Asynchronous Teledermatology Assessment of Young Adult Acne Likely Concordant With In-Person Evaluation

April 2021 | Volume 20 | Issue 4 | Original Article | 432 | Copyright © April 2021


Published online March 3, 2021

Ted Jacoby a, Alice Woolard b, Salim Chamoun c, Ron Moy MDc

aUniversity of Hawaii, John A. Burns School of Medicine, Honolulu, HI
bUniversity of North Carolina Chapel Hill, Chapel Hill, NC
cMoy-Fincher-Chipps Dermatology and Facial Plastics, Los Angeles, CA

Abstract
Telemedicine, defined as practicing medicine at a distance, has grown in popularity over the past ten years, as advances in consumer technology have permitted its expansion. Dermatology is a field that especially lends itself to this method of care, as many common dermatological diagnoses can be made upon visual inspection. With social distancing becoming the new standard in this age of COVID-19, telemedicine emerges as a key tool in continuing patient care without interruption. In this pilot study, we examine the reliability of acne vulgaris diagnostic assessments made via patient-taken photos compared to in-office assessments in patients between the ages of 16 and 23 with mild to moderate acne. Fourteen patient encounters were clinically examined for three outcomes: inflammatory lesions, noninflammatory acne lesions, and facial nodules. On the same day patient outcomes were counted and recorded in-person, patients were instructed to photograph their faces. These images were reviewed 8–12 weeks later by investigators for the same assessment. Initial findings suggest strong concordance between in-person and digital diagnosis, with a Spearman’s correlation coefficient of 0.96 across all lesion and nodule scores. These data support further research on the expansion and implementation of telemedicine for dermatology.

J Drugs Dermatol. 20(4):432-435. doi:10.36849/JDD.5688

INTRODUCTION

Telemedicine, defined as practicing medicine at a distance, provides an opportunity for patients to see their physician without physical interaction.1 This platform of medical service delivery has become more common, especially during the COVID-19 pandemic, where social distancing is the new standard.2,3 In order for this tool to be correctly applied in current practice, it must be vetted through validation studies that assess the accuracy and diagnostic reliability of such systems.1

Among the medical specialties that value and have utilized telemedical evaluations, dermatology has been at the forefront since 1995.4 The proposed benefits of teledermatology include increased access to care, improved clinical outcomes, and patient satisfaction.5 Furthermore, compared to traditional face-to-face visits, this method of care has been proposed to be more efficient as well as to foster improved patient compliance by removing the waiting times and distance traveled to see a physician.6

There are three main teledermatology delivery system categories that are used in clinical practice: synchronous, asynchronous, and hybrid. Synchronous platforms use live video conferencing to connect the patient and the physician. The ability to have live patient-physician interactions is a strength of this delivery system technique. It allows the dermatologist to interview, convey treatment plans, and educate the patient in a clear way that promotes patient centered care.7 Despite its versatility in clinical practice, there are weaknesses to synchronous interactions, which include patient-physician encounters separated by different time zones, as well as encounters where higher resolution images are required for diagnosis and management of the particular disease.8 Although synchronous teledermatology has value in patient care, current evidence suggests that the asynchronous method is superior and has higher versatility in clinical practice.9

Asynchronous teledermatology utilizes stored images taken by the patient or the physician and subsequently sent to the dermatologist for review and clinical judgement. This is called the store-and-forward technique.8,9 There are several advantages that this technique has over its synchronous counterpart. Some examples of this include not needing an active high speed internet connection, cost effectiveness, and lack of a set appointment time, which can be limiting factors among some patients.9 Furthermore, the superiority of the store-and forward technique becomes especially apparent when compared to low resolution live video conferencing, which has been shown to be less effective with low image quality.10

Although less commonly used, the hybrid technique, which combines both synchronous and asynchronous