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Asynchronous teledermatology (TD) has shown promise in improving access to dermatological care, yet studies reveal varied methodologies and results. This study aimed to design a mobile app using the store-and-forward model, marking a pioneering effort in Iran to facilitate written documentation of patient history and skin lesion imagery for accurate diagnosis. Conducted from July 2022 to July 2023, this study involved the development and implementation of a smartphone app to collect clinical data and photographs from 89 patients at a dermatology clinic. Diagnoses made at the clinic served as the gold standard. Three dermatologists independently reviewed the app-recorded data, providing diagnoses that were compared to in-person assessments using the Kappa coefficient and agreement percentage. Lesions were predominantly located on the whole body (47%), with psoriasis (19.1%), acne vulgaris (11.2%), and eczema (10%) being the most common. The overall inter-observer Kappa value demonstrated excellent agreement at 0.856. The study's findings endorse the use of a mobile app for TD as an effective adjunct in regions with scarce dermatological services, such as Iran. To promote the broader application of TD, ongoing research is essential to further establish its reliability and practicality., (© 2024. The Author(s).)

Background: Blurry images in teledermatology and consultation increased the diagnostic difficulty for both deep learning models and physicians. We aim to determine the extent of restoration in diagnostic accuracy after blurry images are deblurred by deep learning models. Methods: We used 19,191 skin images from a public skin image dataset that includes 23 skin disease categories, 54 skin images from a public dataset of blurry skin images, and 53 blurry dermatology consultation photos in a medical center to compare the diagnosis accuracy of trained diagnostic deep learning models and subjective sharpness between blurry and deblurred images. We evaluated five different deblurring models, including models for motion blur, Gaussian blur, Bokeh blur, mixed slight blur, and mixed strong blur. Main Outcomes and Measures: Diagnostic accuracy was measured as sensitivity and precision of correct model prediction of the skin disease category. Sharpness rating was performed by board-certified dermatologists on a 4-point scale, with 4 being the highest image clarity. Results: The sensitivity of diagnostic models dropped 0.15 and 0.22 on slightly and strongly blurred images, respectively, and deblurring models restored 0.14 and 0.17 for each group. The sharpness ratings perceived by dermatologists improved from 1.87 to 2.51 after deblurring. Activation maps showed the focus of diagnostic models was compromised by the blurriness but was restored after deblurring. Conclusions: Deep learning models can restore the diagnostic accuracy of diagnostic models for blurry images and increase image sharpness perceived by dermatologists. The model can be incorporated into teledermatology to help the diagnosis of blurry images.

Homelessness in the United States is a significant public health issue, with dermatologic disease being the most prevalent health concern among the undomiciled and sheltered populations. Despite a growing need for dermatologic care, the supply of dermatologists remains insufficient, contributing to disparities in healthcare access for this vulnerable group. This review aims to detail the spectrum of dermatologic conditions experienced by homeless individuals, identify barriers to adequate care, and explore teledermatology as a potential solution to bridge these gaps. A comprehensive literature review was conducted, analyzing studies and reports on dermatologic issues prevalent among the homeless population and the efficacy of teledermatology in addressing these concerns. Homeless individuals face a wide range of dermatologic problems, from common conditions like acne and eczema to severe issues such as cellulitis, leg ulcers, and skin cancer. Drug abuse, domestic and sexual abuse, and parasitic infestations further complicate the dermatologic health of this population. Teledermatology has emerged as a promising tool to enhance access to dermatologic care, showing significant improvements in clinical outcomes and accessibility, especially in underserved urban settings. However, challenges remain, such as the digital divide affecting the elderly and low-income populations, which could potentially exacerbate disparities. Addressing the dermatologic needs of the homeless population requires a multifaceted approach. Teledermatology offers a viable solution to improve care access and efficiency, but additional efforts are necessary to ensure inclusivity and avoid further marginalization. Volunteer-driven multidisciplinary clinics also play a crucial role in providing care, though they face challenges in continuity and resource availability. Future strategies should focus on integrating teledermatology with other supportive services to create a comprehensive care model for this underserved population., (© 2024. The Author(s).)

Background: During the COVID-19 pandemic, teledermatology became a popular mode of health care delivery. Thus, deciphering which diagnoses are best suited for synchronous video visits is important to guide providers on appropriate patient care. Methods: We conducted a retrospective study of 1,647 submitted synchronous video visits from September 1, 2020 to March 31, 2021 at a single, large academic institution. Results: Video visits' follow-up rate was significantly associated with diagnosis subtype ( p < 0.001). Compared with patients with skin lesions and nonskin dermatologic conditions, patients with a rash had higher odds of being recommended to have their follow-up visit as a video visit (odds ratio [OR] = 0.222, p < 0.001; OR = 0.296, p < 0.001). Patients with a rash had lower odds of being recommended to have their follow-up visit as an in-person office visit when compared with skin lesions (OR = 9.679, p < 0.001), nonskin dermatologic conditions (OR = 4.055, p < 0.001), and other skin dermatologic conditions (OR = 2.23, p < 0.01). Demographically, employed, middle-aged patients with private insurance made up the majority of video visit usage. African American patients were less likely to utilize a video visit compared with Asian patients (OR = 2.06, p < 0.038). Conclusions: Certain dermatologic diagnoses, most notably rashes, are more conducive to video visit management. Rashes made up 86% of new patient video visits, were more likely to have video visit follow-up if needed and were more likely to not require further follow-up indicating that the management of rashes from initial diagnosis to completion in care is suitable for video visit management.

