1
|
Mashoudy KD, Perez SM, Nouri K. From diagnosis to intervention: a review of telemedicine's role in skin cancer care. Arch Dermatol Res 2024; 316:139. [PMID: 38696032 PMCID: PMC11065900 DOI: 10.1007/s00403-024-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.
Collapse
Affiliation(s)
- Kayla D Mashoudy
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Sofia M Perez
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
| |
Collapse
|
2
|
Barrera-Valencia C, Perea-Flórez EX. Comparison of Costs in Teledermatology Using PC and Camera Versus Smartphone. Telemed J E Health 2024. [PMID: 38669106 DOI: 10.1089/tmj.2023.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Introduction: One of the challenges faced by the Colombian Health System is to improve access to health services for the dispersed and isolated rural population, particularly in the field of dermatology. This article examines the implementation of a teledermatology service using a PC and camera versus smartphone technology. Methods: A total of 542 teledermatology visits were conducted, involving 478 patients, in addition to 64 visits for clinical follow-up for patients as per the dermatologist's recommendation. Out of the 478 patients, 461 met the inclusion criteria and agreed to participate in the study. The data collection instrument from the general practitioner or referring provider covered three consultation moments: (1) sending an initial consultation, (2) providing a response to the patient, and (3) sending a follow-up consultation. Seven hundred forty-seven records were completed by the general practitioner for the three consultation moments. Furthermore, 372 consultations were documented by the dermatologist or referring provider for two moments: (1) response to the initial consultation by the dermatologist, and (2) response to the follow-up consultation by the dermatologist. After validating the information reported in the instruments, a descriptive analysis of the data was conducted, utilizing absolute frequencies and percentages for qualitative variables and measures of central tendency (mean, median, standard deviation, and interquartile range) for quantitative variables. The data were analyzed from 747 records of the referring provider instrument related to 461 patients, between 18 and 98 years of age, with a predominantly female representation. Results: The results indicated that for teleconsultations conducted using a mobile device, the average total duration of the teleconsultation was longer on the traditional platform compared with the mobile device (13.03 vs. 8.27 min). Additionally, it was observed that the time taken to store, send, and capture a single image (clinical or dermoscopic) using the mobile device was three times lower than that on the conventional platform (25 vs. 75 s). Similar findings were noted for teleconsultations carried out by the dermatologist, predominantly utilizing a mobile device. The average consultation time was shorter for the mobile device compared with the traditional platform (8.14 vs. 12 min). Conclusions: The cost reduction suggests that the operation of the service is more efficient with smartphone technology in comparison to the use of a PC and camera. Teledermatology with smartphones provides a streamlined, efficient, and technically sound process for obtaining clinical and dermoscopic images.
Collapse
Affiliation(s)
- Camilo Barrera-Valencia
- Oficina Docencia e Investigación, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
| | - Elin Xiomara Perea-Flórez
- Oficina Docencia e Investigación, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
| |
Collapse
|
3
|
Luo J, Yang Z, Xie Y, He Y, Wu M, Fang X, Liao X. Emerging Trends in Teledermatology Research: A Scientometric Analysis from 2002 to 2021. Telemed J E Health 2024; 30:393-403. [PMID: 37449779 DOI: 10.1089/tmj.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Background: With advances in technology, teledermatology (TD) research has increased. However, an updated comprehensive quantitative analysis of TD research, especially one that identifies emerging trends of TD research in the coronavirus disease 2019 (COVID-19) era, is lacking. Objective: To conduct a scientometric analysis of TD research documents between 2002 and 2021 and explore the emerging trends. Methods: CiteSpace was used to perform scientometric analysis and yielded visualized network maps with corresponding metric values. Emerging trends were identified mainly through burst detection of keywords/terms, co-cited reference clustering analysis, and structural variability analysis (SVA). Results: A total of 932 documents, containing 27,958 cited references were identified from 2002 to 2021. Most TD research was published in journals from the "Dermatology" and "Health Care Sciences & Services" categories. American, Australian, and European researchers contributed the most research and formed close collaborations. Keywords/terms with strong burst values to date were "primary care," "historical perspective," "emerging technique," "improve access," "mobile teledermoscopy (TDS)," "access," "skin cancer," "telehealth," "recent finding," "artificial intelligence (AI)," "dermatological care," and "dermatological condition." Co-cited reference clustering analysis showed that the recently active cluster labels included "COVID-19 pandemic," "skin cancer," "deep neural network," and "underserved population." The SVA identified two reviews (Tognetti et al. and Mckoy et al.) that may be highly cited in the future. Conclusion: During and after the COVID-19 era, emerging trends in research on TD (especially mobile TDS) may be related to skin cancer and AI as well as further exploration of primary care in underserved areas.
