Joan de Deu, Barcelona, Spain.

(12)Harvard Medical School, Boston, Massachusetts, USA.

(13)University of Missouri - Kansas City, Kansas City, Missouri, USA.

(14)Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine 

University Hospital Centre, University of Montreal, Montreal, QC, Canada.

(15)Baylor College of Medicine, Houston, Texas, USA.

(16)University of Minnesota, Minneapolis, Minnesota, USA.

The COVID-19 pandemic has caused significant shifts in patient care including a 

steep decline in ambulatory visits and a marked increase in the use of 

telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk 

stratification to determine which infants need treatment and which can be 

managed with continued observation. For those requiring treatment, prompt 

initiation decreases morbidity and improves long-term outcomes. The Hemangioma 

Investigator Group has created consensus recommendations for management of IH 

via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice 

guidelines, and relevant, up-to-date publications regarding initiation and 

monitoring of beta-blocker therapy were used to inform the recommendations. 

Clinical decision-making guidelines about when telehealth is an appropriate 

alternative to in-office visits, including medication initiation, dosage 

changes, and ongoing evaluation, are included. The importance of communication 

with caregivers in the context of telemedicine is discussed, and online 

resources for both hemangioma education and propranolol therapy are provided.

© 2020 Wiley Periodicals, LLC.

DOI: 10.1111/pde.14196

PMCID: PMC7262142

PMID: 32298480

Conflict of interest statement: Ilona J. Frieden is a member of Venthera Medical 

Advisory Board; Other: Pfizer (Data Safety Monitoring Board and investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01) Beth A. 

Drolet reports an investigator‐initiated trial funded by Pierre Fabre, Venthera 

consultant and medical advisory, and founder of Peds Derm Development, LLC and 

investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and 

Pharmacokinetics of Topical Timolol in Infants With Infantile Hemangioma (IH) 

(TIM01). Maria C. Garzon MD is an investigaror NCT02913612 Pediatric Trials 

Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants 

With Infantile Hemangioma (IH) (TIM01). Sarah L. Chamlin MD is an investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01). Other: 

Sarah L. Chamlin MD is a consultant in Regeneron and Sanofi. Elena Pope MD 

investigator in Pierre Fabre. Dawn H. Siegel MD is reviewer in ArQule (expert 

reviewer) and investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy, 

Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile 

Hemangioma (IH) (TIM01). Deepti Gupta MD has no conflicts of interest to 

declare. Anita N. Haggstrom MD is investigator NCT02913612 Pediatric Trials 

Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants 

With Infantile Hemangioma (IH) (TIM01), Anthony J. Mancini MD is an investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Megha M. 

Tollefson MD is an investigator NCT02913612 Pediatric Trials Network‐NIH 

Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants With 

Infantile Hemangioma (IH) (TIM01), Christine T. Lauren MD is an investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Erin F. 

Mathes MD is an investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy, 

Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile 

Hemangioma (IH) (TIM01). Eulalia Baselga MD is a consultant and advisory board 

member in Pierre Fabre, Venthera co‐founder and medical advisor. Kristen E. 

Holland MD is an investigator NCT02913612 Pediatric Trials Network‐NIH Efficacy, 

Safety and Pharmacokinetics of Topical Timolol in Infants With Infantile 

Hemangioma (IH) (TIM01); Other: Kristen E. Holland MD is an investigator and 

consultant in Pfizer, consultant in Regeneron, and investigator in Celgene and 

Sanofi. Denise M. Adams MD is an advisory board member in Venthera and Novartis. 

Katherine B. Püttgen MD is an investigator NCT02913612 Pediatric Trials 

Network‐NIH Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants 

With Infantile Hemangioma (IH) (TIM01), Kimberly A. Horii MD is an investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Kimberly 

D. Morel MD, is an investigator NCT02913612 Pediatric Trials Network‐NIH 

Efficacy, Safety and Pharmacokinetics of Topical Timolol in Infants With 

Infantile Hemangioma (IH) (TIM01), Kimberly A. Horii MD is an investigator 

NCT02913612 Pediatric Trials Network‐NIH Efficacy, Safety and Pharmacokinetics 

of Topical Timolol in Infants With Infantile Hemangioma (IH) (TIM01), Brandon D. 