Background: Despite the global upscale of teledermatology during the COVID-19 pandemic, persistent barriers, such as the poor anamnesis and photo quality, hinder its effective use in practice. Understanding Dutch dermatologists' experiences and satisfaction with using the teledermatology system in the Dutch health care system is needed. A holistic evaluation may provide valuable insight to understand how barriers interrelate which is deemed necessary for the innovation of teledermatology in practice., Objective: Guided by a complex adaptive system perspective, this study aims to understand Dutch dermatologists' experience and satisfaction with their training, support communication, interaction, and usage of a teledermatology platform of a Dutch digital hospital during the COVID-19 pandemic, uncovering insights to improve teledermatology services for the future., Methods: A web-based questionnaire was sent in December 2021 to Dutch dermatologists who (1) had an active teledermatology platform account, and (2) responded to a teledermatology consultation between October 1, 2019, and September 30, 2021. The questionnaire consisted of the validated Store-and-Forward Telemedicine Service User-satisfaction Questionnaire (SAF-TSUQ) questionnaire, and new questions regarding; demographics of teledermatologists, the use of teledermatology during the COVID-19 pandemic, the performance of teledermatology by general practitioners (GP), and the role of dermatologists in the teledermatology process. The open-ended questions were analyzed by a grounded theory approach guided by a sociotechnical model and complemented by a complex adaptive system perspective. A panel discussion with 3 dermatologists was performed to provide additional insight into the responses to the questionnaire., Results: We obtained responses from 25 out of the 249 (10%) invited dermatologists. Overall, dermatologists had a positive experience with teledermatology. Interestingly, teledermatology use frequency remained unaffected by the COVID-19 pandemic. However, the insufficient quality and incompleteness of the clinical content (photos and anamneses information) of the teledermatology consultation impacted the efficiency of the teledermatology workflow. Dermatologists expressed the need for improvement to avoid time-consuming processes or physical referrals. The panel discussion enriched and confirmed the responses, suggesting solutions like mandatory fields for the GPs for a complete anamnesis., Conclusions: Dutch Dermatologists view teledermatology as a valuable tool to provide access to dermatology care. However, improvements regarding the quality and completeness of the provided clinical content are necessary for the effectiveness and efficiency of the complex teledermatology system in Dutch health care. This could increase both the dermatologists' satisfaction and the quality of teledermatology services. Managing trade-offs, such as time investments versus image quality, is crucial for teledermatology implementation and should be assessed from a complexity perspective to understand trade-offs and prevent unintended consequences., (©Femke van Sinderen, Craig Kuziemsky, Monique W Jaspers, Linda W Peute. Originally published in JMIR Dermatology (http://derma.jmir.org), 26.07.2024.)

The diagnostic accuracy rate of live videoconferencing (LVC) teledermatology, by board-certified dermatologists compared to non-dermatologists has not yet been fully investigated. The aim of this study was to compare the diagnostic accuracy of board-certified dermatologists, dermatology specialty trainees, and board-certified internists in LVC teledermatology. We examined the diagnostic accuracy of clinicians from different specialties in diagnosing the same group of patients. The clinicians were isolated from each other during the diagnosis process. We enrolled 18 volunteer physicians (six board-certified dermatologists, six dermatology specialty trainees, and six board-certified internists) who reviewed the skin conditions of 18 patients via LVC teledermatology. The diagnostic accuracy of the participating physicians was evaluated using the final diagnosis as the reference standard. The diagnostic accuracy averages were compared according to the physicians' specialties and disease categories. The mean ± standard deviation diagnostic accuracy of the most detailed level diagnosis was 83.3% ± 3.5% (range, 77.8%-89.0%) for board-certified dermatologists, 53.7 ± 20.7% (range 27.8%-77.8%) for dermatology specialty trainees, and 27.8 ± 5.0% (range, 22.2%-33.3%) for board-certified internists. Board-certified dermatologists showed significantly higher diagnostic accuracy, not only against board-certified internists (p < 0.0001) but also against dermatology specialty trainees (p < 0.05). Disease categories with high accuracy rates (≥80%) only by board-certified dermatologists were inflammatory papulosquamous dermatoses (87.5%), compared to 58.3%, and 20.8% for dermatology specialty trainees and board-certified internists respectively). For inflammatory erythemas and other reactive inflammatory dermatoses the accuracy rates for board-certified dermatologists, dermatology specialty trainees, and board-certified internists were 83.3%, 33.3%, 8.3% respectively; for melanoma in situ neoplasms, 83.3%, 50.0%, 66.7% respectively), and for genetic disorders of keratinization 83.3%, 33.3%, and 0% respectively). Our findings showed that board-certified dermatologists may have high diagnostic accuracy with practical safety and effectiveness in LVC teledermatology., (© 2024 Japanese Dermatological Association.)

Introduction: Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years., Methods: Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality., Main Measures: referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation., Results: The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations., Conclusions: Teledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies., Registry: ClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 ( https://clinicaltrials.gov/ct2/show/ NCT05625295)., (© 2024. The Author(s).)

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.