Collapse
Affiliation(s)
- Jianzhao Luo
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyu Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang He
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Miaomiao Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Fang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Fazil Jaber N, Jerkovic Gulin S, Seifert O. Analysis of Teledermoscopy and Face-to-Face Examination of Atypical Pigmented Lesions: a Cross-Sectional, Retrospective Study. Dermatol Pract Concept 2023; 13:e2023212. [PMID: 37093567 PMCID: PMC10412092 DOI: 10.5826/dpc.1303a212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Malignant melanoma (MM) is one of the most fatal skin cancers. Early detection and treatment are crucial for metastasis prevention. The growing number of MM cases has led to an increased need for skin examinations, increasing the healthcare demand in dermatology departments. OBJECTIVES The purpose of this cross-sectional, retrospective study was to analyze the accuracy and reliability of two different methods, teledermoscopy (TD) and face-to-face examination (FTF), with two different patient groups for MM detection in Jönköping County. METHODS In teledermoscopic evaluation, a general practitioner takes photographs of a suspected skin lesion (clinical and dermoscopic images) and sends TD referrals to a dermatologist for digital assessment. In the FTF group, the diagnosis was made during regular clinical visits to the dermatology department by a dermatologist. RESULTS The TD group comprised 55 women and 57 men, and an FTF group comprised 72 women and 66 men. Based on the histopathology report, in the TD group, 75% of suspected MM lesions were accurately classified as MM compared with 57% of suspected MM lesions correctly diagnosed in the FTF group. When compared with histopathology report, the diagnostic concordance of TD and FTF examinations were 80% and 69%, respectively. CONCLUSIONS We report a high diagnostic concordance between TD and the final histopathological diagnosis. Metrics analyzed for diagnostic accuracy confirmed that TD is an effective and accurate method for early diagnosis of MM. TD is suitable, non-inferior and a useful alternative to FTF examination.
Collapse
Affiliation(s)
- Nor Fazil Jaber
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
| | - Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Schultz K, Ivert LU, Lapins J, Sartorius K, Johansson EK. Lead Time from First Suspicion of Malignant Melanoma in Primary Care to Diagnostic Excision: a Cohort Study Comparing Teledermatoscopy and Traditional Referral to a Dermatology Clinic at a Tertiary Hospital. Dermatol Pract Concept 2023; 13:dpc.1301a18. [PMID: 36892392 PMCID: PMC9946101 DOI: 10.5826/dpc.1301a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The increasing use of teledermatoscopy in clinical practice has led to demands to evaluate the effects of this new technology on traditional healthcare systems. OBJECTIVES To study lead times from first consultation in primary care to diagnostic excision of suspected malignant melanoma lesions in traditional referrals to a tertiary hospital-based dermatology clinic compared with mobile teledermatoscopy referrals. METHODS A retrospective cohort study design was used. Data on sex, age, pathology, caregivers, clinical diagnosis, date for first visit to primary care unit, and date for diagnostic excision were collected from medical records. Patients managed through traditional referral (n=53) were compared with patients managed at primary care units using teledermatoscopy (n=128) regarding lead time from first visit to diagnostic excision. RESULTS Mean time from date of first visit at primary care unit to diagnostic excision did not differ between the traditional referral and teledermatoscopy groups (16.2 vs. 15.7 days, median 10 vs. 13 days, p=0.657). Lead times from date of referral to diagnostic excision did not significantly differ (15.7 vs. 12.8 days, median 10 vs. 9 days, p=0.464). CONCLUSIONS Our study indicates that lead time to diagnostic excision for patients with suspected malignant melanoma managed by teledermatoscopy was comparable and not inferior to that of the traditional referral pathway. If teledermatoscopy is used at first consultation in primary care, it could potentially be more efficient than traditional referral.
