Teledermatology

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Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. [1] In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio, visual, and data communication. Applications comprise health care management such as diagnoses, consultation, and treatment as well as (continuous) education. [2] [3] [4]

Contents

The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists. [5]

Modes of data transmission

Teledermatology (as telemedicine) is practised on the basis of two concepts: Store and forward (SAF) and real time/live interactive teledermatology. Hybrid modes also exist (combining SAF and real time applications).

The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment.

In real-time/ live interactive teledermatology applications, provider and individuals usually interact via live videoconferencing. It may also involve remote surgery and the use of telerobotic microscopes in dermatopathology. This mode generally requires more sophisticated and costly technology than used in the SAF mode. Both participants must be available at the same time.

Areas of application

Health care management

There is insufficient evidence to support teledermatology in diagnosing and triaging patients for specialist care. Therefore, more studies are needed to determine its effectiveness. [6]

Direct consultation involves an individual with a skin condition contacting a dermatologist via telecommunication to request diagnosis and treatment. In this field, mobile applications of teledermatology gain importance.

Telediagnosis in the absence of personal contact with health care workers to the individual is complex. It requires active participation of the individual and without appropriate guidance may lead to improper management. However, as a triage tool, leading the individual directly to the appropriate specialist for his/her disease, could be very valuable in the near future.

Specialist referral is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication to get a second opinion. The specialist then helps the GP in rendering a diagnosis, providing management options et cetera. [7]

Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as crural ulcers or psoriasis management. Crural ulcers are a common skin condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. [8] Psoriasis is experienced by 3.2% of adults in the United States, and emerging research on teledermatology treatment of this condition suggests increased access to specialty care with positive patient satisfaction, outcomes, and cost savings. [9]

Education and information

Medical education/continuous education are a major advantage of telemedicine/e-health. Numerous universities offer online courses, computer-based training and Web applications in this field principally aimed at medical students. Specialist training courses via internet are also available, particularly in dermoscopy. [10]

General medical/health information may be accessed by non-professionals, such as individuals affected by a skin condition, and their relatives, through the internet. They are also able to join peer support groups with others affected by the same condition. [11]

Domains with special interest

Teledermoscopy

In teledermoscopy, digital dermoscopic lesion images (with or without clinical images) are transmitted electronically to a specialist for examination. This can be done on the web-based telediagnostic network Campus Medicus.

Dermoscopy (dermatoscopy, epiluminescence microscopy) is the technical field of using an epiluminescence microscope for viewing skin lesions in magnification in-vivo. It is particularly useful in the early detection of malignant skin lesions (i.e., melanoma). Digital dermoscopic images can be taken with a digital camera attached to a dermatoscope or special video cameras suited for dermoscopy, e.g. the Fotofinder. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology.

Teledermatopathology

Teledermatopathology is the transmission of dermatopathologic images either in real-time with the aid of a robotic microscope or using a store-and-forward system (transmission as a single file). In the latter method (SAF) a rather new development is the introduction of virtual slide systems (VSS). [12]

Virtual slides are made by digitally scanning an entire glass slide at a high resolution and then sending the images to a storage system. These can be then assessed on a computer screen similar to conventional microscopy, allowing the pathologist to maneuver around the image and view every part of the slide at any magnification.

Teledermoscopically aided dermatopathology

This is the transmission of crucial medical data and dermoscopic as well as clinical images to a pathologist who renders the conventional histopathologic diagnosis.

In the everyday clinical setting, skin biopsies are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person. These limitations can be overcome by teledermoscopically aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of diagnosis. [13]

Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists.

