Introduction
Dermatology is a visual specialty. The availability of clinical and histopathological images for diagnosis makes it an ideal choice for teledermatology consultation (TC). Transmission of electroencephalogram by Willem Einthoven[1] using telephone network in 1906 and providing psychiatry care between two hospitals in 1959, USA,[2] are the earlier telemedicine developments. There is a rapid progress to monitor astronaut’s heart rate, blood pressure, and electrocardiogram during 1960-1970.[3] In 1995, the term “teledermatology” was introduced by Perednia and Brown.[4] In 1997, Zelickson and Homan[5] demonstrated teledermatology in a nursing home setting. These are the milestones in telemedicine and its transformation to teledermatology.[1-5]
Teledermatology is a branch of dermatology involving the application of electronics, communications, and information technology to transmit the information between the patient and dermatologist and vice versa for practice and research to cater dermatology care.[4,6] TC is performed everywhere.[7-10] COVID-19 pandemic and lockdown have motivated dermatologists and patients to adopt TC as a medium to seek and provide patient care.
Transformation/Revolution of Teledermatology Consultation
Images were captured by ordinary camera, scanned, and sent through E-mail. Digital cameras transformed the art of TC. Images are easily transferred between computers using the Internet. Advances in technology resulted in an enhanced speed of the Internet. Transfer of images between mobile phones and personal digital assistants is made easy.[11-13] Advances in information technology, innovation in smartphones, android technology, and various mobile messenger applications (apps)[14,15] have revolutionized the TC and made it convenient for dermatologists and patients to communicate with each other [Figure 1]. Capture, transfer, and storage of the data are the steps involved between the patient and the dermatologist. Self-acquired patient images,[16,17] “selfies,” a mode to capture the images as an impact in patient-assisted TC. Patients participate actively[18] and directly send the image and receive advice from the dermatologist. Digitalization across the globe, with active participation by dermatologists and patients, resulted in the transmission of images through E-mail/web and social media[19] [Figure 1].
;)
Figure 1: The digital camera, Internet, personal digital assistants,[
13] mobile phones,[
11 , 12] android technology, selfie images,[
16 , 17] and messenger apps[
14 , 15] and social media[
19] have revolutionized teledermatology
consultation and provided easy patient and dermatologist access for clinical interaction. Capture and transfer of the data are made easy and simple
The Need for Teledermatology Consultation in COVID-19 Pandemic
A TC consultation is provided without exposing staff to viruses/infections in times of contagious disease outbreaks like the COVID-19 pandemic. Infectious disease transmission can be prevented by reducing the risks to both health-care workers and patients. COVID-19, a viral pandemic, is a well-suited scenario, in which dermatologists can evaluate and manage patients on a virtual platform.[20-22]
Scope and Purpose/Indications for Teledermatology Consultation
The various purposes or common applications of TC are: (1) diagnosis,[23-25] (2) triage[26-28] and counseling, (3) follow-up care,[29-39] and (4) investigation.[40-42] A dermatologist should identify the purpose before offering TC [Table 1]. The various indications[23-42] of TC are summarized in Table 1.
Table 1: Various purposes/indications[
23 - 44 , 58 - 62 , 69] for teledermatology
consultationTeledermatology Consultation and its Advantages
Feasibility studies[23-42] on TC applied for the purpose of triage, diagnosis, and follow-up care are analyzed. The selection of cases for TC depends on three of the following parameters: (i) clinical morphology and distribution pattern, (ii) course of the disease, and (iii) purpose/objective of dermatology care. The differences between TC for diagnosis and follow-up care are analyzed in Table 2.