Collapse
Affiliation(s)
- Karina Schultz
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Ulrika Ivert
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jan Lapins
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sartorius
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Emma Kristin Johansson
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Lee C, Witkowski A, Żychowska M, Ludzik J. The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic. Indian J Dermatol Venereol Leprol 2022; 89:347-352. [PMID: 36688890 DOI: 10.25259/ijdvl_118_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022]
Abstract
The unprecedented onset of the COVID-19 crisis poses a significant challenge to all fields of medicine, including dermatology. Since the start of the coronavirus outbreak, a stark decline in new skin cancer diagnoses has been reported by countries worldwide. One of the greatest challenges during the pandemic has been the reduced access to face-to-face dermatologic evaluation and non-urgent procedures, such as biopsies or surgical excisions. Teledermatology is a well-integrated alternative when face-to-face dermatological assistance is not available. Teledermoscopy, an extension of teledermatology, comprises consulting dermoscopic images to improve the remote assessment of pigmented and non-pigmented lesions when direct visualisation of lesions is difficult. One of teledermoscopy's greatest strengths may be its utility as a triage and monitoring tool, which is critical in the early detection of skin cancer, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. Mobile teledermoscopy may act as a communication tool between medical practitioners and patients. By using their smartphone (mobile phone) patients can monitor a suspicious skin lesion identified by their medical practitioner, or alternatively self-detect concerning lesions and forward valuable dermoscopic images for remote medical evaluation. Several mobile applications that allow users to photograph suspicious lesions with their smartphones and have them evaluated using artificial intelligence technology have recently emerged. With the growing popularity of mobile apps and consumer-involved healthcare, this will likely be a key component of skin cancer screening in the years to come. However, most of these applications apply artificial intelligence technology to assess clinical images rather than dermoscopic images, which may lead to lower diagnostic accuracy. Incorporating the direct-to-consumer mobile dermoscopy model in combination with mole-scanning artificial intelligence as a mobile app may be the future of skin cancer detection.
Collapse
Affiliation(s)
- Claudia Lee
- Department of Medicine, University of California Riverside, Riverside, California, United States
| | - Alexander Witkowski
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon, United States
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Joanna Ludzik
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon, United States
| |
Collapse
|
7
|
A Call to Action: Evidence for the Military Integration of Teledermoscopy in a Pandemic Era. Dermatopathology (Basel) 2022; 9:327-342. [PMID: 36278540 PMCID: PMC9590112 DOI: 10.3390/dermatopathology9040039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Skin disease remains a common complaint among deployed service members. To mitigate the limited supply of dermatologists in the U.S. Military Health System, teledermatology has been harnessed as a specialist extender platform, allowing for online consultations in remote deployed settings. Operational teledermatology has played a critical role in reductions of medical evacuations with significant cost-savings. When direct in-person lesion visualization is unattainable, teledermoscopy can be harnessed as an effective diagnostic tool to distinguish suspicious skin lesions. Teledermoscopy has the versatile capacity for streamlined incorporation into the existing asynchronous telemedicine platforms utilized worldwide among deployed U.S. military healthcare providers. In terms of clinical utility, teledermoscopy offers a unique and timely opportunity to improve diagnostic accuracy, early detection rates, and prognostic courses for dermatological conditions. Such improvements will further reduce medical evacuations and separations, thereby improving mission readiness and combat effectiveness. As mission goals are safeguarded, associated operational budget costs are also preserved. This innovative, cost-effective technology merits integration into the U.S. Military Health System (MHS).
Collapse
|
8
|
Rogers T, McCrary MR, Yeung H, Krueger L, Chen SC. Dermoscopic Photographs Impact Confidence and Management of Remotely Triaged Skin Lesions. Dermatol Pract Concept 2022; 12:e2022129. [PMID: 36159122 PMCID: PMC9464534 DOI: 10.5826/dpc.1203a129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Improving remote triage is crucial given expansions in tele-dermatology and with limited in-person care during COVID-19. In addition to clinical pictures, dermoscopic images may provide utility for triage. Objectives To determine if dermoscopic images enhance confidence, triage accuracy, and triage prioritization for tele-dermatology. Methods In this preliminary parallel convergent mixed-methods study, a cohort of dermatologists and residents assessed skin lesions using clinical and dermoscopic images. For each case, participants viewed a clinical image and determined diagnostic category, management, urgency, and decision-making confidence. They subsequently viewed the associated dermoscopy and answered the same questions. A moderated focus group discussion followed to explore perceptions on the role of dermoscopy in tele-dermatology. Results Dermoscopy improved recognition of malignancies by 23% and significantly reduced triage urgency measures for non-malignant lesions. Participants endorsed specific utilities of tele-dermoscopy, such as for evaluating pigmented lesions, with limitations including poor image quality. Conclusions Dermoscopic images may be useful when remotely triaging skin lesions. Standardized imaging protocols are needed.
