Researchers found that dermatologists who evaluated
hospitalized patients remotely using pictures and health information
often reached the same conclusions as a doctor who examined the
patients in person.
Using so-called teledermatology to identify patients who need
additional care or screening may improve access to dermatology
services in rural areas, according to the study's senior author.
"Across the country and the world there are places that have limited
or no dermatology support," Dr. Misha Rosenbach told Reuters Health.
"There are a lot of issues with having the right doctors in the
right place to care for patients."
Rosenbach is director of the inpatient dermatology service at Penn
Medicine in Philadelphia.
He and his colleagues write in JAMA Dermatology that many hospitals
don't have dermatologists available for patient consultations. By
using teledermatology, doctors at other hospitals or in private
practice can look at pictures and make recommendations.
"There is a real dermatology workforce shortage, especially in rural
areas," Dr. Lindy P. Fox told Reuters Health in an email.
"Teledermatology is a viable way to deliver care to those who do not
have direct access to dermatologists as it allows dermatologic care
to be delivered in a timely manner to patients who might have long
wait times to see a dermatologist or have to travel long distances
to see a dermatologist," she added.
Fox, a dermatologist at the University of California, San Francisco,
wrote an editorial accompanying the new study.
To see how reliable offsite evaluations are, the researchers
compared the recommendations of a doctor who evaluated 50 patients
in person to the recommendations of two doctors who evaluated the
patients via teledermatology.
All the patients were over 18 years old and inpatients at the
Hospital of the University of Pennsylvania in Philadelphia from
September 2012 through April 2013.
Overall, they found that if the in-person doctor suggested the
patient have a consultation that same day, the offsite doctors
agreed 90 percent of the time.
When doctors did disagree, the researchers write, it was usually
over how to manage the condition while still agreeing with each
other on the diagnosis.
Also, when the in-person doctor recommended samples of the patients'
skin be taken for testing, the offsite doctors agreed 95 percent of
"Our findings suggest that teledermatology is reliable for the
initial triage of inpatient dermatologic consultations," the
"I do think there is some hope that using teledermatology can really
expand access to get patients dermatology help when they need it,"
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He said that patients needing a consultation with a dermatologist
in a hospital are often complex and may have life-threatening
conditions, such as Stevens-Johnson syndrome, a severe reaction to
infection or medication that includes a painful rash.
"One of the unique perspectives of this study is that it addresses
improving access to dermatologists in the hospital setting, a place
where dermatologists traditionally do not spend the majority of
their practice time," Fox wrote.
In the past, researchers have mostly evaluated the use of
teledermatology in the form of individuals using mobile phone
cameras to transmit pictures of suspicious moles or lesions to
In another report published in JAMA Dermatology, a group of
researchers builds on their previous research to see how high-risk
patients select which moles or lesions to photograph.
Led by Monika Janda at the Queensland University of Technology in
Brisbane, Australia, the researchers report that people tended to
photograph lesions located on their arms, face, legs, shoulder and
back. They avoided their "sexually sensitive" and hard-to-see areas.
They conclude more research is needed and suggest that people who
get help with self-evaluations and who increase the number of
self-evaluations they perform on themselves may miss fewer moles and
In an editorial published in the same journal, Courtney Rubin and
Dr. Carrie Kovarik of the University of Pennsylvania in Philadelphia
say that teledermatology is promising but patients should be aware
of its limitations.
"The patient must understand the limitations of private
provider-to-patient consultation services: follow-up and diagnostic
testing such as skin biopsy may not be possible, and the accuracy of
the diagnosis is limited by the information provided by the patient
and the quality of the photographs," they write.
JAMA Dermatology, online Feb. 12, 2014.
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