Newell MD, Catherine C. McCuaig, Amy J. Nopper MD, Denise W. Metry MD, Sheilagh 

Maguiness and Sonal D. Shah MD have no conflicts of interest to declare. Julie 

Powell MD is a member of advisory board and speaker in Pierre‐Fabre Dermatology.

7. Dermatol Ther. 2020 Apr 29:e13472. doi: 10.1111/dth.13472. Online ahead of 

print.

Changing paradigms of dermatology practice in developing nations in the shadow 

of COVID-19: Lessons learnt from the pandemic.

Kumar S(1)(2), Bishnoi A(2), Vinay K(2).

Author information:

(1)Department of Dermatology, Venereology and Leprosy, All India Institute of 

Medical Sciences, Rishikesh, India.

(2)Department of Dermatology, Venereology and Leprology, Postgraduate Institute 

of Medical Education and Research, Chandigarh, India.

At present, routine dermatology practices stay mostly disrupted worldwide owing 

to the ongoing COVID-19 pandemic. However, dermatology services need to be 

resumed in future and dermatologists especially in developing countries face a 

mammoth task of devising plans to tackle the upcoming surge of patients while 

still maintaining the precautions to avoid risk of infection to health care 

workers and our patients. Teledermatology practice is a viable alternative and 

there is need of starting functioning teledermatology centers at primary health 

care centers and training health care workers in telemedicine. Several steps 

like increasing the working hours of outpatient clinics, posting dermatologists 

and health staffs in shifts, encouraging online registration and payment, 

providing time slots to patients should be taken to prevent overcrowding at 

outpatient departments in hospitals of developing countries like India where the 

usual patient turnover during summers maybe around 600 to 800 per day. Once 

diagnosed by the dermatologist, a subsequent meticulous use of teledermatology 

can limit the number of follow-up visits. To avoid student gatherings, the 

undergraduate and postgraduate teaching schedule should be replaced by online or 

virtual teaching in form of webinars and video conferencing. Above all, intense 

upgradation of health care infrastructure, recruitment, training of new health 

care staffs on mass level and huge investment in health care sector is required 

in all the developing countries.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/dth.13472

PMCID: PMC7261977

PMID: 32347612

Conflict of interest statement: The authors declare no conflicts of interest.

Teledermatology

1. J Dermatolog Treat. 2020 May 4:1-9. doi: 10.1080/09546634.2020.1762843. [Epub

ahead of print]

Inpatient Teledermatology During the COVID-19 Pandemic.

Rismiller K(1), Cartron AM(2), Trinidad JCL(1).

Author information: 

(1)Division of Dermatology, Department of Internal Medicine, The Ohio State

University Wexner Medical Center, Columbus, Ohio, USA.

(2)Department of Dermatology, University of Maryland School of Medicine,

Baltimore, MD, USA.

DOI: 10.1080/09546634.2020.1762843 

PMID: 32364809 

2. J Am Acad Dermatol. 2020 May 4. pii: S0190-9622(20)30776-3. doi:

10.1016/j.jaad.2020.04.154. [Epub ahead of print]

The COVID-19 crisis: A unique opportunity to expand dermatology to underserved

populations.

Ashrafzadeh S(1), Nambudiri VE(2).

Author information: 

(1)Harvard Medical School, Boston, Massachusetts, USA; Department of Dermatology,

Brigham and Women's Hospital, Boston, Massachusetts, USA.

(2)Department of Dermatology, Brigham and Women's Hospital, Boston,

Massachusetts, USA. Electronic address: vnambudiri@bwh.harvard.edu.

DOI: 10.1016/j.jaad.2020.04.154 

PMCID: PMC7198179

PMID: 32380217 

3. Australas J Dermatol. 2020 May 3. doi: 10.1111/ajd.13301. [Epub ahead of print]

Practice guidelines for teledermatology in Australia.