Background: Teledermatology provides a platform for swift specialist advice without the potential need for face-to-face review. Our objectives were to investigate the effectiveness, accuracy and diagnostic concordance of the platform with regard to the remote management of skin conditions., Methods: We undertook a single-centre, retrospective chart review over a 1-year period, comprising a total of 1703 teledermatology referrals. Two physicians independently assessed the diagnostic concordance between telederm diagnosis (TD), in-person diagnosis (ID) and histopathological diagnosis (HD)., Results: There were a total of 1703 TD referrals, of which 341 were rejected, leaving 1362 referrals for evaluation. Sixty-five per cent of these referrals were managed remotely and discharged with advice, although 4.6% of these were later re-referred for an in-person review. A total of 20% of referrals were rejected, of which the majority was due to a lack of appropriate imaging. The total concordance of TD compared to ID was 76.4%. When comparing the TD and ID/HD, we obtained a Kappa value of 0.636 indicating substantial agreement. In terms of accuracy, there were 49 biopsy-proven skin cancers picked up by the service in this cohort of data. Of these, 61.2% were given an accurate diagnosis on first impression via teledermatology, 14.3% were given a different diagnosis but correctly categorised as skin cancer and 24.5% could not be assessed; however, they were triaged and escalated based upon clinical suspicion., Conclusion: Our study demonstrates that teledermatology is an effective platform in terms of diagnosis and remote management, with adequate diagnostic accuracy and concordance to in-person diagnosis., (© 2024 Australasian College of Dermatologists.)

Background: An eConsult is a growing teledermatology tool that has the potential to address health disparities. Trends in teledermatology usage are still being defined in the context of the pandemic, postpandemic recovery, and a growing nonphysician primary care provider population. Objective: The aim was to understand teledermatology utilization trends for asynchronous dermatology eConsults in the geographically expansive state of Texas. Methods: This multicenter retrospective study examined the eConsult tool within a large, nonprofit health system, comparing characteristics of 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023. Results: When comparing the demographics of patients seen through eConsult versus traditional in-person visits, eConsults demonstrated a significantly higher prevalence of pediatric (22.5% vs. 7.6%, p < 0.001), Hispanic/Latino (20.5% vs. 10.4%, p < 0.001), African American (12.5% vs. 6.9%, p < 0.001), Asian (4.6% vs. 2.1%, p < 0.001), and American Indian (1.0% vs. 0.5%, p  = 0.049) patients compared with in-person visits. eConsult users came from areas with a lower percentage of bachelor's degree holders, reduced average household income, and an increased proportion of Medicaid and Tricare users. Physicians (MD/DO) submitted more eConsult cases than nonphysician providers (NPPs), with comparable diagnostic agreement with teledermatologists and similar recommendation rates for in-person dermatology visits. Conclusions: While the limitation of this study was that it was a descriptive data analysis in a single health care system with limited generalizability, eConsults hold promise to broaden dermatologic access for underserved groups, especially children, individuals from underrepresented backgrounds, and Medicaid and Tricare members. While no significant diagnostic or referral differences were seen for eConsults initiated by primary care physician and NPPs, these changing trends should continue to be examined.

Introduction: Teledermatology adoption continues to increase, in part, spurred by the COVID-19 pandemic. This study analyzes the utility and cost savings of a store-and-forward teledermatology consultative system within the Veterans Health Administration (VA). Methods: Retrospective cohort of 4,493 patients across 14 remote sites in Tennessee and Kentucky from May 2017 through August 2019. The study measured the agreement between the teledermatology diagnoses and follow-up face-to-face clinic evaluations as well as the cost effectiveness of the teledermatology program over the study period. Results: Fifty-four percent of patients were recommended for face-to-face appointment for biopsy or further evaluation. Most patients, 80.5% received their face-to-face care by a VA dermatologist. There was a high level of concordance between teledermatologist and clinic dermatologist for pre-malignant and malignant cutaneous conditions. Veterans were seen faster at a VA clinic compared with a community dermatology site. Image quality improved as photographers incorporated teledermatologist feedback. From a cost perspective, teledermatology saved the VA system $1,076,000 in community care costs. Discussion: Teledermatology is a useful diagnostic tool within the VA system providing Veteran care at a cost savings.

Background: Dermatology consultations in Québec, Canada, face accessibility challenges, with most dermatologists concentrated in urban areas. Teledermatology, offering remote diagnosis and treatment, holds promise in overcoming these limitations. However, concerns regarding patient-doctor relationships and logistical issues exist., Objectives: This article aims to introduce a dermatology patient learning pathway (PLP) developed by the Centre of Excellence on Partnership with Patients and the Public (CEPPP), focusing on knowledge, abilities, and skills mobilized by patients and their loved ones at key moments of the life course with an illness, as well as emerging educational needs., Methods: The PLP development was co-developed with dermatology patient and caregiver partners, stakeholders, and the CEPPP team. The process encompassed stakeholder engagement, exploration, recruitment of patient and caregiver partners, co-development of the PLP draft, and validation through consensus building., Results: The PLP methodology led to the creation of 44 learning objectives, comprising a total of 107 subobjectives. These objectives were organized into 8 phases of the patient life course with a dermatological condition: (1) prevention and predisposition; (2) discovery, self-examination, or observation of a change; (3) first consultation; (4) wandering; (5) consultation with a dermatologist; (6) diagnosis; (7) treatments; and (8) living with it., Conclusions: The dermatology PLP serves as a resource outlining patient competency across different stages of managing a dermatological condition throughout their life course. In the context of teledermatology, the PLP might facilitate patient and caregiver engagement by helping select appropriate information and tools to support active participation in care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Conflicts of interest None disclosed.