Mobile teledermatology

Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor, for instance) uses wireless or mobile equipment [14] (i.e. mobile phones, handheld devices), in contrast to conventional stationary telemedicine platforms. Travellers who develop skin lesions as well as doctors who are on the move in hospital/non-hospital area can benefit from this new development in teledermatology. To facilitate access to medical advice and enable individuals to play a more active role in managing their own health status, mobile teledermatology seems to be especially suited for patient filtering or triage. (i.e. referral based on the severity and character of their skin condition). Another possible practical application is for follow-up of individuals with chronic skin conditions. [15] However, currently available studies show a high rate of missed skin cancers including melanoma, and there is not enough robust data to recommend this method of diagnosis. [16]

Suitability of cases

Not all cases are suitable for teledermatology. The type of cases suited for teledermatology is a topic, which requires more studies. Some studies have observed that eczema and follicular lesions were diagnosed with relatively more certainty, while in some other studies it was seen that diagnoses were made with more certainty in cases like viral warts, herpes zoster, acne vulgaris, irritant dermatitis, vitiligo, and superficial bacterial and fungal infections. Unlike in western studies where pigmented lesions suspicious of melanomas are one of the most referred cases for teledermatology (with or without teledermatoscopy), Asian studies have fewer cases referred based on the suspicion of melanoma. [17]

Implemented projects by country

United Kingdom

24% of the population in England and Wales seek medical advice for a skin condition, and approximately 6% of patients presenting with a skin problem are referred for specialist advice each year. [18]

The Department of Health encourages the use of digital technology in key areas to support delivery of the quality, innovation, productivity, and prevention (QIPP). This includes the introduction of digital or online services to deliver greater convenience for patients and to free up face-to-face clinical time for individuals who really need it. [19]

Brazil

Brazil has had a high influx of white-skinned European immigrants from Portugal, Spain, Italy, Austria, Germany, Poland, Russia, etc., for many centuries. High ultraviolet content of solar exposure of skin leads to a high prevalence of lesions, especially skin cancer, with almost 200,000 diagnosed cases per year (30% of call cancer cases in the country). [20] Teledermatology and teledermoscopy services both at the level of public and private medicine have been implemented since 2005 in almost all states, particularly in Southern states where prevalence is higher. The Ministry of Health and the state's Health Secretaries have funded several initiatives within the framework of the Brazilian Primary Care Telehealth Program, such as in the state of Santa Catarina, where all municipalities have access to a teledermatology diagnosis and triage system headed by the Federal University of Santa Catarina [21] In the private sector, several initiatives have also taken place, such as a joint effort by the Albert Einstein Israelite Hospital of São Paulo's Telemedicine Center and the Municipal Health Secretary to provide teledermatology services to public health units, and was very useful to reduce queues, prioritize and expedite care for the more urgent cases of cancer care. [22] In addition, several private telemedicine services and startups experienced growth during the COVID-19 pandemic in the country.

Australia

Teledermatology and teledermoscopy currently exist in different forms in Australia. They assist with combatting the high skin cancer rates and allows rural patients to access specialist advice without having to travel. However, store-and-forward teledermatology or teledermoscopy are not currently funded under the Australian national health scheme called Medicare. Research has been done into the economic impact of funding teledermoscopy in the Australian setting, finding that it would cost around $2 for every day that diagnosis or treatment was expedited. [23] Australian dermatologists have been reported as reflecting on teledermoscopy by saying "that it is valuable, [and] advanced dermatology service" but given the option "they would prefer face-to-face consultation with patients where possible to allow for a full body examination". [24]

See also

Related Research Articles

<span class="mw-page-title-main">Melanocytic nevus</span> Medical condition

A melanocytic nevus is usually a noncancerous condition of pigment-producing skin cells. It is a type of melanocytic tumor that contains nevus cells. Some sources equate the term mole with "melanocytic nevus", but there are also sources that equate the term mole with any nevus form.

Dermatology is the branch of medicine dealing with the skin. It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems.

<span class="mw-page-title-main">Melanoma</span> Cancer originating in melanocytes

Melanoma, also redundantly known as malignant melanoma, is a type of cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye. In women, they most commonly occur on the legs, while in men, they most commonly occur on the back. About 25% of melanomas develop from moles. Changes in a mole that can indicate melanoma include an increase in size, irregular edges, change in color, itchiness, or skin breakdown.

