Dermatologists' perceptions on the utility and limitations of teledermatology after examining 55,000 lesions

Abstract

Introduction: Few studies have assessed the perception of teledermatologists about the utility and limitations of teledermatology, especially to diagnose a broad range of skin diseases. This study aimed to evaluate dermatologists' confidence in teledermatology, its utility and limitations for dermatological conditions in primary care.

Methods: An analytical study that used a survey for dermatologists who diagnosed 30,916 patients with 55,012 lesions through teledermatology during a 1-year project in São Paulo, Brazil.

Results: Dermatologists found teledermatology useful for triage and diagnosis, especially for xerotic eczema, pigmentary disorders and superficial infections. Their confidence in teledermatology was statistically higher by the end of the project (p = 0.0012). Limitations included some technical issues and the impossibility to suggest how soon the patient should be assisted face-to-face by a dermatologist. The most treatable group of diseases by teledermatology was superficial infections (92%). The use of dermoscopy images would significantly increase the confidence to treat atypical naevi and malignant tumours (p < 0.0001 and p = 0.0003 respectively). Follow-ups by teledermatology or feedback from primary-care physicians would be desirable, according to the dermatologists.

Discussion: We found it interesting that dermatologists became increasingly confident in teledermatology after the project and how they classified teledermatology as useful for triage, diagnosis and even treatment of most types of skin conditions followed at primary care. Dermoscopy should definitely be added to the photographs, especially for malignant tumours and atypical naevi. Most of the technical limitations found could be solved with a few improvements in the software/platform.

Keywords: Teledermatology; dermatologist; limitations; survey; utility.

Figure 1.

Dermatologists’ confidence in teledermatology before and after the project.

Figure 2.

Utility of teledermatology (n = 12). Note. Please refer to the online version to see this figure in colour.

Figure 3.

Limitations with the software/platform or as a physician during the project. ¹When two or more teledermatologists were reporting lesions from the same patient, concomitantly, without knowing it. The first one to click the ‘done’ box saved the work. The other(s) lost their work. Note. Please refer to the online version to see this figure in colour.

Figure 4.

Dermatologists’ confidence in diagnosing diseases using teledermatology: ¹vitiligo, melasma, solar lentigo, solar leukoderma, postinflammatory hyperpigmentation; ²melanocytic nevus, seborrheic keratosis, dermatofibroma, soft fibromas, acrochordon, warts; ³basal cell carcinoma, squamous cell carcinoma, melanoma; ⁴acne, psoriasis, atopic dermatitis, nummular eczema, stasis dermatitis, lichen simplex chronicus, seborrheic dermatitis, pityriasis alba; ⁵epidermoid cyst, trichilemmal cyst, lipoma; ⁶molluscum contagiosum, impetigo, folliculitis, tineas, candidiasis, scabies, onychomycosis, pityriasis versicolor; ⁷hypertrophic scar, keloid, stretch marks, acne scars; ⁸androgenic alopecia, alopecia areata, telogen effluvium. Note. Please refer to the online version to see this figure in colour.

Figure 5.

Possibility of treatment the following diseases using teledermatology. ¹Vitiligo, melasma, solar lentigo, solar leukoderma, postinflammatory hyperpigmentation. ²Acne, psoriasis, atopic dermatitis, nummular eczema, stasis dermatitis, lichen simplex chronicus, seborrheic dermatitis, pityriasis alba. ³Molluscum contagiosum, impetigo, folliculitis, tineas, candidiasis, scabies, onychomycosis, pityriasis versicolor. ⁴Androgenic alopecia, alopecia areata, telogen effluvium.