Collapse
Affiliation(s)
- Tova Rogers
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,Regional Telehealth Service, VISN 7, Duluth, Georgia, USA
| | - Loren Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suephy C Chen
- Regional Telehealth Service, VISN 7, Duluth, Georgia, USA,Department of Dermatology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
9
|
Naik PP. Rise of teledermatology in the COVID-19 era: A pan-world perspective. Digit Health 2022; 8:20552076221076671. [PMID: 35154805 PMCID: PMC8832130 DOI: 10.1177/20552076221076671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective During the coronavirus disease pandemic, enforced restrictions prevented face-to-face consultations for patients requiring non-emergency medical treatment. In response, there was a rise in telemedical practices, such as teledermatology. This study aimed at understanding the pan-world experiences of patients and healthcare staff who adapted to teledermatology in the coronavirus disease era. Methods This study made use of an online survey presented to dermatology professionals using social media and WhatsApp groups. Professionals who applied teledermatology between March and June 2020 were targeted. The survey was designed to identify respondent demographics and the preferred platforms for digital consultations. The most common diagnoses and rates of referral for further evaluation were recorded. Lastly, a platform was provided for practitioners to report their own and their patient's perspectives on the advantages and operational challenges of teledermatology. Data were collated and analyzed in Microsoft Excel. Results In total, 653 stakeholders participated, representing countries worldwide. Facebook and WhatsApp services were the most popular mediums of digital consultation. Diagnoses of ailments, such as acne and eczema, as well as skin-related infections, were most common. Of the cases referred for biopsy, 10 patients were subsequently diagnosed with cutaneous malignancies. Practitioners and patients not only reported personal benefit from adopting teledermatology, but also reported concerns regarding data privacy and the levels of technological literacy required. Conclusions Teledermatology proved an innovative clinical response to unprecedented challenges. However, further policy development and technological advancement aimed at increasing the diagnostic power of digital consultations are needed to support the continuation of teledermatology in the post-pandemic world.
Collapse
Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi German Hospital and Clinics, Opposite Burj Al Arab, Dubai, United Arab Emirates
| |
Collapse
|
10
|
Mahmood F, Bendayan S, Ghazawi FM, Litvinov IV. Editorial: The Emerging Role of Artificial Intelligence in Dermatology. Front Med (Lausanne) 2021; 8:751649. [PMID: 34869445 PMCID: PMC8635630 DOI: 10.3389/fmed.2021.751649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Farhan Mahmood
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, QC, Canada
| |
Collapse
|
11
|
Taywade M, Panda PS, Sirka CS, Patro BK. Neonatal dermatitis neglecta---Neglect by health system: A case report. J Family Med Prim Care 2021; 10:2718-2719. [PMID: 34568163 PMCID: PMC8415667 DOI: 10.4103/jfmpc.jfmpc_2442_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/13/2021] [Indexed: 11/04/2022] Open
Abstract
A 29 days old female child presented to the general outpatient department of Community Health Center with greenish black crusting over left ear for 7-8days duration without any other signs and symptoms. We report the diagnosis and management of the condition through ad-hoc store and forward tele-dermatology. This is the first reported case of dermatitis neglecta in neo-natal period.
Collapse
Affiliation(s)
- Manish Taywade
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prem Sagar Panda
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra Sekhar Sirka
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Binod Kumar Patro
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
12
|
Mu Z, Liu X, Li K, Zhang J. Teledermatology Service During the COVID-19 Pandemic in China: A Mobile Application-Based Retrospective Study. Clin Cosmet Investig Dermatol 2021; 14:1119-1124. [PMID: 34475770 PMCID: PMC8407777 DOI: 10.2147/ccid.s326105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022]
Abstract
Purpose During the COVID-19 pandemic, teledermatology service was increased rapidly. The purpose of our study was to analyze the characteristics of patients and common skin diseases via teledermatology during the COVID-19 pandemic in mainland China. Patients and Methods During weekends between January 21 and April 4, 2020, the data of patients who used teledermatology service via a mobile application were collected, including gender, age, and diagnosis. Results A total of 698 patients (315 men and 383 women), with a mean age of 26 years, used this service. The top ten common diseases in order of proportion were eczema (22%), acne (9%), atopic dermatitis (9%), urticaria (5%), contact dermatitis (5%), herpes zoster (3%), warts (3%), folliculitis (3%), prurigo (3%), and androgenetic alopecia (2%). When classified according to age groups, atopic dermatitis was the most common condition for patients in the first decade, acne was more prevalent in the second and third decades, and eczema was the most prevalent condition for all other age groups. Conclusion The ten common diseases accounted for the majority of the evaluated cases and varied by age group, allowing individualizing teledermatology services.