Background: The factors necessitating the need for referrals for in-person evaluations by a dermatologist are not adequately understood and have not been studied using automated text mining so far. The objective of this study was to compare the prevalence of required in-person dermatologist care in the presence or absence of certain clinical features. Methods: Observational cross-sectional study of 11,661 teledermatology reports made from February 2017 to March 2020. Results: The need for dermoscopy was associated with a 348% increase in the possibility of referral for in-person dermatologist evaluations (prevalence ratio [PR]: 4.48, 95% confidence interval [CI]: 4.17-4.82). Infectious diseases were associated with a 64% lower possibility of referral (PR: 0.36, 95% CI: 0.30-0.43). Discussion: Some lesions and poorly documented cases are challenging to assess remotely. This study presents a different approach to research more detailed data from teledermatology reports, using text mining, and points out the risk magnitude for demanding dermatologic in-person care of which feature analyzed. As limitations, the variables related to lesion location, size, and extension were not analyzed and the dictionaries used were originally in Brazilian Portuguese. Conclusions: Teledermatology seems sufficient for the management of 75% of clinical cases, especially acute in young patients with inflammatory or infectious lesions. Referrals for in-person dermatologist consultations were not only strongly associated with the need for dermoscopy, but also for therapeutic reasons like surgical procedures, phototherapy, and the use of some systemic medications .

Store-and-forward teledermatology (SAFT) has become increasingly popular as a means to increase access to specialist care and address healthcare disparities such as those experienced by rural communities. A contemporary systematic overview of the Australian SAFT services and outcomes for all dermatological conditions is missing. This scoping review provides an overview of Australian SAFT models. Twelve studies were identified through web databases, grey literature sites and reference lists of eligible articles. Eligibility criteria included studies evaluating doctor-to-dermatologist Australian SAFT services provided to Australians for all skin conditions but excluded the studies that solely focused on skin cancers. Data on study design, setting, population, SAFT model, referral characteristics, patient, and general practitioner perspectives, diagnostic concordance, and measured outcomes such as follow up, investigation and waiting time were extracted. Quality of the included studies was assessed using CASP tools. Synthesis reveals that SAFT can be used for patients with any dermatological condition, provides more accurate diagnostics compared to cases without dermatologist input, may reduce waiting times for dermatological expertise, and users generally had positive experiences with SAFT. Although results are positive, this review reveals the heterogenous nature of the literature on SAFT in Australia and a need to establish a uniform approach to assessing the outcomes and impacts of such services., (© 2023 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Skin diseases are a major public health concern in Indonesia, although access to specialized care in remote areas is limited. We initiated a low-cost teledermatology service in Sumba, a remote island in eastern Indonesia. Eighteen healthcare workers (HCWs) at five primary healthcare centers received training to manage common skin diseases and submit clinical cases beyond their expertise to an online platform. Submitted cases were reviewed by at least one dermatologist. Diagnostic agreement between HCWs and dermatologists was calculated. The HCWs participated in a satisfaction survey 2 years after project initiation. Since October 2020, of 10,384 patients presenting with skin complaints in a 24-month period, 307 (3%) were submitted for a teledermatology consultation. The most frequent skin diseases were infections and infestations (n = 162, 52.8%) and eczematous (85, 27.7%) and inflammatory (17, 5.5%) conditions. Fifty-three patients (17.3%) were diagnosed with a neglected tropical skin disease, including leprosy and scabies. Dermatologist advice was provided within a median of 50 minutes (interquartile range, 18-255 minutes), with 91.9% of consultations occurring within 24 hours. The diagnostic agreement level between HCWs and dermatologists significantly improved over time, from 46.9% in the first 6-month period (κ = 0.45; 95% CI, 0.37-0.54) to 77.2% in the last 6-month period (κ = 0.76; 95% CI, 0.67-0.86; global P < 0.001). The HCWs reported that the teledermatology service was extremely/very useful in supporting daily practice (100%) and improved their knowledge of skin diseases tremendously/a lot (92%). Teledermatology can improve accessibility and quality of skin services in medically underserved areas, providing opportunities for scalability and knowledge transfer to frontline HCWs.

Utilization of telemedicine for dermatology has greatly expanded since the start of the COVID-19 pandemic, with over 500 new teledermatology studies published since 2020. An updated review on teledermatology is necessary to incorporate new findings and perspectives, and educate dermatologists on effective utilization. We discuss teledermatology in terms of diagnostic accuracy and clinical outcomes, patient and physician satisfaction, considerations for special patient populations, published practice guidelines, cost effectiveness and efficiency, as well as administrative regulations and policies. Our findings emphasize the need for dermatologist education, prioritization of reliable reimbursement systems, and technological innovations to support the continued development of teledermatology in the post-pandemic era., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.