Table 2: The differences between diagnostic and follow-up care by teledermatology consultation
A TC reduces multiple visits for follow-up care and benefits the elderly, especially those coming from far-off places. It saves cost and time. TC is found to be cost-effective and reliable in reducing in-person visits, which saves time, and allows for the faster delivery of care. TC provides triage and reduces waiting time. Advantages of TC with respect to various purposes are:
- Diagnosis[23-25] – Instant diagnosis and treatment for cases presenting with characteristic morphology and distribution pattern
- Triage and counseling[26-28] – Prioritize for in-person examination and investigation or both
- Follow-up care[29-39] – The studies[29-39] reveal that store-and-forward (SAF) is appropriate for clinicians with established patients who require regular follow-up. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring,[29-32] and postprocedural[43,44] follow-up care. It minimizes/eliminates in-person follow-up visits and saves cost and time. Management of patients with established diagnoses. The chronic disorders that persist for a longer period may be characterized by remissions and exacerbations. Therefore, they need multiple visits for follow-up care to provide periodic assessments. Recently, follow-up care is delivered for chronic cutaneous autoimmune diseases[39] during the COVID-19 pandemic. In chronic disorders, TC has a significant impact on the elderly, especially those coming from far-off places. It saves cost and time. If the patient is not satisfied, he will be called for in-person examination
- Investigation [40-42] – involves interpretation of multiple patch test readings to diagnose and confirm allergic contact dermatitis. It minimizes in-person follow-up visits, saves cost and time, and is convenient to capture the serial images of the upper back and compare.
Teledermatology Consultation in Various Subspecialties
TC is applied widely in various dermatology fields: (a) cutaneous and esthetic surgery,[43,44] (b) geriatric care,[45-47] (c) pediatric care,[48-60] and (d) emergency dermatology care.[61-65] It is summarized in Table 3.
Table 3: The subspecialties area for teledermatology consultation
Cutaneous and esthetic surgery
Cases can be triaged for priority in-person examination and posted for investigational procedures like skin biopsy. Presurgery/procedure counseling can be performed.[43] Follow-up care is easy and feasible in wound care[29-32]/postchemical peels, postcutaneous-esthetic surgeries, postacne procedures, and vitiligo surgeries. Studies[44] have revealed TC to be useful following postlaser procedures to provide follow-up care. Satisfactory follow-up care is provided by TC; it is continued; if it is not satisfactory, the patient is called for in-person examination.
Geriatric Care
Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in the elderly who lack easy and/or direct access to dermatologists.[45-47] It minimizes follow-up visits, cost, and time.
Pediatric care
Accurate triage and diagnosis of childhood dermatology cases decrease travel and outpatient clinic visits. It also provides an avenue for ongoing support and education for primary care physicians.[48-60]
Emergency dermatology
The skin emergency TC has proved to be successful to provide specialist dermatology services across Australia. The use of TC within the context of emergency-based care has achieved patient acceptance and confidence.[61-65] Newer generation mobile devices reduce the cost of video conferencing, increase the adaptability of teledermatology, and decrease general practitioner time.
Teledermatology consultation Diagnostic Agreement and Patient satisfaction:
The diagnostic accuracy is good when TC is compared to gold-standard in-person examination.[23] The diagnostic accuracy of SAF TC was good and comparable to video conference TC. Health-care providers need to plan for the appropriate utility of SAF-TC either alone or in combination with video conference TC to implement and deliver teledermatology care in India.[24] Messenger apps[14,15] (e.g., WhatsApp) are a medium for TC to capture and transfer of images.
The direct consult may increase patient satisfaction. Patient-assisted TC achieves a good patient satisfaction.[18] Patient satisfaction will play an integral role in the further growth, development, and implementation of TC.[66-70]
The Organization and Approach to a Case for Teledermatology Consultation
It comprises a basic model of SAF teledermatology, where a dermatologist interacts with the patients directly for regular cases or patients can directly send images to the dermatologist.[6,18] A dermatologist interacts in an online discussion forum to obtain a second opinion for the management of difficult-to-manage cases.[71]
Prerequisites for a Successful Teledermatology Consultation
Informed written consent for TC is a prerequisite. A dermatologist should obtain a proper history and observe the digital images for clinical findings. Consent form[72] and pro forma[72] for TC are prepared by the IADVL Academy and can be freely downloaded. A technical guideline for TC is prepared by the American Teledermatology Association.[73] Guidelines for telemedicine platforms are prepared by the National Medical Commission[74] and issued by the Ministry of Health and family welfare. A dermatologist should adhere to the regulations and practices to offer quality care.
The various feasibility studies using several teledermatology tools[75-93] involved to provide dermatology care are summarized in Table 4.
Table 4: The various feasibility studies[
75 - 93] using tools for teledermatology
consultationLimitations of teledermatology consultation
It is broadly divided into: (a) dermatological conditions and (b) technical factors that come in the way of TC.