Collapse
Affiliation(s)
- Zhanglei Mu
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaojing Liu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People's Republic of China
| | - Kun Li
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| |
Collapse
|
13
|
Puri P, Yiannias JA, Mangold AR, Swanson DL, Pittelkow MR. The policy dimensions, regulatory landscape, and market characteristics of teledermatology in the United States. JAAD Int 2021; 1:202-207. [PMID: 34409341 PMCID: PMC8362249 DOI: 10.1016/j.jdin.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic has spurred healthcare systems across the world to rapidly redesign their models of care delivery. As such, this pandemic has accelerated the adoption of teledermatology in the United States. However, it remains unknown whether this momentum will be maintained after the pandemic. The future of teledermatology in the United States will be significantly influenced by a complex set of policy, legal, and regulatory frameworks. An understanding of these frameworks will help dermatologists more effectively adopt and implement teledermatology platforms. In this article, we review the current state of teledermatology in the United States, including policy dimensions, the regulatory landscape, market characteristics, and future directions.
Collapse
Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | |
Collapse
|
14
|
Vestergaard T, Andersen MK, Bygum A. Acceptance of Teledermoscopy by General Practitioners and Dermatologists in Denmark. Dermatol Pract Concept 2021; 11:e2021033. [PMID: 33954016 DOI: 10.5826/dpc.1102a33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background Teledermoscopy can be used to triage referrals of suspected skin cancers, thereby reducing waiting time and number of face-to-face consultations with a dermatologist. However, the success of the implementation of this technology in part relies on the acceptance of the providers. Objectives This study assessed the attitudes towards teledermoscopy of referring general practitioners and consultant dermatologists. Methods General practitioners from 48 practices and 3 dermatologists in the region of Southern Denmark, who had previous experience with teledermoscopy, were invited to answer questionnaires on their acceptance of the technology. Results General practitioners from 23 practices responded. All domains of the questionnaire received high scores, indicating a high degree of acceptance of teledermoscopy among respondents. All 3 dermatologists agreed that teledermoscopy was useful for triaging referrals, but they were less confident in their diagnoses and management plans proposed by teledermoscopy than in traditional face-to-face evaluations of patients. Two of the 3 dermatologists were satisfied with using teledermoscopy as a consult method. Conclusions This study reports high levels of provider acceptance of teledermoscopy. However, a low response rate among general practitioners may limit its generalizability.
Collapse
Affiliation(s)
- Tine Vestergaard
- Department of Dermatology and Allergy Centre & Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Merethe K Andersen
- Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| |
Collapse
|
15
|
Nguyen OT, Alishahi Tabriz A, Huo J, Hanna K, Shea CM, Turner K. Impact of Asynchronous Electronic Communication-Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review. J Med Internet Res 2021; 23:e27531. [PMID: 33843592 PMCID: PMC8135030 DOI: 10.2196/27531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. OBJECTIVE To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. METHODS We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits' impacts on clinical and health care delivery outcomes. RESULTS Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. CONCLUSIONS Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.
Collapse
Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States.,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
| | - Jinhai Huo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States.,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
| |
Collapse
|
16
|
Sung C, Salem S, Nguyen E, Koo J. Pediatric Factitious Disorder Perpetuated by Others: A Dermatologist's Duty Beyond the Skin. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:22-24. [PMID: 34188745 PMCID: PMC8211330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Factitious disorders and factitious disorders imposed on another are a prevalent encounter during dermatology visits. Here, we present a case of a pediatric patient who presented with ulcer-like lesions that, based on initial biopsy, suggested an immunobullous etiology. Further exploration revealed her underlying psychiatric disorder. Dermatologists play an integral role in recognizing and initiating "nervous system" management to establish a level of trust with the patient that will ultimately allow bridging to psychiatric care. The case discussed here serves as an example of the successful diagnosis and treatment of a pediatric psychiatric patient by raising clinical suspicion, using investigative techniques, employing separate interviews and the Patient Health Questionnaire-9, and sensitively addressing the relationship between the patient, guardian, and provider within the dermatology clinic.