The aim of this research is to gain a deeper understanding of the ethnic and socio-demographic differences in the utilisation of the national 24/7 Healthline service in relation to skin condition calls and their outcomes. Healthline is one of the 39 free telehealth services that Whakarongorau Aotearoa | New Zealand Telehealth Services provides to New Zealanders. This is a retrospective observational study analysing Healthline data over a 4-year period: January 2019 through to December 2022. A total of 61,876 skin condition calls were analysed including demographics of service users: age group, ethnicity, area of residence and call outcome. Higher acuity skin condition calls resulting in an outcome of a recommendation for emergency department (ED) care accounted for 5.3% (n=3,294) of calls. This research found that Māori were over-represented in this ED recommendation data over four years (942 ED outcomes; 28.6%), and Pasifika were under-represented (203 ED outcomes; 5.9%). Wairarapa and West Coast were found to have the highest number of ED outcomes per capita. Our results support the theory that severe skin conditions positively correlate with smaller district populations and increased deprivation in access to services. This study highlights the potential that telehealth services have to help reduce the inequity of access to care., Competing Interests: This article uses Whakarongorau Aotearoa data. Several authors of this article are employees of Whakarongorau Aotearoa (as stated in the author's information)., (© PMA.)

Introduction: German prisons face organizational and time-consuming difficulties in access to medical specialties. Since 2019, our institute offers interdisciplinary video consultations with spatially independent dermatological support for German prisons. Methods: Documentation of n  = 200 consultations between February 2020 and July 2021 with retrospective analysis of dermatological conditions and consultation requests. Results: Most cases (98.0%; 196 of 200) were performed during a regular weekly teleclinic and only few cases on urgent demand. The average duration of the skin disease before request for consultation was 10.3 ± 26.9 months (mean ± standard deviation), the majority had first onset of their disease or acute recurrence of previously known skin diseases. With respect to medical complaints, 39.7% of patients reported severe itch and 7.7% indicated severe pain. For most cases (84.0%), topical treatment and for almost one-third (32.5%) we recommended systemic treatment. The predominant number of cases was only presented once (92.0%) and further treatment of the skin disease could be managed by the medical staff inhouse. Only few consultations could not be solved virtually and were referred to local physicians for face-to-face consultations or procedures. Discussion: Teledermatological care for prisoners effectively supports the inhouse medical resources of prisons. Our interdisciplinary approach enables general practitioners and medical staff of the respective prison to manage the case and shortens the time period until therapy starts.

In the inpatient setting, dermatology consultants help reduce mortality, shorten length of stay, and reduce hospital readmissions. Recent research underscores the contributions of dermatology hospitalists, including phenotyping known and new severe cutaneous adverse drug reactions; showing improved progression-free and overall survival among those receiving dermatologic care for cutaneous reactions to immune checkpoint inhibitors; highlighting the role of dermatologists in reducing emergency department and hospital utilization by those with inflammatory skin diseases; and demonstrating ways in which dermatologists can effectively diagnose common and severe cutaneous diseases using asynchronous teledermatology, meeting the growing demand for inpatient dermatology services. This review covers selected highlights from the 2022-2023 inpatient dermatology literature.

Background: Teledermatology has provided new avenues through which dermatologists can provide healthcare. Teledermatology was introduced to the Emergency Department (ED) to enable immediate dermatological consult. We aimed to assess the impact of teledermatology on the management of dermatological conditions by emergency medicine physicians and subsequent health resource utilization., Methods: We conducted a retrospective review of teledermatology referrals from the ED of our tertiary hospital in Singapore from June 2015 to December 2019. The dermatological conditions, the triaging and treatment recommendations were analyzed. Follow-up plans were recorded., Results: Between June 2015 and December 2019, 147 patients were referred from the ED via teledermatology; 11 (7.5%) were admitted, and 136 (92.5%) were recommended to be discharged with a dermatological diagnosis and management plan. If required, a follow-up appointment in the dermatology specialist clinic was arranged. Of the 136 patients who were discharged, 129 (94.9%) patients were provided with outpatient appointment in the dermatology clinic, out of which 110 patients returned for follow-up. 90 (81.8%) patients retained the initial teledermatology diagnoses and 20 (18.2%) patients had their teledermatology diagnoses revised after in-person review., Conclusions: Teledermatology allows for more efficient triaging of patients with dermatological conditions. Reliability between teledermatology and clinic-based examination is good. Patients may be managed mainly in the outpatient setting with appropriate specialty-directed treatment, return advice, and appropriately-triaged follow-up outpatient appointment., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Use of inpatient teledermatology increased during the COVID-19 pandemic. We surveyed the Society for Dermatology Hospitalists to better characterize the impact of COVID-19 on teledermatology use by inpatient dermatology providers, particularly on provider perceptions of teledermatology. Prior to the COVID-19 pandemic, 40% (8/20) of surveyed providers had used telehealth at their institution to help perform inpatient consults, while 90% (18/20) adapted use of teledermatology during the pandemic. 80% (16/20) reported that their opinion of teledermatology changed as a result of the COVID-19 pandemic, with the vast majority (87.5%, 14/16) reporting having a more positive opinion. Benefits of teledermatology included efficiency, ability to increase access safely, and ability for clinicians to focus on complex cases. Some providers expressed concerns over the potential implications regarding the perception of dermatology within medicine, limitations of inadequate photos, and breakdowns in communication with consulting teams and patients. Robust algorithms and or utilization criteria of teledermatology may help to mitigate risk, while increasing access to inpatient dermatologic evaluation., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There is a high demand for dermatological care in Germany. As use of teledermatology has increased significantly, this study aimed to investigate the impact of teledermatology on patient care. Methods: This retrospective cross-sectional study used data from a direct-to-consumer teledermatology platform using store-and-forward technology available in Germany between July 2021 and April 2022. Additional patient characteristics were collected using a voluntary follow-up questionnaire, 28 days after teleconsultation. Results: Data of 1,999 enrolled patients were evaluated. Patients had a mean age of 36 years, and 61.2% (1,223/1,999) lived in a rural residence. The most common diagnoses included eczema (36.0%, 701/1,946), fungal diseases (15.4%, 299/1,946), and acne (12.5%, 243/1,946). The follow-up questionnaire was answered by 166 patients (8.3%, 166/1,999). In total, 42.8% (71/166) of patients had undergone no previous medical consultation. The most frequent reason for using teledermatology was the waiting time for a dermatology outpatient appointment (62.0%, 103/166). A total of 62.0% (103/166) participants rated the treatment success as good or very good, while 86.1% (143/166) rated the quality of telemedical care as equal or better to that of an outpatient visit. Conclusion: This study showed that patients often use teledermatology because of functional barriers (waiting times). In this cohort, the diagnoses strongly corresponded to reasons for outpatient presentation. Most patients rated the quality of teledermatology service as at least equivalent to that of outpatient physician visits and reported treatment success. Thus, teledermatology can relieve the burden of outpatient care while providing high benefits from the patient's perspective.

