The Role of Store-and-Forward Teledermatology in Dermatologic Emergency Units: A Comparative Study

Dermatologic emergency units (DEUs) are critical for handling severe dermatologic emergencies, yet they are increasingly burdened by a rise in patient volume and a reduction in resources and manpower, according to a recent clinical letter and comparative study published in the Journal der Deutschen Dermatologischen Gesellschaft.¹

While the efficacy of store-and-forward teledermatology (SFTD) has been studied in general emergencies, its role in specialized dermatologic emergencies remains underexplored, according to authors of the review. Their study aimed to compare the characteristics and management of patients referred to DEUs versus those managed via urgent SFTD at a national reference center for severe dermatologic emergencies.

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Background and Methods

The DEU, established in 1989, and the SFTD program, initiated in 2015, both operate 24/7 to handle dermatologic emergencies.² SFTD involves sending patient images and histories for remote evaluation by dermatologists, which can save time and reduce health care costs. Prior studies have demonstrated the utility of SFTD in general medical settings, highlighting its potential to streamline care delivery and reduce unnecessary in-person visits.³

In the retrospective study, researchers analyzed data from 5 months in 2017 (January, May, June, July, November), selected to capture different activity periods, resident rotations, and potential seasonal variations in skin conditions. Researchers reviewed all patients who consulted at the DEU during this period and randomly selected 10% of these cases using Stata software, including those referred by physicians and compared them with all urgent SFTD requests received during the same period.

Data collected included patient age, sex, referring physician type, and diagnosis. Diagnoses were categorized into groups such as inflammatory conditions, drug eruptions, infections, skin cancer, and severe conditions such as Stevens-Johnson syndrome and necrotizing fasciitis.

Findings

A total of 899 DEU patients (10% sample) were studied, with 144 referred by physicians. Concurrently, there were 1006 urgent SFTD requests. The comparative analysis revealed several key findings:

• Age and Gender: The average age of DEU patients was 50 years, compared to 49 years for SFTD patients, with no significant difference. The proportion of female patients was also similar between groups.
• Referring Physicians: A higher percentage of SFTD requests came from emergency departments and inpatient units, while DEU referrals were predominantly from private practice physicians.
• Diagnoses: DEU patients were more likely to have inflammatory conditions, whereas SFTD patients had higher incidences of drug eruptions and severe infections.
• Severe Conditions: Severe conditions such as Stevens-Johnson syndrome were more frequently managed through SFTD, suggesting the effectiveness of teledermatology in handling critical cases remotely.
• Follow-Up: SFTD patients had higher rates of follow-up in other outpatient departments, while DEU patients were more likely to receive follow-up care within the same department.

The findings indicated that hospitalized patients and those in emergency settings are more likely to receive dermatologic consultations through SFTD than DEU referrals, primarily due to logistical challenges in transferring patients to DEUs. Private practitioners preferred referring patients directly to DEUs, suggesting a need for better integration and communication between hospital and private practice settings to optimize patient referrals.

The study also highlights challenges, particularly the DEU's evolving role as a walk-in clinic due to the scarcity of dermatologists, which complicates follow-up care and strains resources. In contrast, SFTD patients who do not need specialized management in the department can be referred elsewhere.

Conclusions

While DEUs remain essential for in-person evaluations, SFTD offers a scalable and efficient alternative for urgent consultations, especially for severe cases, noted authors.

"In establishing future specialized DEUs, urgent SFTD must be implemented and distinguished from regular SFTD," according to Skayem et al. "It not only provides an accessible resource for true dermatologic emergencies, but it is also a cornerstone in the optimization of workforce organization, referral patterns, and quality of care for these cases."

References

1. Skayem C, Drahy F, Hirsch G, Hua C, Duong TA. Expertise in dermatologic emergencies: real-world study on in-person vs. teledermatology emergencies in a reference center. J Dtsch Dermatol Ges. June 14, 2024. https://doi.org/10.1111/ddg.15475
2. Giraud-Kerleroux L, Ingen-Housz-Oro S, De Prost N, et al. Store and forward Teledermatology for epidermal necrolysis management: Experience of a French reference centre. J Eur Acad Dermatol Venereol. 2023; 37(1): e110-e112.
3. Hines AS, Zayas J, Wetter DA, et al. Retrospective analysis of 450 emergency department dermatology consultations: An analysis of in-person and teledermatology consultations from 2015 to 2019. J Telemed Telecare. 2021:1357633X211024844.