Collapse
Affiliation(s)
- Calvin Sung
- Dr. Sung is with the Department of Dermatology, University of California Irvine in Irvine, California
- Ms. Salem is with the University of California Riverside School of Medicine in Riverside, California
- Dr. Nguyen is with Raincross Medical Center of Dermatology in Riverside, California
- Dr. Koo is with the Department of Dermatology, University of California San Francisco in San Francisco, California
| | - Secilia Salem
- Dr. Sung is with the Department of Dermatology, University of California Irvine in Irvine, California
- Ms. Salem is with the University of California Riverside School of Medicine in Riverside, California
- Dr. Nguyen is with Raincross Medical Center of Dermatology in Riverside, California
- Dr. Koo is with the Department of Dermatology, University of California San Francisco in San Francisco, California
| | - Ethan Nguyen
- Dr. Sung is with the Department of Dermatology, University of California Irvine in Irvine, California
- Ms. Salem is with the University of California Riverside School of Medicine in Riverside, California
- Dr. Nguyen is with Raincross Medical Center of Dermatology in Riverside, California
- Dr. Koo is with the Department of Dermatology, University of California San Francisco in San Francisco, California
| | - John Koo
- Dr. Sung is with the Department of Dermatology, University of California Irvine in Irvine, California
- Ms. Salem is with the University of California Riverside School of Medicine in Riverside, California
- Dr. Nguyen is with Raincross Medical Center of Dermatology in Riverside, California
- Dr. Koo is with the Department of Dermatology, University of California San Francisco in San Francisco, California
| |
Collapse
|
17
|
Jakhar D, Sharma A, Kaur I, Sharma R, Das A, Madke B, Jindal V, Aradhya SS, Mhatre M. Indian Dermatologists Wield Technology to Combat COVID-19! Indian Dermatol Online J 2020; 11:991-994. [PMID: 33344354 PMCID: PMC7734970 DOI: 10.4103/idoj.idoj_292_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/08/2020] [Accepted: 07/03/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Aseem Sharma
- Consultant Dermatologist, Skin Saga Centre for Dermatology, Mumbai, India
| | - Ishmeet Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Rashmi Sharma
- Dermatology, Fortis Hospital, Vasant Kunj, New Delhi, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhushan Madke
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Veenu Jindal
- Consultant Dermatologist, Clinic Derma Tech, New Delhi, India
| | - Sujala Sacchidanand Aradhya
- Department of Dermatology, Sujala Polyclinic and Laboratory, Siddaiah Puranik Road, Near Shankarmutt Signal, Basaveshwaranagar, Bengaluru, Karnataka, India
| | - Madhulika Mhatre
- Department of Dermatology, Wockhardt Hospitals and Skin Saga Center for Skin, Hair, Aesthetics and Vitiligo, Mumbai, India
| |
Collapse
|
18
|
Cugmas B, Štruc E. Accuracy of an Affordable Smartphone-Based Teledermoscopy System for Color Measurements in Canine Skin. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6234. [PMID: 33142901 PMCID: PMC7662536 DOI: 10.3390/s20216234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Quality smartphone cameras and affordable dermatoscopes have enabled teledermoscopy to become a popular medical and veterinary tool for analyzing skin lesions such as melanoma and erythema. However, smartphones acquire images in an unknown RGB color space, which prevents a standardized colorimetric skin analysis. In this work, we supplemented a typical veterinary teledermoscopy system with a conventional color calibration procedure, and we studied two mid-priced smartphones in evaluating native and erythematous canine skin color. In a laboratory setting with the ColorChecker, the teledermoscopy system reached CIELAB-based color differences ΔE of 1.8-6.6 (CIE76) and 1.1-4.5 (CIE94). Intra- and inter-smartphone variability resulted in the color differences (CIE76) of 0.1, and 2.0-3.9, depending on the selected color range. Preliminary clinical measurements showed that canine skin is less red and yellow (lower a* and b* for ΔE of 10.7) than standard Caucasian human skin. Estimating the severity of skin erythema with an erythema index led to errors between 0.5-3%. After constructing a color calibration model for each smartphone, we expedited clinical measurements without losing colorimetric accuracy by introducing a simple image normalization on a white standard. To conclude, the calibrated teledermoscopy system is fast and accurate enough for various colorimetric applications in veterinary dermatology.
