ADEN and Derm Epi-ERG

COVID-19 and the need for teledermatology and telemedicine

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