Abbott LM(1)(2), Miller R(1), Janda M(3), Bennett H(1), Taylor M(4), Arnold C(1),

Shumack S(1), Soyer HP(5), Caffery LJ(5).

Author information: 

(1)The Australasian College of Dermatologists, Sydney, New South Wales,

Australia.

(2)Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.

(3)Centre for Health Services Research, The University of Queensland, St Lucia,

Queensland, Australia.

(4)Centre for Online Health, Centre for Health Services Research, The University 

of Queensland, St Lucia, Queensland, Australia.

(5)The University of Queensland Diamantina Institute, Woolloongabba, Queensland, 

Australia.

Despite the potential of teledermatology to increase access to dermatology

services and improve patient care, it is not widely practised in Australia. In an

effort to increase uptake of teledermatology by Australian dermatologists and

support best practice, guidelines for teledermatology for the Australian context 

have been developed by The University of Queensland's Centre for Online Health in

collaboration with The Australasian College of Dermatologists' E-Health

Committee. The guidelines are presented in two sections: 1. Guidelines and 2.

Notes to support their application in practice, when feasible and appropriate.

Content was last updated March 2020 and includes modalities of teledermatology;

patient selection and consent; imaging; quality and safety; privacy and security;

communication; and documentation and retention of clinical images. The guidelines

educate dermatologists about the benefits and limitations of telehealth while

articulating how to enhance patient care and reduce risk when practicing

teledermatology.

© 2020 The Authors. Australasian Journal of Dermatology published by John Wiley &

Sons Australia, Ltd on behalf of Australasian College of Dermatologists.

DOI: 10.1111/ajd.13301 

PMID: 32363572 

4. Int J Med Inform. 2020 Mar 13;139:104118. doi: 10.1016/j.ijmedinf.2020.104118.

[Epub ahead of print]

Teleoncology for children with cancer: A scoping review on applications and

outcomes.

Kermani F(1), Orooji A(2), Sheikhtaheri A(3).

Author information: 

(1)Department of Health Information Management, School of Health Management and

Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

(2)School of Medicine, North Khorasan University of Medical Science (NKUMS),

North Khorasan, Iran.

(3)Health Management and Economics Research Center, Department of Health

Information Management, School of Health Management and Information Sciences,

Iran University of Medical Sciences, Tehran, Iran. Electronic address:

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.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ijmedinf.2020.104118 

PMID: 32353751 

5. Telemed J E Health. 2020 Apr 27. doi: 10.1089/tmj.2020.0013. [Epub ahead of

print]

Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM

Framework.

Peracca SB(1), Jackson GL(2)(3), Lamkin RP(4), Mohr DC(4)(5), Zhao M(4), Lachica 

O(1), Prentice JC(4)(6), Grenga AM(7), Gifford A(4), Chapman JG(2), Weinstock

MA(7)(8)(9), Oh DH(1)(8)(10).

Author information: 

(1)Dermatology Service, San Francisco Veterans Affairs Health Care System, San

Francisco, California, USA.

(2)Center of Innovation to Accelerate Discovery and Practice Transformation

(ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.

(3)Department of Population Health Sciences and Division of General Internal

Medicine, Department of Medicine, Duke University, North Carolina, USA.

(4)Center for Healthcare Organization and Implementation Research (CHOIR),

Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.

(5)Department of Health Law, Policy and Management, School of Public Health,

Boston University, Boston, Massachusetts, USA.

(6)Department of Psychiatry, School of Medicine, Boston University,

Massachusetts, USA.

(7)Providence VA Medical Center, Providence, Rhode Island.

(8)Office of Connected Care, Veterans Health Administration, Washington, District

of Columbia, USA.

(9)Dermatoepidemiology Unit, Departments of Dermatology and Epidemiology, Brown

University, Providence, Rhode Island, USA.

(10)Department of Dermatology, University of California at San Francisco, San

Francisco, California, USA.

