Is Teledermatology the Future of Dermatology, or Just a Tool in the Dermatologist's Kit?

🔍 Key Finding Teledermatology is increasingly used and accepted by both patients and physicians, proving cost-effective and convenient, especially for chronic conditions and triage; however, it cannot replace in-person examinations, particularly given current limitations of AI diagnostic tools and medico-legal considerations. Further technological advancements and standardized guidelines are needed to maximize teledermatology’s potential while preserving the doctor-patient relationship.

🔬 Methodology Overview

• Design: Narrative review
• Data Sources: PubMed, Google Scholar, Cochrane Skin, Embase, EBSCO, and MEDLINE (until December 31, 2023)
• Search Terms: “telemedicine”, “teledermatology”, “artificial intelligence”, “dermatology”, “ChatGpt”
• Selection Criteria: Meta-analyses, reviews, and real-life studies regarding teledermatology, prioritizing English language manuscripts.
• Analysis Approach: Qualitative synthesis of findings from selected articles and their references.
• Scope: Historical overview of teledermatology, current challenges, the impact of advancing technologies (especially AI), and implications for healthcare.

📊 Results

• Early adoption: First teledermatology experience reported in Norway (1993), first publication (1995) originating from the US due to high demand and limited access to dermatologists, especially in rural areas.
• Program Fluctuation: 62 teledermatology programs in the US (2003), decreased to 38 (2011), then increased to 102 (2016), with 62 governmental, reflecting evolving technology and institutional support.
• Military Use: Teledermatology played a significant role in providing specialized care to US troops in war zones (2004-2012), accounting for ~40% of telemedicine consultations (4379 total) with a 98% response rate within 24 hours.
• COVID-19 Impact: Teledermatology publications nearly tripled in 2020 compared to 2019, driven by the pandemic and social distancing measures, highlighting its role in maintaining access to dermatological care.
• Patient and Physician Satisfaction: A study showed 92% patient satisfaction with teledermatology during the pandemic, with 82% willing to use it again (58% preferring combined with in-person visits). Another study found 58% of dermatologists found teledermatology convenient for most patients, though 71% found diagnosis more challenging than in-person.
• Cost-Effectiveness: Teledermatology demonstrated cost-effectiveness for triage and chronic disease management, particularly for conditions like psoriasis, atopic dermatitis, acne, and hidradenitis suppurativa.
• AI Integration: While AI shows promise in dermatology, particularly for melanoma diagnosis, current systems cannot replace dermatologists due to limitations in data and the need for physical examination. Patient trust in AI diagnosis remains a concern.

💡 Clinical Impact Teledermatology has emerged as a cost-effective tool for triage, diagnosis, monitoring, and prescription renewals in dermatology, expanding access to care, particularly for patients in underserved areas or with limited mobility. While it cannot replace in-person examinations for all cases, advancements in technology and artificial intelligence are enhancing its capabilities and integration into routine clinical practice, improving efficiency and patient access while requiring careful consideration of ethical and medico-legal implications.

🤔 Limitations

• Availability of the internet
• Quality of the devices (must transmit sharp images)
• Ability of users to use the devices
• Risk of misdiagnosis
• Risk of missing a diagnosis of incidental malignancy
• Absence of informed consent for teledermatology patients
• Risk of loss of patient privacy

✨ What It Means For You Teledermatology, boosted by advancements in technology and the COVID-19 pandemic, offers doctors efficient and cost-effective methods for diagnosis, triage, monitoring, and prescription renewals, particularly for chronic skin conditions. While AI tools can support these efforts, they cannot replace the crucial physical examination and doctor-patient relationship, necessitating continued refinement of teledermatology practices and medico-legal frameworks for optimal patient care.

Reference Tommasino N, Megna M, Cacciapuoti S, Villani A, Martora F, Ruggiero A, Genco L, Potestio L. The Past, the Present and the Future of Teledermatology: A Narrative Review. Clinical, Cosmetic and Investigational Dermatology. 2024;17:717-723. https://doi.org/10.2147/CCID.S462799