Assessing the Use of Telehealth in Dermatology After the COVID-19 Pandemic

As telehealth appointments became crucial during the COVID-19 pandemic, many clinicians and practices have continued to offer telehealth services to their patients to improve access to care. This week, Dermatology Times is highlighting recent COVID-19 research affecting skin, hair, and nails. Specifically, 2 studies published this year have evaluated the uses of and attitudes toward telehealth in dermatology after the COVID-19 pandemic.

Measuring Attitudes Toward Telehealth Among German Dermatologists

One study conducted in Germany assessed the trajectory of digital health adoption among dermatologists from 2019 to 2021, particularly emphasizing the influence of the COVID-19 pandemic. Through a quantitative cross-sectional survey approach, Augustin et al examined the use of various digital health technologies, including telemedicine, artificial intelligence, and mobile applications, within dermatological practices. The study author’s findings demonstrated a notable increase in the integration of digital tools during the study period, driven by the pandemic-induced shift towards remote healthcare delivery.

However, disparities emerged across demographic factors such as age, gender, and geographic location, emphasizing potential inequalities in access to innovative healthcare solutions. Despite a rise in overall adoption, Augustin et al’s study showed a decline in interest and confidence among dermatologists regarding digital health technologies over time. Notably, younger practitioners demonstrated higher levels of interest, knowledge, and confidence in using digital applications compared to their older colleagues.

Overall, urban-based dermatologists showed more favorable attitudes toward digital health technologies, suggesting regional disparities in adoption rates. The study author’s findings highlight the importance of addressing these disparities through targeted policy interventions and strategic initiatives to ensure equitable access to digital healthcare solutions.

“In the future, policy strategies must be developed to counteract these disparities and improve nationwide implementation. Developers of innovations should incorporate physicians’ perspectives more commonly to ensure feasibility and use. Future research should support policymakers and developers by identifying barriers to implementation, monitoring disparities, and ensuring an evidence base for digital applications,” concluded Augustin et al.¹

Advantages and Disadvantages of Telehealth vs In-Person Dermatology Visits Regarding Non-Melanoma Skin Cancer Diagnoses

Nikolakis et al’s systematic review investigated the comparison between teledermatology (TD) and face-to-face dermatology (FTF) for the diagnosis and management of non-melanoma skin cancer (NMSC). Out of 56 initially reviewed articles, 33 were deemed eligible for inclusion in the study. The results were categorized based on barriers, limitations, and future perspectives related to the 2 different approaches.

One key aspect highlighted in the study is the importance of establishing a gold standard for NMSC diagnosis, with histopathology serving as the reference method for malignant lesions and FTF evaluation by dermatologists for non-malignant lesions. Despite the high sensitivity and specificity of TD and teledermoscopy evaluations for NMSC, certain limitations were identified, such as recall bias when the same dermatologist conducts both TD and FTF evaluations.

Various studies from different countries, including New Zealand, the United Kingdom, the Netherlands, Brazil, and the United States, were analyzed to provide a comprehensive overview of the effectiveness and challenges of TD in NMSC diagnosis. The findings revealed varying levels of diagnostic concordance between TD and FTF evaluations, with some studies reporting substantial agreement on primary diagnoses and management plans.

The study author’s findings demonstrate the potential of TD in enhancing access to dermatologic care, particularly for patients with NMSC. However, it also emphasizes the need to address certain limitations, such as interrater disagreements in histopathological diagnoses and technical difficulties in image-based evaluations.

“An efficient TD consultation for NMSC is shown to decrease waiting times for biopsy or diagnostic excision, offer a quick consultation for the population of rural areas, and cover the high demand for diagnosis and lesion-specific follow-up for non-melanocytic epithelial tumors and their precursors. Additionally, TD can be used to ameliorate the three most important barriers to accessing specialty dermatology care, i.e., being uninsured continuously, living in an underserved county, or being under the poverty level,” concluded Nikolakis et al.²

References

1. Augustin M, Reinders P, Janke TM, et al. Attitudes toward and use of eHealth technologies among German dermatologists: repeated cross-sectional survey in 2019 and 2021. J Med Internet Res. 2024;26:e45817. Published 2024 Feb 12. doi:10.2196/45817
2. Nikolakis G, Vaiopoulos AG, Georgopoulos I, Papakonstantinou E, Gaitanis G, Zouboulis CC. Insights, advantages, and barriers of teledermatology vs. face-to-face dermatology for the diagnosis and follow-up of non-melanoma skin cancer: a systematic review. Cancers (Basel). 2024;16(3):578. Published 2024 Jan 30. doi:10.3390/cancers16030578