Introduction: Few systematic evaluations of implementing teledermatology programs

in large health care systems exist. We conducted a longitudinal evaluation of a

U.S. Department of Veterans Affairs (VA) initiative to expand asynchronous

consultative teledermatology services for rural veterans. Methods: The reach,

effectiveness, adoption, implementation, and maintenance framework guided the

evaluation, which included analysis of quantitative VA administrative data as

well as an online survey completed by participating facilities. The first 2 years

of the program were compared with the year before the start of funding. Results: 

Sixteen hub facilities expanded teledermatology's reach over the 2-year period,

increasing the number of referral spoke sites, unique patients served, and

teledermatology encounters. Effectiveness was reflected as teledermatology

constituted an increasing fraction of dermatology activity and served more

remotely located patients. Adoption through defined stages of implementation

progressed as facilities engaged in a variety of strategies to enhance

teledermatology implementation, and facilitators and barriers were identified.

Program maintenance was assessed by Program Sustainability Index scores, which

reflected the importance of executive support, and ongoing concerns about

staffing and longitudinal funding. Discussion: Enabling hubs to create solutions 

that best fit their needs and culture likely increased reach and effectiveness.

Important facilitators included organizational leadership and encouraging

communication between stakeholders before and during the intervention.

Conclusions: A systematic analysis of teledermatology implementation to serve

rural sites in VA documented a high degree of implementation and sustainability

as well as areas for improvement.

DOI: 10.1089/tmj.2020.0013 

PMID: 32343924 

6. PLoS One. 2020 Apr 27;15(4):e0232131. doi: 10.1371/journal.pone.0232131.

eCollection 2020.

Teledermatology in Norway using a mobile phone app.

Rizvi SMH(1)(2), Schopf T(3), Sangha A(2), Ulvin K(2), Gjersvik P(4).

Author information: 

(1)Department of Dermatology, Oslo University Hospital, Oslo, Norway.

(2)Askin AS, Oslo, Norway.

(3)National Centre for e-Health Research, University Hospital Northern Norway,

Tromsø, Norway.

(4)Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Rashes, ulcers and skin lesions are well suited for telemedicine. We have

developed a smartphone app, the first of its kind in Norway, where a referring

physician can write a short medical history and take clinical and dermatoscopic

photographs with a smartphone, which is then sent to and evaluated by a

dermatologist. In the period from June 1st, 2017, to September 1st, 2019,

clinical information and photographs of rash and skin lesions from 171 patients

were sent by 40 primary care and nursing home physicians via the smartphone app

to four dermatologists for diagnosis and therapeutic advice. A wide range of

dermatological conditions were diagnosed, most commonly chronic ulcers (17%),

eczema (15%) and pigmented lesions (13%). Assessed later by a dermatologist,

referral for regular consultations with a specialist was avoided in 119 patients 

(70%). Sixteen patients (9%) were recommended a regular consultation with a

dermatologist; information for prioritization in the specialist healthcare

service was then provided. In 36 patients (21%), further measures by the

referring physician were recommended. Our experience indicates that many ordinary

consultations on rash, ulcers and skin lesions in the specialist healthcare

services can be avoided when using the smartphone app.

DOI: 10.1371/journal.pone.0232131 

PMCID: PMC7185702

PMID: 32339203 

Conflict of interest statement: SMHR, AS and KU founded and are shareholders in

Askin AS (www.askin.no) of which TS is a partner. PG has no conflict of interest.

The commercial affiliation does not alter our adherence to PLOS ONE policies on

sharing data and materials.

7. J Am Acad Dermatol. 2020 Apr 22. pii: S0190-9622(20)30696-4. doi:

10.1016/j.jaad.2020.04.080. [Epub ahead of print]

Teledermatology in the Wake of COVID-19: Advantages and Challenges to Continued

Care in a Time of Disarray.

Gupta R(1), Ibraheim MK(2), Doan HQ(3).

Author information: 

(1)School of Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic

address: rohit.gupta@bcm.edu.

(2)The University of Texas McGovern Medical School, Houston, TX, USA.

(3)Department of Dermatology, Division of Internal Medicine, The University of

Texas MD Anderson Cancer Center, Houston, TX, USA.