Dermatological conditions
All cases may not be feasible with an objective of diagnosis in TC. These cases are not diagnosed by instant/spot examination. The various clinical situations a dermatologist may choose not to offer TC for diagnosis purposes[94] are: (i) nonspecific presentation, (ii) varied morphology, (iii) requires palpation, for example, skin tumors, (vi) multiorgan involvement, for example, Stevens–Johnson syndrome/Toxic epidermal necrolysis, (v) rare diseases –syndromes/genodermatoses (apart from skin examination, palpation for multisystem involvement may be needed), (vi) diseases that require criteria to diagnose, for example, atopic dermatitis, systemic lupus erythematosus, and Behcet’s disease, (vii) symptomatic presentation, for example, generalized itching, burning excessive sweating/hyperhidrosis (without any obvious lesion to capture the image and requires evaluation of the symptom/s by investigations, and (viii) represent a clinical entity due to various causes, for example, erythroderma, palmoplantar keratoderma, urticaria, and leg ulcer. In these situations, initial face-to-face examination needs to be performed, followed by follow-up care[29-39] using TC.
Technical factors
The various technology situations a dermatologist may choose not to offer TC for diagnosis purpose[94] are: (i) Poor quality of images, (ii) poor net connectivity, (iii) inability to palpate the lesions, (iv) lack of clinical data, (v) misinterpretation while transferring the information or while delivering the management, and (vi) lack of patient confidence in the technology. In these situations, initial face-to-face examination needs to be performed, followed by follow-up care[29-39] using TC.
A Protocol for Teledermatology Consultation
Mobile messenger apps provide a dermatologist to capture and transfer clinical images either in still (SAF) and motion (video) or both to offer quality care. Feasibility studies[14,15] have confirmed that using WhatsApp, TC can be provided. It is easy, technical feasibility, and cost-effective. WhatsApp groups make it possible for dermatologists and other specialties to discuss various dermatological diseases and their appropriate management. It is one of the easiest media to exchange knowledge and experience on a one-to-one basis. It is considered one of the safest instant messaging media due to encryption technology.
A dermatologist should screen the received clinical image from a general practitioner or self-acquired patient images (selfies[16,17]) and define the objective/purpose of dermatology care. If the case suits for diagnostic purpose, a treatment is offered. A clinician should be aware of the dermatological conditions where not to offer consultation for diagnostic purposes.[94] In these cases, a dermatologist can perform a face-to-face examination, investigate, analyze the case, offer treatment, and provide follow-up care by TC.[94]
Conclusion
TC serves best when it is used in specific situations. Studies have highlighted the importance of diagnostic purpose and follow-up care in TC. Patients and physicians know each other in follow-up care as they frequently interact with each other and achieve the best patient satisfaction. However, more studies are needed to analyze the role of follow-up care in individual dermatological conditions. In an Indian scenario, mobile teledermatology using messenger apps, for example, WhatsApp, can be used to provide follow-up care for chronic dermatological conditions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We acknowledge the JSS Academy of Higher Education and Research-JSSAHER (Deemed-to-be University) for their constant academic encouragement and constructive suggestions in completing this project.
References
1. Stanberry B. Telemedicine:Barriers and opportunities in the 21
st century. J Intern Med 2000;247:615–28.
2. Zundel KM. Telemedicine:History, applications, and impact on librarianship. Bull Med Libr Assoc 1996;84:71–9.
3. Cipolat C, Geiges M. The history of telemedicine. Curr Probl Dermatol 2003;32:6–11.
4. Perednia DA, Brown NA. Teledermatology:One application of telemedicine. Bull Med Libr Assoc 1995;83:42–7.
5. Zelickson BD, Homan L. Teledermatology in the nursing home. Arch Dermatol 1997;133:171–4.
6. Kanthraj GR. Newer insights in teledermatology practice. Indian J Dermatol Venereol Leprol 2011;77:276–87.
7. Sun A, Lanier R, Diven D. A review of the practices and results of the UTMB to South Pole teledermatology program over the past six years. Dermatol Online J 2010;16:16.
8. Feroze K. Teledermatology in India:Practical implications. Indian J Med Sci 2008;62:208–14.
9. Kaddu S, Soyer HP, Gabler G, Kovarik C. The Africa teledermatology project:Preliminary experience with a sub-Saharan teledermatology and e-learning program. J Am Acad Dermatol 2009;61:155–7.
