Teledermatology in the Covid-19 pandemic
Covid-19 and the Skin
The pandemic has accelerated the use of teledermatology, relevant in the management of skin diseases, it can reduce face-to-face consultations, and indirectly reduce usage of critical personal protective equipment supplies.
Dr. Nisha Suyien Chandran, Head of Division of Dermatology, National University Hospital and member of the WCD NOC
Dr. Valencia Long, Senior Resident in Dermatology
In pre-pandemic times, teledermatology was first described in American literature as an adequate avenue for care in 1994 rural Oregon. (1) It is defined as the practice of dermatology at a distance. Infection-control, physical distancing measures and reduction in hospital attendances during the pandemic have accelerated the use of teledermatology. Teledermatology can reduce face-to-face consultations, and indirectly reduce usage of critical personal protective equipment supplies. Globally, many centres have also reported a significant increase in the uptake of teledermatology since the pandemic, citing feasibility in managing ambulatory conditions such as acne, psoriasis and hair disorders. (2) Teledermatology can be used to treat COVID-19 related dermatoses such as acne related to mask-wear, hand eczema and irritant contact dermatitis from hand rubs, averting the need for face-to-face consults. (3)
Pandemic-related infectious precautions necessitate the evolution of teledermatology practices to cater to a wider range of conditions Although ambulatory dermatoses could be readily seen over teledermatology, medically complex conditions such as immunobullous diseases, connective tissue diseases and paediatric genodermatoses may require hybrid teledermatology, underscoring the need for more detailed assessment and history taking via synchronous methods, with supplementation by platforms providing high quality clinical images/videos. (4)
Physicians will need to be mindful that use of teledermatology may lead to inability to conduct real-world physical examination with or without special equipment, or schedule same-day investigations. These occurrences may inadvertently result in misdiagnosis and delay in the care provided when a conversion to face-to-face visit is required.(5) Physician judgement will also be required for adequate ‘triaging’ of patients with conditions that could not be practically reviewed over teledermatology. Concerns of medicolegal implications and the possibility of a breach of patient privacy when medical information is transmitted electronically may arise. (6) In developing countries, the lack of electronic/internet infrastructure may impede teledermatology use.
In this new era, teledermatology will continue to be relevant in the management of skin diseases. Whilst embracing the convenience and benefits associated with teledermatology, practitioners should also pay heed to the limitations of the various modes of teledermatologic delivery and maintain sensitivity to new barriers which can arise.
References
- Perednia DA, Brown NA. Teledermatology: one application of telemedicine. Bull Med Libr Assoc. 1995;83(1):42-7.
- Su MY, Das S. Expansion of asynchronous teledermatology during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83(6):e471-e2.
- Kiely LF, Moloney E, O’Sullivan G, Eustace JA, Gallagher J, Bourke JF. Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic: a cross-sectional study. Clin Exp Dermatol. 2021;46(1):142-4.
- Kazi R, Evankovich MR, Liu R, Liu A, Moorhead A, Ferris LK, et al. Utilization of Asynchronous and Synchronous Teledermatology in a Large Health Care System During the COVID-19 Pandemic. Telemed J E Health. 2021;27(7):771-7.
- Shahidi-Dadras M, Abdollahimajd F, Ohadi L, Tabary M, Araghi F, Mozafari N, et al. COVID-19 in pemphigus vulgaris patients with previous rituximab therapy: a tele-medicine experience. J Dermatolog Treat. 2020:1-2.
- Loh CH, Chong Tam SY, Oh CC. Teledermatology in the COVID-19 pandemic: A systematic review. JAAD Int. 2021;5:54-64.