DOI: 10.1016/j.jaad.2020.04.080 

PMCID: PMC7175895

PMID: 32334056 

8. J Med Internet Res. 2020 Apr 21;22(4):e16700. doi: 10.2196/16700.

Benefits of Teledermatology for Geriatric Patients: Population-Based

Cross-Sectional Study.

G Bianchi M(#)(1), Santos A(#)(1), Cordioli E(#)(1).

Author information: 

(1)Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.

(#)Contributed equally

BACKGROUND: Teledermatology is a health care tool that has been increasingly used

around the world, mostly because dermatology has an emphasis on visual diagnosis.

Many studies have shown that access to specialized care improves using

teledermatology, which provides accurate diagnosis and reduces the time taken for

treatment, with high patient satisfaction. As the population around the world

grows old, there will be even more demand for dermatologists in years to come. It

is essential to know which are the most prevalent skin conditions in the primary 

care population and if they can be addressed through teledermatology.

OBJECTIVE: Our main goal was to evaluate the proportion of lesions in individuals

aged 60 years and older that could be managed using teledermatology in

conjunction with primary care physicians. Second, we aimed to assess the most

frequent skin lesions, the most common treatments provided to patients, and the

distribution and causes of referrals made by the teledermatologists.

METHODS: This was a retrospective cohort study from July 2017 to July 2018 in São

Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented

with 12,770 skin lesions. Teledermatologists had three options to refer patients:

(1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) 

back to the primary care physician with the most probable diagnosis and

treatment.

RESULTS: Teledermatology managed 66.66% (8408/12614) of dermatoses with the

primary care physician without the need for an in-presence visit; 27.10%

(3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to

biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo,

onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid

cyst, xerosis, leucoderma, and wart, with significant differences between sexes. 

Malignant tumors increased with age and were the leading cause for biopsies,

while infectious skin conditions and pigmentary disorders decreased. Emollient

was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases.

CONCLUSIONS: Teledermatology helped to treat 67% of the dermatoses of older

individuals, addressing cases of minor complexity quickly and conveniently

together with the primary care physician, thus optimizing dermatological

appointments for the most severe, surgical, or complex diseases. Teledermatology 

does not aim to replace a face-to-face visit with the dermatologist; however, it 

might help to democratize dermatological treatment access for patients and

decrease health care expenses.

©Mara G Bianchi, Andre Santos, Eduardo Cordioli. Originally published in the

Journal of Medical Internet Research (http://www.jmir.org), 21.04.2020.

DOI: 10.2196/16700 

PMCID: PMC7201316

PMID: 32314966 

9. Mil Med. 2020 Apr 20. pii: usz479. doi: 10.1093/milmed/usz479. [Epub ahead of

print]

Synchronous Teledermoscopy in Military Treatment Facilities.

Day WG(1), Shrivastava V(2), Roman JW(2).

Author information: 

(1)Internal Medicine Intern, Naval Medical Center Portsmouth, 620 John Paul Jones

Cir, Portsmouth, VA 23708.

(2)Department of Dermatology, Naval Medical Center Portsmouth, 620 John Paul

Jones Cir, Portsmouth, VA 23708.

Sustained demand for dermatologic care throughout military medicine, in

conjunction with increasing dermatologic provider shortages, has led to increase 

use of teledermatology in military treatment facilities (MTFs). Initially used to

aid in the differentiation of suspicious melanocytic lesions, dermoscopy has

found increasing clinical utility in an expanding realm of general dermatologic

conditions. We demonstrate the use of synchronous teledermoscopy within a remote 

MTF by repurposing webcam technology already available at most MTFs. Two patients

were seen in clinic at a remote naval primary care clinic with limited

subspecialties. Once written consent was retrieved, an on-site dermatologist

evaluated each patient and performed a history and skin exam with dermoscopy.