10. McManus J, Salinas J, Morton M, Lappan C, Poropatich R. Teleconsultation program for deployed soldiers and healthcare professionals in remote and austere environments. Prehosp Disaster Med 2008;23:210–6.
11. Braun RP, Vecchietti JL, Thomas L, Prins C, French LE, Gewirtzman AJ. Telemedical wound care using a new generation of mobile telephones:A feasibility study. Arch Dermatol 2005;141:254–8.
12. Massone C, Lozzi GP, Wurm E, Hofmann-Wellenhof R, Schoellnast R, Zalaudek I. Cellular phones in clinical teledermatology. Arch Dermatol 2005;141:1319–20.
13. Massone C, Lozzi GP, Wurm E, Hofmann-Wellenhof R, Schoellnast R, Zalaudek I. Personal digital assistants in teledermatology. Br J Dermatol 2006;154:801–2.
14. Jakhar D, Kaul S, Kaur I. WhatsApp messenger as a teledermatology tool during coronavirus disease (COVID-19):From bedside to phone-side. Clin Exp Dermatol 2020;45:739–40.
15. Hogan SC, van Hees C, Asiedu KB, Fuller LC. WhatsApp platforms in tropical public health resource-poor settings. Int J Dermatol 2019;58:228–30.
16. Damanpour S, Srivastava D, Nijhawan RI. Self-acquired patient images:The promises and the pitfalls. Semin Cutan Med Surg 2016;35:13–7.
17. Hogan K, Cullan J, Patel V, Rajpara A, Aires D. Overcalling a teledermatology selfie:A new twist in a growing field. Dermatol Online J 2015;21:pii:13030/qt84×5d2gg.
18. Kanthraj GR. Patient-assisted teledermatology practice:What is it?When, where, and how it is applied?. Indian J Dermatol Venereol Leprol 2015;81:136–43.
19. Serhrouchni S, Malmartel A. Diagnostic agreement between telemedicine on social networks and teledermatology centers. Ann Fam Med 2021;19:24–9.
20. Rismiller K, Cartron AM, Trinidad JC. Inpatient teledermatology during the COVID-19 pandemic. J Dermatolog Treat 2020;31:441–3.
21. Elsner P. Teledermatology in the times of COVID-19 –A systematic review. J Dtsch Dermatol Ges 2020;18:841–5.
22. Ruggiero A, Megna M, Annunziata MC, Abategiovanni L, Scalvenzi M, Tajani A. Teledermatology for acne during COVID-19:High patients'satisfaction in spite of the emergency. J Eur Acad Dermatol Venereol 2020;34:e662–3.
23. Levin YS, Warshaw EM. Teledermatology:A review of reliability and accuracy of diagnosis and management. Dermatol Clin 2009;27:163–76 vii.
24. Kanthraj GR. A longitudinal study of consistency in diagnostic accuracy of teledermatology tools. Indian J Dermatol Venereol Leprol 2013;79:668–78.
25. Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the diagnosis and management of skin cancer:A systematic review. JAMA Dermatol 2017;153:319–27.
26. Moreno-Ramírez D, Ferrándiz L. A 10-year history of teledermatology for skin cancer management. JAMA Dermatol 2015;151:1289–90.
27. Massone C, Maak D, Hofmann-Wellenhof R, Soyer HP, Frühauf J. Teledermatology for skin cancer prevention:An experience on 690 Austrian patients. J Eur Acad Dermatol Venereol 2014;28:1103–8.
28. Moreno-Ramirez D, Ferrandiz L, Nieto-Garcia A, Carrasco R, Moreno-Alvarez P, Galdeano R. Store-and-forward teledermatology in skin cancer triage:Experience and evaluation of 2009 teleconsultations. Arch Dermatol 2007;143:479–84.
29. Hofmann-Wellenhof R, Salmhofer W, Binder B, Okcu A, Kerl H, Soyer HP. Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers. J Telemed Telecare 2006;12 Suppl 1 15–7.
30. Bianciardi Valassina MF, Bella S, Murgia F, Carestia A, Prosseda E. Telemedicine in pediatric wound care. Clin Ter 2016;167:e21–3.
31. Eber EL, Arzberger E, Michor C, Hofmann-Wellenhof R, Salmhofer W. Mobile teledermatology in the treatment of chronic ulcers. Hautarzt 2019;70:346–53.
