Teledermatology on Par with Clinic Dermatology, New Review Finds

Image Credit: © Miiskin - dermnetnz.org

Teledermatology may be a viable alternative to traditional, in-person dermatology, according to a new meta-analysis.¹ In this novel systemic review, researchers analyzed the current landscape of teledermatology research, noting that it is currently well-accepted by patients and clinicians alike.

The resulting evidence map indicated that telehealth is generally accepted as a form of dermatology care by patients and health professionals. Teledermatology is also more cost-effective when compared to typical clinical treatment.

To review the evidence, the investigators conducted a search for relevant studies in 8 databases (CINAHL, Embase, PubMed, Scopus, Web of Science, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, and OpenGray) published between 2004 and 2022. From these eligible studies, data such as study design, demographics of participants, and dermatological diseases, were extracted. After removing duplicates, reviewing titles, and screening abstracts, 14 studies were ultimately used for the analysis.

Acne was the most common diagnosis that was treated via telehealth but other addressed conditions include psoriasis, skin cancer, atopic dermatitis, and various wounds/rashes. However, 8 of the systemic reviews did not specify which conditions were being managed.

Some studies looked at specific differences between store-and-forward (SF) teledermatology, in which photos of a patient’s skin are collected and sent to be analyzed by a dermatologist at a later time, and live interactive (LF) teledermatology, which uses video conferencing and allows real-time communication. Regarding SF services, 96% of patients and 82% of providers were satisfied. Conversely, 89% of LI patients and 100% of providers were satisfied.

It was also found that teledermatology is more cost-effective, with SF services being less costly than LI services. This is primarily due to factors such as patient travel/clinic costs and the volume of consultations. The authors concluded that teledermatology could be very beneficial in communities where specialized health care is scarce and difficult to travel to. Teledermatology has also proven to be helpful when training medical professionals.

Although the availability and convenience of teledermatology have improved, there is not enough evidence to support it completely replacing in-person dermatology. Diagnostic accuracy and management were tested in several reviews, with face-to-face dermatology having higher accuracy than both SF and LI teledermatology. 

There are some dermatology patients who have concerns about privacy, technical issues, and accurate communication when being treated digitally. Additionally, clinicians may be less confident in these asynchronous treatments. Doctors also noted that they tend to spend more time in telehealth consultations rather than standard face-to-face appointments. 

The researchers acknowledged their study’s limitations, one being the significant heterogeneity in skin conditions and overall methodologies among the utilized studies. They also noted that all studies took place in developed countries and reviews that were not published in English were excluded.

Overall, the prevalence and validity of telehealth in dermatology have greatly increased since the COVID-19 pandemic.² The authors concluded that although there are some concerns with reliability, the study is a promising start in analyzing the effectiveness of teledermatology. Further research that studies the accuracy and safety of telemedicine in the field is recommended.

“The review identifies gaps, emphasizing the need for more randomized controlled trials, standardized outcome measures, and exploration of non-Western contexts,” the authors wrote. “The review suggests future research should address dissatisfaction reasons, safety concerns, and global disparities in teledermatology literature, urging inclusivity and patient involvement for comprehensive insights.”

Are you for or against teledermatology? Share your thoughts, experiences, successes, and challenges with colleagues by writing to us at DTEditor@mmhgroup.com.

References

1. Chow A, Smith HE, Car LT, et al. Teledermatology: an evidence map of systematic reviews. Syst Rev. 2024;13(1):258. Published 2024 Oct 12. doi:10.1186/s13643-024-02655-5

2. Augustin M, Reinders P, Janke TM, et al. Attitudes Toward and Use of eHealth Technologies Among German Dermatologists: Repeated Cross-Sectional Survey in 2019 and 2021. J Med Internet Res. 2024;26:e45817. Published 2024 Feb 12. doi:10.2196/45817