Synchronous consultations were conducted with the Global Med Cart (GlobalMed(R)

Clinical Access Station with TotalExam(R) 3 HDUSB camera), and Cisco webcam video

jabber (Cisco TelePresence PrecisionHD USB Camera part number TTC8-03). The

patients then underwent individual synchronous teledermatology consultations with

an off-site U.S. Navy dermatologist located in the continental United States. The

methodology for the consultation involved the use of a standard dermatoscope and 

jabber webcam. Two synchronous teledermatology consultations were completed

successfully on patients in MTFs with limited subspecialty capabilities. Both

cases, with two lesions of concern per case, had 100% concordance between the

on-site and teleconsulted dermatologist. Through observing inter-rater agreements

between the on-site and remote dermatologists, this small study demonstrates a

novel application of technology readily available at most MTFs.

© The Author(s) 2020. Published by Oxford University Press on behalf of the

Association of Military Surgeons of the United States. All rights reserved. For

permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/milmed/usz479 

PMID: 32307547 

10. J Am Acad Dermatol. 2020 Apr 16. pii: S0190-9622(20)30661-7. doi:

10.1016/j.jaad.2020.04.048. [Epub ahead of print]

Teledermatology in the Era of COVID-19: Experience of an Academic Department of

Dermatology.

Perkins S(1), Cohen JM(2), Nelson CA(2), Bunick CG(2).

Author information: 

(1)Department of Dermatology, Yale University, New Haven, CT, 06520. Electronic

address: sara.perkins@yale.edu.

(2)Department of Dermatology, Yale University, New Haven, CT, 06520.

DOI: 10.1016/j.jaad.2020.04.048 

PMCID: PMC7162755

PMID: 32305442 

11. Clin Exp Dermatol. 2020 Apr 18. doi: 10.1111/ced.14245. [Epub ahead of print]

Telemedicine and support groups in order to improve the adherence to treatment

and health related quality of life in patients affected by inflammatory skin

conditions during COVID-19 emergency.

Marasca C(1), Ruggiero A(1), Fontanella G(1), Ferrillo M(1), Fabbrocini G(1),

Villani A(1).

Author information: 

(1)Section of Dermatology, Department of Clinical Medicine and Surgery,

University of Naples Federico II, Napoli, Italy.

We have read with great interest the article by Deepak et al. which reported the 

measures applied during the COVID-19 emergency in order to answer to the request 

of consultations. Particularly they described the growing importance that

telemedicine is having during this emergency, focusing on the use of mobile

technology (particularly the use of WhatsApp) as a method to communicate via text

messages, voice messages, photos and videos, which is rapidly expanding within

the field of telemedicine.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/ced.14245 

PMID: 32304587 

12. Clin Exp Dermatol. 2020 Apr 17. doi: 10.1111/ced.14244. [Epub ahead of print]

Secure communication conduits during COVID19 lockdown.

Black SM(1), Ali FR(2).

Author information: 

(1)Medical Sciences Division, University of Oxford, Oxford, UK.

(2)Vernova Healthcare Community Interest Company, Macclesfield, UK.

We commend Deepak and colleagues in highlighting the virtues of instant messaging

tools such as WhatsApp during the COVID-19 crisis1 . Whilst WhatsApp's advantages

include being highly intuitive, widely used and accessible, there are concerns

among clinicians about its use, as well as that of other commercially available

communications apps. These include the loss of anonymity to patients, the need to

reveal their personal telephone number as well questions over privacy and data

security.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/ced.14244 

PMID: 32302418 

13. Dermatol Online J. 2019 Nov 15;25(11). pii: 13030/qt6xh9p2nn.

Implementation of a patient-assisted teledermatology model in the Veteran Health 

Administration.

Fortugno AP, Dellavalle RP(1).

Author information: 

(1)Department of Dermatology, University of Colorado School of Medicine, Aurora, 

CO Dermatology Service, U.S. Department of Veterans Affairs, Eastern Colorado

Health Care System, Aurora, CO Department of Epidemiology, Colorado School of

Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.

