Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study

The objective of this multicentre study was to undertake a systematic comparison of face-to-face consultations and teleconsultations performed using low-cost videoconferencing equipment. One hundred and twenty-six patients were enrolled by their general practitioners across three sites. Each patient underwent a teleconsultation with a distant dermatologist followed by a traditional face-to-face consultation with a dermatologist. The main outcome measures were diagnostic concordance rates, management plans and patient and doctor satisfaction. One hundred and fifty-five diagnoses were identified by the face-to-face consultations from the sample of 126 patients. Identical diagnoses were recorded from both types of consultation in 59% of cases. Teledermatology consultations missed a secondary diagnosis in 6% of cases and were unable to make a useful diagnosis in 11% of cases. Wrong diagnoses were made by the teledermatologist in 4% of cases. Dermatologists were able to make a definitive diagnosis by face-to-face consultations in significantly more cases than by teleconsultations (P = 0.001). Where both types of consultation resulted in a single diagnosis there was a high level of agreement (kappa = 0.96, lower 95% confidence limit 0.91-1.00). Overall follow-up rates from both types of consultation were almost identical. Fifty per cent of patients seen could have been managed using a single videoconferenced teleconsultation without any requirement for further specialist intervention. Patients reported high levels of satisfaction with the teleconsultations. General practitioners reported that 75% of the teleconsultations were of educational benefit. This study illustrates the potential of telemedicine to diagnose and manage dermatology cases referred from primary care. Once the problem of image quality has been addressed, further studies will be required to investigate the cost-effectiveness of a teledermatology service and the potential consequences for the provision of dermatological services in the U.K.

T-cell subset assay. A useful differentiating marker of atopic and seborrheic eczema in infancy?

To confirm T-cell changes previously reported in atopic eczema, to compare T-cell subset values in atopic and seborrheic infants, and to determine whether T-cell subset assay would be a useful differentiating marker between atopic and seborrheic infants, three age- and sex-matched groups of normal, seborrheic, and atopic infants were recruited. T-cell subset values, total serum IgE, and serum IgE to specific allergens (Dermatophagoides pteronyssimus, cat epithelium, dog dander, rye grass, egg white, and milk) were measured. The results showed that total and allergen-specific IgE levels were higher in atopic disease in infancy, but no statistical differences in T-cell subset values between seborrheic and atopic infants were found. T-cell subset values are therefore not a reliable differentiating marker between atopic and seborrheic eczema in infancy.