Objectives: To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions., Design: Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results., Results: 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology., Conclusions and Relevance: Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies., Trial Registration Number: 10.17605/OSF.IO/FJDVG., Competing Interests: Competing interests: RDJF is an employee, and SCW is a co-founder, chief medical officer, and shareholder of Swift Medical. JRGL and AL were formerly employees of Swift. No funding bodies have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors declare no conflict of interest, (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo., Method: A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform., Results: A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist’s expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist’s diagnosis was not included in the health worker’s hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice., Conclusions: The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Competing Interests: Conflicts of interest None disclosed.

Timely and comprehensive dermatological care is a major challenge. Digitized medical consultation offers a possibility to overcome this problem. Here, we studied the diagnostic spectrum and treatment success in teledermatology in the largest cohort to date. Over 12 months, 21 725 individuals received a diagnosis and therapeutic advice using the asynchronous image-text method. In the context of quality management, 1802 individuals (~10%) of both sexes with a mean age of 33.7 years (SD 15.36) received a follow-up 3 months after the initial consultation to assess the treatment outcome. Of these, 81.2% did not require a face-to-face consultation. Therapeutic efficiency could be ascertained in 83.3% of the patients, whereas 10.9% did not improve, and 5.8% did not provide an information on the course of therapy. Teledermatology is a useful tool in digitalized medicine and complements the classical in-person dermatological examination, as shown by the high degree of treatment efficacy in this study. Although face-to-face consultations can not and should not be completely substituted by teledermatology it reflects a significant contribution to patient care and justifies the further expansion of digital structures in dermatological care., (© 2023 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Introduction: Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation., Methods: Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data. Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males ( n  = 104), and most patients were white ( n  = 179, 87%) and not Hispanic/Latino ( n  = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

Importance: Telemedicine use accelerated during the COVID-19 pandemic, and skin conditions were a common use case. However, many images submitted may be of insufficient quality for making a clinical determination., Objective: To determine whether an artificial intelligence (AI) decision support tool, a machine learning algorithm, could improve the quality of images submitted for telemedicine by providing real-time feedback and explanations to patients., Design, Setting, and Participants: This quality improvement study with an AI performance component and single-arm clinical pilot study component was conducted from March 2020 to October 2021. After training, the AI decision support tool was tested on 357 retrospectively collected telemedicine images from Stanford telemedicine from March 2020 to June 2021. Subsequently, a single-arm clinical pilot study was conducted to assess feasibility with 98 patients in the Stanford Department of Dermatology across 2 clinical sites from July 2021 to October 2021. For the clinical pilot study, inclusion criteria for patients included being adults (aged ≥18 years), presenting to clinic for a skin condition, and being able to photograph their own skin with a smartphone., Interventions: During the clinical pilot study, patients were given a handheld smartphone device with a machine learning algorithm interface loaded and were asked to take images of any lesions of concern. Patients were able to review and retake photos prior to submitting, so each submitted photo met the patient's assumed standard of clinical acceptability. A machine learning algorithm then gave the patient feedback on whether the image was acceptable. If the image was rejected, the patient was provided a reason by the AI decision support tool and allowed to retake the photos., Main Outcomes and Measures: The main outcome of the retrospective image analysis was the receiver operator curve area under the curve (ROC-AUC). The main outcome of the clinical pilot study was the image quality difference between the baseline images and the images approved by AI decision support., Results: Of the 98 patients included, the mean (SD) age was 49.8 (17.6) years, and 50 (51%) of the patients were male. On retrospective telemedicine images, the machine learning algorithm effectively identified poor-quality images (ROC-AUC of 0.78) and the reason for poor quality (blurry ROC-AUC of 0.84; lighting issues ROC-AUC of 0.70). The performance was consistent across age and sex. In the clinical pilot study, patient use of the machine learning algorithm was associated with improved image quality. An AI algorithm was associated with reduction in the number of patients with a poor-quality image by 68.0%., Conclusions and Relevance: In this quality improvement study, patients use of the AI decision support with a machine learning algorithm was associated with improved quality of skin disease photographs submitted for telemedicine use.