Owing to the inherently visual nature of the field of dermatology, advances in

imaging and communication technology have resulted in wide-spread application of 

teledermatology since its introduction in the mid-1990s. In the last 20 years,

studies have repetitively shown that teledermatology provides effective and

efficient quality care for patients. It also increases access to underserved

patients and reduces traveling costs, wait times, and unnecessary referrals. In

this letter the authors seek to analyze implementation of a direct patient to

dermatologist model in a Veteran Health Administration (VHA) patient population, 

referred to as patient-assisted teledermatology. This population is largely over 

the age of 65 and a significant portion are either without internet or have the

minimum technology necessary to participate in the studied model. Owing to these 

observations and personal experiences, the authors found the implementation

process of a patient-assisted model to be challenging in this population.

PMID: 32045144  [Indexed for MEDLINE]

14. JAAD Case Rep. 2020 Jan 30;6(2):141-143. doi: 10.1016/j.jdcr.2019.11.006.

eCollection 2020 Feb.

A suspected hedgehog dermatosis diagnosed via store and forward teledermatology.

Said JT(1), Stavert R(2).

Author information: 

(1)Harvard Medical School, Boston, Massachusetts.

(2)Department of Dermatology, Cambridge Health Alliance, Harvard Medical School, 

Boston, Massachusetts.

DOI: 10.1016/j.jdcr.2019.11.006 

PMCID: PMC7000437

PMID: 32042872 

15. J Am Acad Dermatol. 2020 Feb 5. pii: S0190-9622(20)30151-1. doi:

10.1016/j.jaad.2020.01.065. [Epub ahead of print]

Clinical effectiveness and cost-effectiveness of teledermatology: Where are we

now, and what are the barriers to adoption?

Wang RH(1), Barbieri JS(2), Nguyen HP(3), Stavert R(4), Forman HP(5), Bolognia

JL(6), Kovarik CL(7); Group for Research of Policy Dynamics in Dermatology.

Author information: 

(1)University of Pennsylvania Perelman School of Medicine, Philadelphia,

Pennsylvania.

(2)Department of Dermatology, University of Pennsylvania Perelman School of

Medicine, Philadelphia, Pennsylvania. Electronic address:

john.barbieri@pennmedicine.upenn.edu.

(3)Department of Dermatology, Emory University School of Medicine, Atlanta,

Georgia.

(4)Department of Dermatology, Beth Israel Deaconess Medical Center, Boston,

Massachusetts.

(5)Department of Public Health (Health Policy), Economics, and Management, Yale

University, New Haven, Connecticut.

(6)Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.

(7)Department of Dermatology, University of Pennsylvania Perelman School of

Medicine, Philadelphia, Pennsylvania.

There has been rapid growth in teledermatology over the past decade, and

teledermatology services are increasingly being used to support patient care

across a variety of care settings. Teledermatology has the potential to increase 

access to high-quality dermatologic care while maintaining clinical efficacy and 

cost-effectiveness. Recent expansions in telemedicine reimbursement from the

Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will

play an increasingly prominent role in patient care. Therefore, it is important

that dermatologists be well informed of both the promises of teledermatology and 

the potential practice challenges a continuously evolving mode of care delivery

brings. In this article, we will review the evidence on the clinical and

cost-effectiveness of teledermatology and we will discuss system-level and

practice-level barriers to successful teledermatology implementation as well as

potential implications for dermatologists.

Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc.

All rights reserved.

DOI: 10.1016/j.jaad.2020.01.065 

PMID: 32035106 

16. Clin Exp Dermatol. 2020 Feb 7. doi: 10.1111/ced.14191. [Epub ahead of print]

Patient satisfaction with a new skin cancer teledermatology service.

Nicholson P(1), Macedo C(1), Fuller C(1), Thomas L(1).

Author information: 

(1)Dermatology Department, Chelsea and Westminster Hospital NHS Foundation Trust,

London, UK.

BACKGROUND: Rising numbers of two-week-wait (2WW) skin cancer referrals have

caused increasing pressure on UK dermatology departments. Initiatives to address 

this include teledermatology. Previous studies have indicated good patient

acceptability but most have focused on general dermatology rather than skin

cancer referrals, and have taken place in rural settings, where teledermatology

may be preferable.

