Can Tele-Dermatology and mHealth Bridge Gaps and Expand Dermatological Care Beyond the Pandemic?

🔍 Key Finding Teledermatology integrated with mobile health (mHealth) significantly advanced during the COVID-19 pandemic, offering increased access to dermatological care and improved patient engagement, but faces challenges related to regulation, data privacy, diagnostic accuracy, and the digital divide.

🔬 Methodology Overview

• Design: Narrative review
• Data Sources: PubMed and Scopus
• Selection Criteria: Studies published in peer-reviewed journals from 2020 onwards focusing on the application of apps/mobile health in teledermatology, excluding conference papers.
• Analysis Approach: Qualitative synthesis of findings categorized by opportunities, development/implementation/testing, integration models, and problems/bottlenecks of teledermatology and mHealth integration. Separate analysis of randomized controlled trials, observational studies, and reviews.
• Scope: Focus on the evolution, opportunities, and challenges of integrating teledermatology and mHealth, particularly in the context of and following the COVID-19 pandemic.

📊 Results

• Increased diagnostic accuracy: A teledermatology (TD) app improved vitiligo diagnosis accuracy. Smartphone-based dermoscopy in the TELESPOT project (Belgium) showed effectiveness in skin cancer diagnosis and treatment.
• High patient satisfaction: A study in Egypt found 91% overall satisfaction and future use score for TD during the COVID-19 pandemic. Another study found most patients satisfied with a smartphone-based hybrid TD model. High satisfaction was also noted for mobile TD in allergic skin disease management.
• Improved access to care: TD and mHealth reduced spatial and temporal barriers to dermatological care. In Norway, a TD app helped patients avoid specialist referrals in 70% of cases. TD increased follow-up capacity after discharge.
• Improved mental health: A disease management app significantly reduced depression scores in psoriasis patients.
• AI outperforms dermatologists: An AI-based app (Skin-Teller) for psoriasis severity assessment outperformed 43 experienced dermatologists, with a 33.2% performance gain in PASI score.
• Variability in image quality: Camera distance and angle affect color accuracy in medical photography, impacting diagnosis and treatment consistency. Few mHealth apps have standardized features for image quality improvement.
• Privacy and security concerns: Studies highlighted the need to address privacy and security issues in TD and mHealth, including informed consent and data usage policies. A zero-watermarking scheme based on federated learning was proposed as a solution.

💡 Clinical Impact Teledermatology, particularly when integrated with mobile health (mHealth), offers improved access to dermatological care, especially for remote or underserved populations, and facilitates efficient triage and monitoring of skin conditions. However, challenges regarding diagnostic accuracy, data privacy, and medico-legal frameworks need to be addressed for successful and ethical implementation in routine clinical practice.

🤔 Limitations

• Quality of publicly available apps may vary, requiring patient involvement in development and evaluation.
• Diagnostic accuracy of TD and mHealth is lower than in-person evaluations, especially for skin cancer.
• Camera distance and angle can affect color accuracy in medical photography, increasing variability in skin appearance.
• Privacy and security concerns exist, including data breaches and misuse of patient information.
• Lack of clear cybersecurity approach, including consent procedures and data usage policies.
• Variability in photographed skin appearance due to camera distance and angle can affect diagnosis and treatment consistency.
• Lack of standardized features in many apps for image quality improvement.

✨ What It Means For You Teledermatology, particularly when integrated with mHealth and AI, offers doctors new tools for remote diagnosis, monitoring, and triage of skin conditions, potentially increasing efficiency and reach, especially in underserved areas. However, doctors must also navigate challenges related to image quality, data privacy, diagnostic accuracy, medico-legal issues, and the need for clear guidelines and standardized workflows for effective implementation. Successful integration requires addressing these challenges while ensuring equitable access and maintaining patient-physician trust.

Reference Giansanti D. Advancing Dermatological Care: A Comprehensive Narrative Review of Tele-Dermatology and mHealth for Bridging Gaps and Expanding Opportunities beyond the COVID-19 Pandemic. Healthcare. 2023;11:1911. https://doi.org/10.3390/healthcare11131911