<span class="mw-page-title-main">Nevus</span> Mole or birthmark; visible, circumscribed, chronic skin lesion

Nevus is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. The term originates from nævus, which is Latin for "birthmark"; however, a nevus can be either congenital or acquired. Common terms, including mole, birthmark, and beauty mark, are used to describe nevi, but these terms do not distinguish specific types of nevi from one another.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

<span class="mw-page-title-main">Keratosis pilaris</span> Skin condition characterized by small bumps caused by overproduction of keratin

Keratosis pilaris is a common, autosomal-dominant, genetic condition of the skin's hair follicles characterized by the appearance of possibly itchy, small, gooseflesh-like bumps, with varying degrees of reddening or inflammation. It most often appears on the outer sides of the upper arms, thighs, face, back, and buttocks; KP can also occur on the hands, and tops of legs, sides, or any body part except glabrous (hairless) skin. Often the lesions can appear on the face, which may be mistaken for acne or folliculitis.

<span class="mw-page-title-main">Seborrheic keratosis</span> Skin disease

A seborrheic keratosis is a non-cancerous (benign) skin tumour that originates from cells, namely keratinocytes, in the outer layer of the skin called the epidermis. Like liver spots, seborrheic keratoses are seen more often as people age.

<span class="mw-page-title-main">Actinic keratosis</span> Skin disorder

Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure. These growths are more common in fair-skinned people and those who are frequently in the sun. They are believed to form when skin gets damaged by UV radiation from the sun or indoor tanning beds, usually over the course of decades. Given their pre-cancerous nature, if left untreated, they may turn into a type of skin cancer called squamous cell carcinoma. Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, so treatment by a dermatologist is recommended.

<span class="mw-page-title-main">Dysplastic nevus</span> Medical condition

A dysplastic nevus or atypical mole is a nevus (mole) whose appearance is different from that of common moles. In 1992, the NIH recommended that the term "dysplastic nevus" be avoided in favor of the term "atypical mole". An atypical mole may also be referred to as an atypical melanocytic nevus, atypical nevus, B-K mole, Clark's nevus, dysplastic melanocytic nevus, or nevus with architectural disorder.

<span class="mw-page-title-main">Dysplastic nevus syndrome</span> Medical condition

Dysplastic nevus syndrome, also known as familial atypical multiple mole–melanoma (FAMMM) syndrome, is an inherited cutaneous condition described in certain families, and characterized by unusual nevi and multiple inherited melanomas. First described in 1820, the condition is inherited in an autosomal dominant pattern, and caused by mutations in the CDKN2A gene. In addition to melanoma, individuals with the condition are at increased risk for pancreatic cancer.

<span class="mw-page-title-main">Erythema ab igne</span> Medical condition

Erythema ab igneEAI, also known as hot water bottle rash, is a skin condition caused by long-term exposure to heat. Prolonged thermal radiation exposure to the skin can lead to the development of reticulated erythema, hyperpigmentation, scaling, and telangiectasias in the affected area. Some people may complain of mild itchiness and a burning sensation, but often, unless a change in pigmentation is seen, it can go unnoticed.

<span class="mw-page-title-main">Dermatoscopy</span> Medical examination of the skin

Dermatoscopy also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The dermatoscope consists of a magnifier, a light source, a transparent plate and sometimes a liquid medium between the instrument and the skin. The dermatoscope is often handheld, although there are stationary cameras allowing the capture of whole body images in a single shot. When the images or video clips are digitally captured or processed, the instrument can be referred to as a digital epiluminescence dermatoscope. The image is then analyzed automatically and given a score indicating how dangerous it is. This technique is useful to dermatologists and skin cancer practitioners in distinguishing benign from malignant (cancerous) lesions, especially in the diagnosis of melanoma.