32. Binder B, Hofmann-Wellenhof R, Salmhofer W, Okcu A, Kerl H, Soyer HP. Teledermatological monitoring of leg ulcers in cooperation with home care nurses. Arch Dermatol 2007;143:1511–4.
33. Koller S, Hofmann-Wellenhof R, Hayn D, Weger W, Kastner P, Schreier G. Teledermatological monitoring of psoriasis patients on biologic therapy. Acta Derm Venereol 2011;91:680–5.
34. Frühauf J, Schwantzer G, Ambros-Rudolph CM, Weger W, Ahlgrimm-Siess V, Salmhofer W. Pilot study using teledermatology to manage high-need patients with psoriasis. Arch Dermatol 2010;146:200–1.
35. Armstrong AW, Parsi K, Schupp CW, Mease PJ, Duffin KC. Standardizing training for psoriasis measures:Effectiveness of an online training video on psoriasis area and severity index assessment by physician and patient raters. JAMA Dermatol 2013;149:577–82.
36. Trindade MA, Wen CL, Neto CF, Escuder MM, Andrade VL, Yamashitafuji TM. Accuracy of store-and-forward diagnosis in leprosy. J Telemed Telecare 2008;14:208–10.
37. Watson AJ, Bergman H, Williams CM, Kvedar JC. A randomized trial to evaluate the efficacy of online follow-up visits in the management of acne. Arch Dermatol 2010;146:406–11.
38. Singer HM, Almazan T, Craft N, David CV, Eells S, Erfe C. Using network oriented research assistant (NORA) technology to compare digital photographic with in-person assessment of acne vulgaris. JAMA Dermatol 2018;154:188–90.
39. Brunasso AM, Massone C. Teledermatologic monitoring for chronic cutaneous autoimmune diseases with smartworking during COVID-19 emergency in a tertiary center in Italy. Dermatol Ther 2020;33:e13495.
40. Ivens U, Serup J, O'goshi K. Allergy patch test reading from photographic images:Disagreement on ICDRG grading but agreement on simplified tripartite reading. Skin Res Technol 2007;13:110–3.
41. Grey KR, Hagen SL, Hylwa SA, Warshaw EM. Utility of store and forward teledermatology for skin patch test readings. Dermatitis 2017;28:152–61.
42. Goodier MC, DeKoven JG, Taylor JS, Sasseville D, Fowler JF Jr, Fransway AF, et al. Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology. Contact Dermatitis 2021;85:274–84.
43. Kanthraj GR. Teledermatology:Its role in dermatosurgery. J Cutan Aesthet Surg 2008;1:68–74.
44. Chee SN, Lowe P, Lim A. Smartphone patient monitoring post-laser resurfacing. Australas J Dermatol 2017;58:e216–22.
45. Rubegni P, Nami N, Cevenini G, Poggiali S, Hofmann-Wellenhof R, Massone C. Geriatric teledermatology:Store-and-forward versus face-to-face examination. J Eur Acad Dermatol Venereol 2011;25:1334–9.
46. Simpson CL, Kovarik CL. Effectively engaging geriatric patients via teledermatology. J Am Acad Dermatol 2020;83:e417–8.
47. G Bianchi M, Santos A, Cordioli E. Benefits of teledermatology for geriatric patients:Population-based cross-sectional study. J Med Internet Res 2020;22:e16700.
48. Fieleke DR, Edison K, Dyer JA. Pediatric teledermatology –A survey of current use. Pediatr Dermatol 2008;25:158–62.
49. Cartron AM, Aldana PC, Khachemoune A. Pediatric teledermatology:A review of the literature. Pediatr Dermatol 2021;38:39–44.
50. Betlloch-Mas I, Martínez-Miravete MT, Berbegal-DeGracia L, Sánchez-Vázquez L, Sánchez-Payá J. Teledermatology in paediatrics:Health-care impact on the early treatment of infantile haemangiomas. J Telemed Telecare 2021;27:424–30.
51. Giavina Bianchi M, Santos AP, Cordioli E. The majority of skin lesions in pediatric primary care attention could be managed by teledermatology. PLoS One 2019;14:e0225479.
52. Beer J, Hadeler E, Tamazian S, Nouri K. Effectiveness of pediatric teledermatology. J Drugs Dermatol 2020;19:1250.
53. Fogel AL, Teng JM. Pediatric teledermatology:A survey of usage, perspectives, and practice. Pediatr Dermatol 2015;32:363–8.
