What is Teledermatology?

What are the benefits of teledermatology? Teledermatology is a subspecialty of dermatology and probably among the most popular applications of e-health and telemedicine. In this field, telecommuncation technologies are being used to transfer medical information over varying distances through audio, visual and data communication. Applications of teledermatology span different areas of health care management such as consultation, diagnoses, treatment and even education.

Perednia and Brown were the dermatologists who first coined the term “teledermatolgoy” in 1995. They studied the value of teledermatology in one rural area that is under served by dermatologists and they published their findings in a scientific publication.

Different Modes Of Data Transmission

There are two concepts which form the basis for the practice of teledermatology (as telemedicine): Store and forward, which is commonly abbreviated SAF, and real time or interactive teledermatology. The SAF and real time application methods can also be combined to form hybrid modes of data transmission.

In teledermatology, the SAF is often times the method of choice: The process involves sending or forwarding digital images linked with medical information to the data storage device of a specialist in the field. It can be as simple as sending an email inquiry with an attached digital image of a lesion to receive advice on how to treat the skin condition. The primary advantages of using this method are that it does not require both parties to be present at the same time and location and that no expensive equipment is necessary.

On the other hand, real time or interactive teledermatology entails the medical provider and the patient to interact through a live video conference. In some cases, a remote surgery may be involved as well as the use of telereobotic microscopes particularly when it comes to dermatopathology. This mode of data transmission is more expensive as sophisticated and costly technology must be used unlike in the store and forward mode. Both parties must also be available at the same time.

What Areas Can Teledermatology Be Applied?

Health Care Management

A direct consultation is a process in which a patient with a certain skin condition contacts a dermatologist through telecommunication to request proper diagnosis and treatment. In this regard, mobile applications that enable teledermatology to become possible are increasingly becoming more important.

Telediagnosis can be a complex procedure especially without the presence of a professional health care worker. It entails the patience to actively participate throughout the entire process and without proper guidance, it can lead to incorrect diagnosis. However, it serves as a triage tool, guiding individuals to the appropriate health care provider for his or her disease, and this could be a very valuable tool in the years to come.

Specialist referral is another key area of application in teledermatology. A medical professional or general practitioner who sees the patient can consult a specialist through telecommunication in order to receive a second opinion. The specialist can then help the general practitioner in rendering the correct diagnosis, providing helpful management options, and other necessary procedures.

Home telehealth, or telehomecare, involves the treatment of a patient with a chronic condition remotely at home. A critical aspect of interest of telehomecare when it comes to dermatology deals with patients crural ulcers or other skin conditions that require follow-up appointments. Crural ulcers are a fairly common skin condition that requires follow up appointments up to two times per week, demanding huge time commitments by the patients on top of all the financial obligations on the health care system. Teledermatology can be used to drive down the time and costs required in such follow-up visits.

Education

Another major benefit of telemedicine or e-health is in the field of medical education. Plenty of universities have online courses, web applications and computer-based training specifically designed for medical students. There are also specialist training courses students can take via the internet, particularly in the field of dermoscopy.

Non-professionals such as those who suffer from a certain skin condition can also benefit as they can access general health information through the internet. They can also find and join peer support groups with other people who are dealing with the same condition.

Special Interest Domains

Teledermoscopy

In teledermoscopy, a specialist can receive digital dermoscopic lesion images through electronic transmission in order to examine them. Campus Medicus is a web-based telediagnostic network that enables specialists to do this kind of work.

Dermoscopy refers to the technical field of utilizing an epiluminescence microscope to view skin lesions in magnification in-vivo. It is especially useful in quickly detecting malignant skin lesions or melanoma. One can take digital dermoscopic images by attaching a digital camera to a dermatoscope or by using special video cameras designed for dermoscopy such as the FotoFinder. Because dermoscopy involves the examination of two-dimensional images, it perfectly suits digital imaging and teledermatology.

Teledermatopathology

Teledermatopathology involves transmitting dermatopathologic images either via a store and forward system (transmission of images as one file) or real-time with the help of a robotic microscope. In the former method, a relatively new development is the advent of virtual slide systems or VSS.

Virtual slides are created by scanning the total glass side digitally at a high resolution followed by sending them to a storage unit. The images can then be assesses on a computer screen that is similar to a conventional microscopy, enabling the pathologist to freely maneuver around the images and see every part of the slide at different magnifications.

Dermatopathology aided by teledermoscopy

This process consists of the transmission of critical medical data, clinical and dermoscopic images to a pathologist who performs the traditional histopathologic diagnosis.

In a typical clinical setting, skin biopsies are performed by the physician who is responsible for the patient and evaluated by a dermatopathologist. The dermatopathologist, in most instances, may not have seen the clinical aspect of the skin lesion and may not have any kind of information about the patient as well. These limitations can be resolved through teledermoscopically-aided dermatopathology, allowing the pathologist to gain access to the patient’s medical history and clinical data which can be used to increase the accuracy of diagnosis.

In addition, it has been proven that such crucial data may improve the degree of diagnostic confidence performed by the dermatopathologist.

Mobile teledermatology

Mobile telemedicine is a process where in at least one party (the person in need of advice or the doctor) makes use of a wireless or mobile equipment such as smartphones and tablets, as opposed to conventional telemedicine platforms. Travelers who find themselves suffering from a skin lesion as well as medical professional who are always on the go can significantly benefit from this new advnacement in teledermatology. In order to gain access to medical advice and encourage patients to take more of an active role in managing their health, mobile teledermatology appears to be particularly suited for patient triage (i.e. referral according to the character and severity of their specific skin condition). Another application of mobile teledematology is for follow-up visits of people suffering from chronic skin conditions.

Cases Suitable For Teledermatology

There are only specific medical cases suitable for teledermatology. However, this aspect remains a topic that needs to be studied further by experts in the field. According to some studies, follicular lesions and eczema have been diagnosed with a moderate certainty, whereas other studies show that diagnoses of viral warts, acne vulgaris irritant dermatitis, herpes zoster, vitiligo and bacterial and fungal infections are more accurate. Unlike studies in the West where suspicious lesions that might be melanomas are among the most referred cases for the application of teledermatology, Asian studies have significantly fewer instances referred based on the suspicion of malignant skin lesions.

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