<span class="mw-page-title-main">Blue nevus</span> Type of melanocytic tumor

A blue nevus is a type of coloured mole, typically a single well-defined blue-black bump.

<span class="mw-page-title-main">Skin biopsy</span> Removal of skin cells for medical examination

Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists. Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a skin biopsy can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery.

FotoFinder is a worldwide brand for medical skin imaging systems. The German company FotoFinder Systems GmbH was founded in 1991 and has developed imaging solutions for the follow-up of skin lesions as well as hair disorders diagnostics (TrichoLAB) and psoriasis assessment.

<span class="mw-page-title-main">Fungal folliculitis</span> Inflammation of hair follicles due to fungal infection

Majocchi's granuloma is a skin condition characterized by deep, pustular plaques, and is a form of tinea corporis. It is a localized form of fungal folliculitis. Lesions often have a pink and scaly central component with pustules or folliculocentric papules at the periphery. The name comes from Domenico Majocchi, who discovered the disorder in 1883. Majocchi was a professor of dermatology at the University of Parma and later the University of Bologna. The most common dermatophyte is called Trichophyton rubrum.

Pseudomelanoma is a cutaneous condition in which melanotic skin lesions clinically resemble a superficial spreading melanoma at the site of a recent shave removal of a melanocytic nevus.

<span class="mw-page-title-main">Teleophthalmology</span>

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning.

First Derm is a US-based online dermatology and tele-health website providing answers to skin conditions. Users send in cases to board certified dermatologists via an iOS, Android or Web app.

International Dermoscopy Society (IDS) is a non-governmental organization offering comprehensive promotion of dermoscopy, also known as dermatoscopy. It has over 16,000 international members from over 160 different countries.

