Telemedicine in dermatology: findings and experiences worldwide – a systematic literature review

Abstract

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.

Live interactive teledermatology compared to in‐person care – a systematic review

“…Third, methodological quality of several studies was poor. Fourth, most of the economic evaluations were fourteen years and older, and many new teledermatological applications have been developed in the last decade . Statements about cost‐effectiveness of LI teledermatology cannot be transferred to the presence.…”

“…Two different forms of teledermatological applications are distinguishable: ‘store and forward’ (S&F) applications describe applications in which data are stored and retrieved time and location independently, whereas ‘live interaction’ (LI) applications avail direct communication between at least two stakeholders using videoconferences . Hybrid forms combine S&F and LI . Due to the increased administrative effort in coordinating live conferences, S&F is the more frequently used method .…”

“…Various reviews on teledermatological applications have been published over the last years, but to our knowledge, no up‐to‐date review on LI teledermatology across different conditions has been published. Hence, an overview is lacking on the effectiveness, costs and accuracy of LI applications compared to standard in‐person care.…”

Concordance of severity scores for photographic assessment of hidradenitis suppurativa

“…8 Further photograph-based assessment studies of patients with HS are required. Digital assessments of patients with HS have several advantages, which include preserving a record of a clinical condition and facilitating the development of telemedicine.…”

“…Prouteau iD , 1,2 M. Dinulescu, 1 E. Oger, 3,4 C. Pruvost-Balland, 1 S. Buche, 5 O.Cogrel, 6 M. Delage, 7 A. Maruani iD , 8,9 I. Nicol, 10 E. Sbidian iD , 11,12,13 A. P. Villani, 14,15,16 M. Viguier, 17 M. Chastagner, 14,15,16 C. Grodner, 10 J. Kaoutar, 7 C. Laurent, 1,2 S. Leducq iD , 8,9 A. Dupuy, 1,2,3 and C. Droitcourt iD 1,2,3,4 Groupe th ematique HS-France de la Soci et e Franc ßaise de Dermatologie Prouteau iD , 1,2 M. Dinulescu, 1 E. Oger, 3,4 C. Pruvost-Balland, 1 S. Buche, 5 O.Cogrel, 6 M. Delage, 7 A. Maruani iD , 8,9 I. Nicol, 10 E. Sbidian iD , 11,12,13 A. P. Villani, 14,15,16 M. Viguier, 17 M. Chastagner, 14,15,16 C. Grodner, 10 J. Kaoutar, 7 C. Laurent, 1,2 S. Leducq iD , 8,9 A. Dupuy, 1,2,3 and C. Droitcourt iD 1,2,3,4 Groupe th ematique HS-France de la Soci et e Franc ßaise de Dermatologie…”