Background: Teledermatology is comparable to face-to-face visits in providing accurate diagnoses and effective treatments. However, there are limited data regarding patient satisfaction with teledermatology models that more directly convey provider recommendations to patients., Objective: To assess patient satisfaction with the teledermatology service at the Atlanta Veterans Affairs Medical Center (AVAMC)., Methods: A cross-sectional, phone-based questionnaire study of 175 AVAMC teledermatology patients was performed to investigate patient satisfaction. In phase 1 (n = 100), we compared the teleconsultative and telemedicine models. In phase 2 (n = 75), we compared patients who received 1 of 3 possible consult outcomes: reassurance, appointment for biopsy, or appointment for face-to-face evaluation., Results: There were no statistically significant differences in satisfaction between patients who were seen with the telemedicine and teleconsultative models. Patients who received appointments for face-to-face evaluation or biopsy were more satisfied than patients who received reassurance only. Both phases were remarkable for high patient satisfaction among all cohorts., Limitations: This study was performed at a single Veterans Affairs medical center and is vulnerable to both nonresponse bias and recall bias., Conclusion: Overall, patients are satisfied with teledermatology services at the AVAMC. Strong partnership with referring primary care providers and clear delineation of responsibilities is vital to the teledermatology process., (Copyright © 2019. Published by Elsevier Inc.)

Little is known about trends in teledermatology adoption and use for managing dermatologic patients, especially changes in use influenced by the COVID-19 pandemic. In this retrospective cohort study, we analyzed encounter data from the Healthjump dataset (containing electronic health record data from throughout the USA) for visits from November 2019 to July 2021 with a primary dermatology-related diagnosis. There was a striking rise in teledermatology use with the onset of the pandemic in February 2020, peaking in April 2020 with 2178 teledermatology encounters (32.8% of all encounters). Subsequently, teledermatology use waned. Most teledermatology care was delivered via synchronous means with little use of asynchronous or telephone communication. When compared to those with neoplastic skin diseases, patients with inflammatory skin diseases were more likely to be seen via teledermatology (OR 3.30, 95% CI 3.12-3.49). Certain demographic groups were less likely to receive care via teledermatology, such as men (compared with females, OR 0.76, 95% CI 0.74-0.78) and patients 65 and older (compared with those below 65, OR 0.59, 95% CI 0.57-0.62). Our work shows increased adoption of teledermatology at the onset of the COVID-19 pandemic with decreasing use over time. Future efforts are needed to ensure continued and expanded use of a valuable care modality to reach vulnerable populations., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Conflicts of interest The authors state no conflict of interest.

Competing Interests: Conflicts of interest None disclosed.

Background and Objectives: Skin diseases are a common reason for consultations in pediatric practice. The present study aims to characterize the dermatological requests of resident pediatric specialists using teledermatology in Germany., Patients and Methods: This analysis of consultation requests, submitted by pediatricians to a designated pediatric dermatologist via a telemedical consultation system (PädExpert) using the store-and-forward technology, was performed between February 2021 and December 2021., Results: The study analysis included 504 telemedical consultation requests. The mean age of the patients was 6.5 ± 5.0 years with 45.5% of the patients being female. Telemedicine was useful in providing a definite diagnosis in 88.3%. The diagnoses were most frequently assigned to the group of infectious skin diseases (28.8%). Referral to a dermatologist was recommended in 11.5%. The requests were answered on the same day in 63.8% of the cases., Conclusions: The study data shows the great potential of teledermatology to improve access for children with skin diseases to specialized dermatological care. Another advantage is its function as a triage instrument. Since most cases could be managed by teledermatology only, it is possible to reduce the need for an in-person visit to the dermatologist, thus saving resources., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Introduction: Teledermatology is the application of new technologies for the care of skin diseases. Its application in prisons allows the diagnosis and treatment of prisoners without the need to transfer them to the hospital, avoiding the problems associated with travel., Material and Method: The objective of this work is to analyze the usefulness of teledermatology in prisons, through a retrospective observational study in the Castellón II-Albocàsser penitentiary., Results: The study sample consisted of 37 patients and 43 interconsultations. All the consultations corresponded to men, with a mean age of 42.43 years. 95.3% of the consultations were asynchronous and in 86% of them a diagnosis and a complete treatment plan were established. Only 18.6% of the consultations required a face-to-face consultation., Discussion: It is concluded that teledermatology in prisons is effective in the care and resolution of dermatological problems.

Background: Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care., Objective: To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC)., Methods: Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05)., Results: During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001)., Study Limitations: The TD service is available only for the public health network and analysis for a limited period (five years)., Conclusions: Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level., (Copyright © 2022 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Store-and-forward (SAF) tele-dermatology (TD) platforms could help promote coordination between hospital and general practitioners (GPs). However, very little data exists on the performance accuracy and opinions of GPs participating in this type of project in France., Methods: We report on the diagnostic and management plan accuracy of an SAF-TD platform developed for neighbouring GPs around our hospital compared with routine face-to-face (FTF) dermatological consultation in our department. We also compared the accuracy of SAF-TD with that of the participating GPs. Lastly, we collected feedback from GPs after their participation in this project., Results: Overall, 298 patients were included by 58 GPs between November 2016 and January 2020, of whom 169 (57%) were female, and with a median age of 44.5 years (range 0-96). The diagnostic accuracy of TD was 62% (n=184/298) for the initial hypothesis and 80% (n=239/298) for aggregated diagnostic accuracy. Management plan accuracy for TD was 81% (n=225/277). At least 43% of consultations (n=127/298) met the criteria for preventable consultation. Diagnostic accuracy for the initial hypothesis was significantly lower for GPs than for TD (Odd Ratio [OR]=0.34; 95% Confidence Interval [95% CI]: 0.20-0.56; p<0.0001), as was management plan accuracy (OR=0.23; 95% CI: 0.10-0.46; p<0.0001). Among the responding GPs, 78% (n=29) reported very high satisfaction and 97% would consider integrating this type of programme in their long-term practice, but they highlighted the time-consuming nature of the platform (46%) and the lack of financial compensation (44%)., Conclusion: SAF-TD in coordination with GPs seems safe and efficient in the management of outpatients, and enjoys a high satisfaction rate among GPs, despite its time-consuming nature and the lack of financial compensation. Healthcare policy should promote financial participation to help the expansion of TD., (Copyright © 2022. Published by Elsevier Masson SAS.)

Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently.

Understanding the utility of virtual visits in pediatric dermatology practice has become increasingly important in the telehealth era. We compared the conditions diagnosed in pediatric dermatology between traditional in-person visits and virtual telehealth visits during the initial 8-month phase of the COVID-19 pandemic at an urban medical institution. When given the option, pediatric dermatology patients and their families were more likely to choose telehealth visits for the diagnosis and/or management of acne, hemangiomas, and contact dermatitis; however, they were more likely to choose in-person visits for atopic dermatitis, viral warts, and alopecia areata. These differences may be attributed to clinical features of pediatric skin conditions, treatment options, and other factors which may influence patient preference for telehealth or in-person care for their condition. J Drugs Dermatol. 2022;21(11):1260-1263. doi:10.36849/JDD.6843.

Background: With increasing shortage of medical personnel also in the medical care in German correctional facilities, telemedicine has been used since 2016, initially in projects and then for regular medical care. Since 2019, there is the possibility of dermatological expertise in regular video consultations., Objective: The benefits of an interdisciplinary online consultation with video and store and forward technology for dermatological issues are highlighted in terms of efficiency and feasibility., Material and Methods: A descriptive analysis of 450 dermatological video consultations for German correctional facilities from February 2020 to July 2022 was carried out with respect to procedures, indications and demand., Results: Requests were made via a standardised form with optional photographs, which were sent via a secure cloud to the dermatology department in store and forward mode. The majority of cases could be presented live in a regular weekly video consultation and only single cases required an acute presentation within 24 h. The spectrum of skin diseases was comparable to cases presenting to a dermatology outpatient clinic. The interdisciplinary consultation management together with colleagues from general medicine enabled the transfer of the cases to the medical personnel at the correctional facility on site for follow-up and further medical procedures. Treatment could be started in all cases without delay., Conclusion: Teledermatology represents an important contribution to medical care in German correctional facilities and the interdisciplinary cooperation saves time and resources in the presentation and treatment of skin diseases., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Importance: Patient-submitted images vary considerably in quality and usefulness. Studies that characterize patient-submitted images in a real-life setting are lacking., Objective: To evaluate the quality and perceived usefulness of patient-submitted images as determined by dermatologists and characterize agreement of their responses., Design, Setting, and Participants: This survey study included patient images submitted to the Department of Dermatology at Duke University (Durham, North Carolina) between August 1, 2018, and December 31, 2019. From a total pool of 1200 images, 10 dermatologists evaluated 200 or 400 images each, with every image being evaluated by 3 dermatologists. Data analysis occurred during the year leading up to the article being written., Main Outcomes and Measures: The primary outcomes were the responses to 2 questions and were analyzed using frequency counts and interrater agreement (Fleiss κ) to assess image quality and perceived usefulness. We performed a random-effects logistic regression model to investigate factors associated with evaluators' decision-making comfort. We hypothesized that most images would be of low quality and perceived usefulness, and that interrater agreement would be poor., Results: A total of 259 of 2915 patient-submitted images (8.9%) did not depict a skin condition at all. The final analysis comprised 3600 unique image evaluations. Dermatologist evaluators indicated that 1985 images (55.1%) were useful for medical decision-making and 2239 (62.2%) were of sufficient quality. Interrater agreement for a given image's diagnostic categorization was fair to substantial (κ range, 0.36-0.64), while agreement on image quality (κ range, 0.35-0.47) and perceived usefulness (κ range, 0.29-0.38) were fair to moderate. Senior faculty had higher odds of feeling comfortable with medical decision-making than junior faculty (odds ratio [OR], 3.68; 95% CI, 2.9-4.66; P &lt; .001) and residents (OR, 5.55; 95% CI, 4.38-7.04; P &lt; .001). Images depicting wounds (OR, 1.75; 95% CI, 1.18-2.58; P = .01) compared with inflammatory skin conditions and that were in focus (OR, 5.56; 95% CI, 4.63-6.67; P &lt; .001) had higher odds of being considered useful for decision-making., Conclusions and Relevance: In this survey study including 10 dermatologists, a slight majority of patient-submitted images were judged to be of adequate quality and perceived usefulness. Fair agreement between dermatologists was found regarding image quality and perceived usefulness, suggesting that store-and-forward teledermatology initiatives should consider a physician's individual experiences and comfort level. The study results suggest that images are most likely to be useful when they are in focus and reviewed by experienced attending physicians for wound surveillance, but dermatologists may be burdened by irrelevant or unsuitable images.