AIM: To evaluate patient satisfaction of teledermatology 2WW services in a

London-based tertiary National Health Service (NHS) setting.

METHODS: A literature search was performed and a patient satisfaction survey was 

designed to evaluate: (i) ease of completing a questionnaire about the skin

lesion; (ii) lifestyle impact; (iii) preferences regarding electronic data

collection and communication of results; and (iv) confidence in the service. A

five-point Likert scale was used to assess responses. The study took place over a

20-week period.

RESULTS: Over half (51%; n = 31 of 60 patients) were female; 78% (47) were aged

≤ 55 years and 65% (39) were Caucasian. Over 80% (49) would recommend the

service, and the majority felt confident with the teledermatology model. Overall,

patients would be happy to complete electronic questionnaires and receive results

electronically, with younger patients being more amenable to this. Patients with 

better health status, those of younger age and those with less frequent visits to

a dermatologist were more accepting of teledermatology.

CONCLUSION: To our knowledge, this is the first comprehensive study evaluating

patient satisfaction with teledermatology specifically for 2WW referrals in an

NHS setting. As skin cancer referrals increase, dermatology departments must

adjust. Patient involvement and feedback is paramount in implementing and

expanding teledermatology services.

© 2020 British Association of Dermatologists.

DOI: 10.1111/ced.14191 

PMID: 32031275 

17. J Eur Acad Dermatol Venereol. 2020 Feb 7. doi: 10.1111/jdv.16275. [Epub ahead of 

print]

Diagnostic accuracy and interobserver concordance: teledermoscopy of 600

suspicious skin lesions in Southern Denmark.

Vestergaard T(1)(2), Prasad SC(1), Schuster A(1), Laurinaviciene R(1), Andersen

MK(3), Bygum A(1).

Author information: 

(1)Department of Dermatology and Allergy Centre, Odense University Hospital,

Odense, Denmark.

(2)OPEN, Odense Patient data Explorative Network, Odense University Hospital,

Odense, Denmark.

(3)Audit Project Odense, Research Unit of General Practice, University of

Southern Denmark, Odense, Denmark.

BACKGROUND: Skin cancer incidences are increasing and early diagnosis, especially

of malignant melanoma, is crucial. Teledermatology including teledermoscopy (TDS)

can be used to triage referrals of suspicious skin lesions, however, this is not 

currently recommended in Denmark.

OBJECTIVES: To evaluate diagnostic accuracy, sensitivity, specificity and

interobserver concordance of TDS, and to evaluate the number of incidental

lesions potentially missed by TDS.

METHODS: Fifty general practices were invited to send images of suspicious skin

lesions for evaluation using smartphone TDS. Simultaneously, the patient was

referred for a face-to-face (FTF) consultation. Images for TDS were independently

evaluated by two dermatologists; a third dermatologist performed the FTF

consultation. Diagnosis, management plan and level of diagnostic confidence were 

noted. For TDS photo quality was rated, and for FTF any incidental findings were 

described.

RESULTS: Six hundred lesions in 519 patients were included. The diagnostic

accuracy was significantly higher on FTF evaluation than on TDS (P < 0.01).

However, this was associated with a significant difference in specificity

(P ≤ 0.012) whereas no significant difference was found in sensitivity. The

concordance between FTF and TDS, and the interobserver concordance of two TDS

evaluations was moderate to substantial (AC1 = 0.57-0.71). Incidental melanomas

were found in 0.6% of patients on FTF evaluation, adding an extra 13% of

melanomas. However, on TDS these patients' photographed lesions all warranted FTF

follow-up, where these melanomas would have been identified.

CONCLUSION: In this large prospective study, no significant difference in

sensitivity was observed between FTF and TDS, but specificity was lower on TDS

than FTF. Taking management plans into account, we would, however, potentially

have dismissed 2 of 23 melanomas, if only TDS had been used for assessment. One

of these was a melanoma located on the scalp, an anatomic region less suitable

for TDS.

© 2020 European Academy of Dermatology and Venereology.

DOI: 10.1111/jdv.16275 

PMID: 32031277 


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