54. Fiks AG, Fleisher L, Berrigan L, Sykes E, Mayne SL, Gruver R. Usability, acceptability, and impact of a pediatric teledermatology mobile health application. Telemed J E Health 2018;24:236–45.
55. Feigenbaum DF, Boscardin CK, Frieden IJ, Mathes EF. Can you see me now?Video supplementation for pediatric teledermatology cases. Pediatr Dermatol 2017;34:566–71.
56. O'Connor DM, Jew OS, Perman MJ, Castelo-Soccio LA, Winston FK, McMahon PJ. Diagnostic accuracy of pediatric teledermatology using parent-submitted photographs:A randomized clinical trial. JAMA Dermatol 2017;153:1243–8.
57. Chen TS, Goldyne ME, Mathes EF, Frieden IJ, Gilliam AE. Pediatric teledermatology:Observations based on 429 consults. J Am Acad Dermatol 2010;62:61–6.
58. Paradela-De-La-Morena S, Fernandez-Torres R, Martínez-Gómez W, Fonseca-Capdevila E. Teledermatology:Diagnostic reliability in 383 children. Eur J Dermatol 2015;25:563–9.
59. Jew OS, Murthy AS, Danley K, McMahon PJ. Implementation of a pediatric provider-to-provider store-and-forward teledermatology system:Effectiveness, feasibility, and acceptability in a pilot study. Pediatr Dermatol 2020;37:1106–12.
60. de Graaf M, Totté JE, van Os-Medendorp H, van Renselaar W, Breugem CC, Pasmans SG. Treatment of infantile hemangioma in regional hospitals with ehealth support:Evaluation of feasibility and acceptance by parents and doctors. JMIR Res Protoc 2014;3:e52.
61. Finnane A, Siller G, Mujcic R, Soyer HP. The growth of a skin emergency teledermatology service from 2008 to 2014. Australas J Dermatol 2016;57:14–8.
62. Jünger M, Arnold A, Lutze S. Teledermatology for emergency patient care:Two-year experience with teledermatological emergency care. Hautarzt 2019;70:324–8.
63. Duong TA, Cordoliani F, Julliard C, Bourrat E, Regnier S, de Pontual L. Emergency department diagnosis and management of skin diseases with real-time teledermatologic expertise. JAMA Dermatol 2014;150:743–7.
64. Wells A, Gupta P, Tian F, Adkins E, Kaffenberger B. The effect of implementing teledermatology in patients presenting with cellulitis versus pseudocellulitis in an academic emergency department setting:A pilot study. J Clin Aesthet Dermatol 2020;13:43–4.
65. Newman SA, Laughter MR, Williams NK, Peart J, Boyers LN, Capp R. The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology. J Am Acad Dermatol 2021;85:992–4.
66. Williams TL, Esmail A, May CR, Griffiths CE, Shaw NT, Fitzgerald D. Patient satisfaction with teledermatology is related to perceived quality of life. Br J Dermatol 2001;145:911–7.
67. Mounessa JS, Chapman S, Braunberger T, Qin R, Lipoff JB, Dellavalle RP, et al. Asystematic review of satisfaction with teledermatology. J Telemed Telecare 2018;24:263–70.
68. Hadeler E, Gitlow H, Nouri K. Definitions, survey methods, and findings of patient satisfaction studies in teledermatology:A systematic review. Arch Dermatol Res 2021;313:205–15.
69. Yeung H, Sargen MR, Luk KM, Berry EG, Gurnee EA, Heuring E. Teledermatology and teledermatopathology as educational tools for international dermatology:A virtual grand rounds pilot curriculum. Int J Dermatol 2018;57:1358–62.
70. Eminovic N, Witkamp L, de Keizer NF, Wyatt JC. Patient perceptions about a novel form of patient-assisted teledermatology. Arch Dermatol 2006;142:648–9.
71. Kanthraj GR. Authors'willingness for second-opinion teledermatology in difficult-to-manage cases:'An online survey'. J Eur Acad Dermatol Venereol 2010;24:961–6.
73. McKoy K, Antoniotti NM, Armstrong A, Bashshur R, Bernard J, Bernstein D. Practice guidelines for teledermatology. Telemed J E Health 2016;22:981–90.