References

  1. ↑ "ATA Teledermatology SIG". American Telemedicine Association. Archived from the original on 2 February 2007.
  2. ↑ Wootton R (December 2017). "Realtime Telemedicine". In Wootton R, Craig J, Patterson V (eds.). Introduction to Telemedicine (Second ed.). CRC Press. p. 88. ISBN   978-1-351-98946-6.
  3. ↑ Wurm EM, Hofmann-Wellenhof R, Wurm R, Soyer HP (February 2008). "Telemedicine and teledermatology: Past, present and future". Journal of the German Society of Dermatology. 6 (2): 106–12. doi:10.1111/j.1610-0387.2007.06440.x. PMID   18005076. S2CID   41450493.
  4. ↑ Burg G, Soyer HP, Chimenti S (2005). "Teledermatology". In Frisch P, Burgdorf W (eds.). EDF White Book, Skin Diseases in Europe. Berlin. pp. 130–133.{{cite book}}: CS1 maint: location missing publisher (link)
  5. ↑ Perednia DA, Brown NA (January 1995). "Teledermatology: one application of telemedicine". Bulletin of the Medical Library Association. 83 (1): 42–7. PMC   225996 . PMID   7703938.
  6. ↑ Chuchu, Naomi; Dinnes, Jacqueline; Takwoingi, Yemisi; Matin, Rubeta N; Bayliss, Susan E; Davenport, Clare; Moreau, Jacqueline F; Bassett, Oliver; Godfrey, Kathie; O'Sullivan, Colette; Walter, Fiona M (4 December 2018). Cochrane Skin Group (ed.). "Teledermatology for diagnosing skin cancer in adults". Cochrane Database of Systematic Reviews. 2018 (12): CD013193. doi:10.1002/14651858.CD013193. PMC   6517019 . PMID   30521686.
  7. ↑ "Telederm.org". eDermConsult.
  8. ↑ Binder B, Hofmann-Wellenhof R, Salmhofer W, Okcu A, Kerl H, Soyer HP (December 2007). "Teledermatological monitoring of leg ulcers in cooperation with home care nurses". Archives of Dermatology. 143 (12): 1511–4. doi: 10.1001/archderm.143.12.1511 . PMID   18086999.
  9. ↑ Ford, Adam R.; Gibbons, Caitlin M.; Torres, Josefina; Kornmehl, Heather A.; Singh, Sanminder; Young, Paulina M.; Chambers, Cindy J.; Maverakis, Emanual; Dunnick, Cory A.; Armstrong, April W. (2019). "Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial". Telemedicine and e-Health. 25 (7): 619–627. doi:10.1089/tmj.2018.0160. ISSN   1530-5627. PMC   6417973 . PMID   30222518.
  10. ↑ "IDD International Dermoscopy Diploma". Medizinische Universität Graz. Archived from the original on 13 January 2011.
  11. ↑ "DermNet NZ". New Zealand Dermatological Society.
  12. ↑ Massone C, Soyer HP, Lozzi GP, Di Stefani A, Leinweber B, Gabler G, et al. (April 2007). "Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system". Human Pathology. 38 (4): 546–54. doi:10.1016/j.humpath.2006.10.006. hdl:11567/255271. PMID   17270240.
  13. ↑
    • Bauer J, Leinweber B, Metzler G, Blum A, Hofmann-Wellenhof R, Leitz N, et al. (September 2006). "Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours". The British Journal of Dermatology. 155 (3): 546–51. doi:10.1111/j.1365-2133.2006.07342.x. PMID   16911279. S2CID   39413421.
  14. ↑ "Handyscope". FotoFinder Systems GmbH. Archived from the original on 10 April 2020. Retrieved 27 November 2018.
  15. ↑ Snoswell C, Finnane A, Janda M, Soyer HP, Whitty JA (June 2016). "Cost-effectiveness of Store-and-Forward Teledermatology: A Systematic Review" (PDF). JAMA Dermatology. 152 (6): 702–8. doi:10.1001/jamadermatol.2016.0525. hdl:10072/410245. PMID   27074289. S2CID   4052611.
  16. ↑ Chuchu N, Takwoingi Y, Dinnes J, Matin RN, Bassett O, Moreau JF, et al. (December 2018). "Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma". The Cochrane Database of Systematic Reviews. 2018 (12): CD013192. doi:10.1002/14651858.cd013192. PMC   6517294 . PMID   30521685.
  17. ↑
  18. ↑ Schofield J, Grindlay D, Williams H. Skin conditions in the UK: a health care needs assessment. Nottingham: Centre of Evidence Based Dermatology, University of Nottingham, 2009.
  19. ↑ "The Operating Framework for the NHS in England 2011/12". Department of Health. GOV.UK.
  20. ↑ "Skin cancer responds to around 30% of all malignant tumors in the Country". Sociedade Brasileira de Medicina Tropical (in Portuguese). 2019.
  21. ↑ von Wangenheim A, Nunes DH (2019). "Creating a Web Infrastructure for the Support of Clinical Protocols and Clinical Management: An Example in Teledermatology". Telemed J e Health. 25 (9): 781–790. doi:10.1089/tmj.2018.0197. PMID   30499753. S2CID   54165649.
  22. ↑ Giavina Bianchi M, Santos A, Cordioli E (2021). "Dermatologists' perceptions on the utility and limitations of teledermatology after examining 55,000 lesions". J Telemed Telecare. 27 (3): 166–173. doi:10.1177/1357633X19864829. PMC   8044615 . PMID   31409225.
  23. ↑ Snoswell CL, Caffery LJ, Whitty JA, Soyer HP, Gordon LG (June 2018). "Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia". JAMA Dermatology. 154 (6): 694–700. doi:10.1001/jamadermatol.2018.0855. PMC   6145645 . PMID   29801161.
  24. ↑ Snoswell CL, Whitty JA, Caffery LJ, Finnane A, Soyer HP (August 2019). "What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation" (PDF). Journal of Telemedicine and Telecare. 25 (7): 438–444. doi:10.1177/1357633x18776766. PMID   29933722. S2CID   49389361.

Further reading

Systematic review of economic evidence

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