The technology for online video conferencing had been available for a few years, however it was underutilized. We were forced to adopt it because of the coronavirus disease 2019 (COVID-19) pandemic. The wide dissemination of smartphones and cheap data tariffs made it feasible. Dermatology can especially benefit from this technology in view of the superior image quality of in-built cell phone cameras. Teledermatology has a role to play, not only in routine practice to save time but also in instances where physical consultation is impossible, either due to travel constraints or geographical constraints, etc.
According to Fogel and Teng, more than 89% of pediatric dermatologists have found teledermatology to be a handy tool in their practice. A study by Giavina Bianchi et al. found that at least 63% of the pediatric patients were effectively managed with teledermatology.
Teledermatology is divided into five different categories, namely primary, secondary, tertiary, patient-assisted, and direct to consumer. In primary teledermatology, there is a direct chain of communication between the patient and the specialist (dermatologist) useful for initial diagnosis and referral to a higher center. In secondary teledermatology, there is indirect communication between the patient and the caregiver. The initial point of contact is a nurse/general practitioner/emergency department, who as an intermediary between the patient and the dermatologist. The intermediaries then communicate with the specialist. Tertiary teledermatology is a form of specialist-to-specialist consultation where a dermatologist seeks a second expert opinion from one of his/her colleagues/peers. When a patient communicates with a dermatologist again after the first consultation for a follow-up visit, it is known as patient-assisted teledermatology. Finally, if a patient initiates the process of seeking health care from a specialist by directly contacting them through a phone call/message using personal devices such as mobile phones, computers, and laptops, it is known as direct-to-consumer teledermatology.
In faraway rural areas where there is a pediatrician or general physician but no access to a dermatologist or pediatric dermatologist, the pediatrician can initiate video conferencing consultation with the dermatologist. In fact, in the coming years, many resource-poor centers might adopt this strategy instead of a direct-to-patient or parent model. The model holds leverage over other modes of teledermatology since the pediatrician at the other end can actually examine the patient and give a much clearer picture of the status of skin and ensure follow-up.
There are three types of teledermatology delivery platforms, namely synchronous (real-time audiovisual), asynchronous (prerecorded video), and hybrid. Hybrid teledermatology is where a combination of synchronous and asynchronous data are available to the doctor. Usually, a dermatologist would have both the patient’s clinical photographs and a real-time video-conferencing session to further hear out the complaints. Hybrid or mixed teledermatology has been regarded to be the most efficient mode of teledermatology. Apparently benign lesions, which can have a serious prognosis like tuberous xanthomas, can be missed in rural areas that lack dermatology services. Teledermatology can be lifesaving in such instances.
Teledermatology is not short of limitations. There is always the risk of the wrong diagnosis due to the poor quality of images. Obtaining a medical history and patient participation is also difficult with the pediatric population. Often a dermatologist would not be able to make a proper diagnosis without appreciating the texture of the lesions with the naked eye and through palpation. In addition, several common rapid bedside diagnostic tests such as dermatoscopy, checking for dermatographism, eliciting Auspitz sign, and Nikolsky sign cannot be done during an online consultation. There are also other issues like nonpayment of fees by the patients after the consultation, and intrusion on the doctor’s privacy due to patients vexatiously calling the doctor at any hour of the day for some trivial reasons.
Since the outbreak of the novel COVID-19, health-care professionals have started adopting teledermatology more frequently. However, the value of teledermatology in pediatric dermatology practice beyond the pandemic lies in using it as a supplementary tool and not merely as a convenience tool.
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Conflicts of interest
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