74. Telemedicine Telemedicine Practice Guidelines–Ministry of Health and Family Welfare–MoHFW Available from:
http://www.mohfw.gov.in[SingleRight-PointingAngleQuotationMark]pdf[SingleRight-PointingAngleQuotationMark] [Last accessed on 2020 Apr 10].
75. Loane MA, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lotery HE, et al. Acomparison of real-time and store-and-forward teledermatology:A cost-benefit study. Br J Dermatol 2000;143:1241–7.
76. High WA, Houston MS, Calobrisi SD, Drage LA, McEvoy MT. Assessment of the accuracy of low-cost store-and-forward teledermatology
consultation. J Am Acad Dermatol 2000;42:776–83.
77. Baba M, Seçkin D, Kapdağli S. A comparison of teledermatology using store-and-forward methodology alone, and in combination with web camera videoconferencing. J Telemed Telecare 2005;11:354–60.
78. Wootton R, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lotery HE. Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care:Societal cost-benefit analysis. BMJ 2000;320:1252–6.
79. Edison KE, Dyer JA. Teledermatology in Missouri and beyond. Mo Med 2007;104:139–43.
80. Romero G, Sánchez P, García M, Cortina P, Vera E, Garrido JA. Randomized controlled trial comparing store-and-forward teledermatology alone and in combination with web-camera videoconferencing. Clin Exp Dermatol 2010;35:311–7.
81. Pecina JL, Wyatt KD, Comfere NI, Bernard ME, North F. Uses of mobile device digital photography of dermatologic conditions in primary care. JMIR Mhealth Uhealth 2017;5:e165.
82. Moreno-Ramírez D, Argenziano G. Teledermatology and mobile applications in the management of patients with skin lesions. Acta Derm Venereol 2017 Suppl 218 31–5.
83. Massone C, Soyer HP, Lozzi GP, Di Stefani A, Leinweber B, Gabler G. Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system. Hum Pathol 2007;38:546–54.
84. Massone C, Brunasso AM, Campbell TM, Soyer HP. State of the art of teledermatopathology. Am J Dermatopathol 2008;30:446–50.
85. Piccolo D, Smolle J, Argenziano G, Wolf IH, Braun R, Cerroni L. Teledermoscopy--results of a multicentre study on 43 pigmented skin lesions. J Telemed Telecare 2000;6:132–7.
86. Massone C, Hofmann-Wellenhof R, Ahlgrimm-Siess V, Gabler G, Ebner C, Soyer HP. Melanoma screening with cellular phones. PLoS One 2007;2:e483.
87. Carli P, de Giorgi V, Chiarugi A, Nardini P, Weinstock MA, Crocetti E. Addition of dermoscopy to conventional naked-eye examination in melanoma screening:A randomized study. J Am Acad Dermatol 2004;50:683–9.
88. Dahlén Gyllencreutz J, Paoli J, Bjellerup M, Bucharbajeva Z, Gonzalez H, Nielsen K. Diagnostic agreement and interobserver concordance with teledermoscopy referrals. J Eur Acad Dermatol Venereol 2017;31:898–903.
89. Soyer HP, Hofmann-Wellenhof R, Massone C, Gabler G, Dong H, Ozdemir F. telederm.org:Freely available online consultations in dermatology. PLoS Med 2005;2:e87.
90. Huntley AC, Smith JG. New communication between dermatologists in the age of the Internet. Semin Cutan Med Surg 2002;21:202–4.
91. Lozzi GP, Soyer HP, Massone C, Micantonio T, Kraenke B, Fargnoli MC. The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases:A best practice model in dermatology?. J Eur Acad Dermatol Venereol 2007;21:30–4.
92. Hu SW, Foong HB, Elpern DJ. Virtual grand rounds in dermatology:An 8-year experience in web-based teledermatology. Int J Dermatol 2009;48:1313–9.
93. Ezzedine K, Amiel A, Vereecken P, Simonart T, Schietse B, Seymons K. Black skin dermatology online, from the project to the website:A needed collaboration between North and South. J Eur Acad Dermatol Venereol 2008;22:1193–9.
94. Kanthraj GR, Betkerur JB. Teledermatology practice in the COVID-19 pandemic. Int J Health Allied Sci 2020;9 Suppl S1 3–10.