Collapse
Affiliation(s)
- Blaž Cugmas
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 19 Rainis Blvd., LV-1586 Rīga, Latvia
| | - Eva Štruc
- Vetamplify SIA, Veterinary Services, 57/59–32 Krišjāņa Valdemāra Str., LV-1010 Rīga, Latvia;
| |
Collapse
|
19
|
Gilling S, Mortz CG, Vestergaard T. Patient Satisfaction and Expectations Regarding Mobile Teledermoscopy in General Practice for Diagnosis of Non-melanoma Skin Cancer and Malignant Melanoma. Acta Derm Venereol 2020; 100:adv00117. [PMID: 32179927 PMCID: PMC9128923 DOI: 10.2340/00015555-3459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2010] [Indexed: 11/16/2022] Open
Abstract
The incidence of non-melanoma skin cancer and malignant melanoma is increasing. Diagnosing these skin lesions is primarily done visually, making it suitable to use new technology, such as teledermoscopy. Before the implementation of teledermoscopy, patient satisfaction, clinician satisfaction and diagnostic accuracy, need to be evaluated. A cross-sectional quantitative survey was conducted to evaluate patient satisfaction and expectations regarding a mobile teledermoscopy service, and to identify factors influencing patient satisfaction and choice of diagnostic method. A total of 287 out of 476 participants responded to the questionnaire. Almost 90% of respondents were satisfied with, or neutral towards, teledermoscopy. No associations between patient satisfaction and age, smartphone/tablet usage, travel time, prior history of non-melanoma skin cancer and malignant melanoma, or worries about malignancy, were found. There was equal distribution between patients who preferred teledermoscopy and those who preferred face-to-face consultation. Respondents with a high level of smartphone usage significantly preferred teledermoscopy.
Collapse
Affiliation(s)
- Sofie Gilling
- Faculty of Health Sciences, University of Southern Denmark, DK-5000 Odense, Denmark.
| | | | | |
Collapse
|
20
|
Martin A, Guitera P. Teledermatology for Skin Cancer: The Australian Experience. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol 2020; 83:299-307. [PMID: 32035106 DOI: 10.1016/j.jaad.2020.01.065] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Robin H Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Stavert
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
22
|
Sonthalia S, Pasquali P, Agrawal M, Sharma P, Jha AK, Errichetti E, Lallas A, Sehgal VN. Dermoscopy Update: Review of Its Extradiagnostic and Expanding Indications and Future Prospects. Dermatol Pract Concept 2019; 9:253-264. [PMID: 31723457 PMCID: PMC6830565 DOI: 10.5826/dpc.0904a02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 12/16/2022] Open
Abstract
The technique of dermoscopy has come a long way since its inception for characterization of suspicious nevi for early detection of dysplastic changes in predisposed individuals. Not only has its scope expanded to aid in quick diagnosis of a majority of nonmelanocytic disorders of the skin, hair, and nails, but it is being rightfully exploited for a plethora of nondiagnostic uses. Its use in the diagnosis of various pigmentary, papulosquamous, and infectious disorders and disorders of the scalp and hair, nails, and mucosa bears testimony to the ongoing expansion of its protean indications across skin types. Dermoscopy has transformed the conventional approach to dermatological diagnosis from clinicopathological correlation to clinico-dermoscopic-pathological correlation. It aids in convincing an otherwise reluctant patient to agree to biopsy and guides the selection of optimum site for the same. Dermoscopic clues suggestive of stability or activity of the lesion and/or disease in various dermatoses are being accrued. Early assessment of therapeutic response to treatment is helpful for physicians, patients, and researchers conducting clinical studies. Aesthetic uses of dermoscopy are opulent and being explored. Dermoscopy has also provided the much-needed balancing act of interaction between practitioners and the new generation of patients. Last but not the least, dermoscopy has resulted in patients' better understanding of their disorders and improved compliance with treatment protocols.
Collapse
Affiliation(s)
| | - Paola Pasquali
- Department of Dermatology, Pius Hospital de Valls, Tarragona, Spain
| | - Mahima Agrawal
- Department of Dermatology & STD, LHMC & Associated Hospitals, New Delhi, India
| | - Poonam Sharma
- Skin Institute & School of Dermatology (SISD), New Delhi, India
| | - Abhijeet K. Jha
- Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
| | - Enzo Errichetti
- Institute of Dermatology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | |
Collapse
|