Teledermatology - Subspecialty of Dermatology

Teledermatology is an area of dermatology that uses telecommunication technologies to capture visual or audio information about skin lesions and then send that data securely to a dermatologist.

Applications may span different areas such as consultation, diagnosis, treatment, and education. One of the main uses of this technology is to connect patients with dermatologists and it is particularly useful for patients who experience difficulties with mobility or who reside in remote areas.

Modes of Transmission

The two main modes of transmission in teledermatology are “store and forward” (SAF) and real-time or interactive teledermatology. The two modes can also be combined.

SAF is often the preferred choice. Digital images and medical information is sent to a storage device or a consultant in the field. It can be as simple as a patient sending an e-mail with an image of their skin lesion to their medical provider and then receiving advice. This way, neither party needs to be present at the same time or same location and no expensive equipment is needed.

The interactive mode, on the other hand, requires that the patient and the healthcare provider interact via a real-time video conference. Costly remote surgery and equipment may be used, making this mode of transmission more expensive than the SAF mode. Both the patient and healthcare provider also need to be available at the same time.

Healthcare Management

Teledermatology can be used in the process of direct consultation, where a patient with a skin condition uses the technology to contact a dermatologist and ask for a diagnosis and treatment. In this sense, mobile devices such as Smartphones and tablets that enable this telecommunication are therefore becoming increasingly important. To obtain a telediagnosis, a patient needs to stay actively engaged throughout the entire process in order for them to be guided to the appropriate medical provider.

Telecommunication is particularly useful when a patient has a chronic condition that can be managed or treated from home. Some skin conditions require follow-up appointments up to two times a week and teledermatology helps relieve the huge time commitments and financial strain this would usually place on patients who would otherwise need to physically attend appointments.

The technology can also be used for specialist referral, where a healthcare provider or doctor who assesses the patient can then employ the telecommunication to contact a specialist and obtain a second opinion. This helps the medical provider ensure the correct diagnosis, as well as advise on disease management or any other necessary steps.

Education

Another key application of teledermatology is in medical education. The technology can be used for internet-based courses and training that is specifically targeted at medical students. Students can take specialist courses, which is particularly useful in the field of dermoscopy.

Specialist Areas

Two of the main specialist areas where teledermatology can be applied are described below:

• Teledermoscopy – Dermoscopy refers to the use of an epiluminescence microscope to look at magnified skin lesions and is particularly useful for the rapid detection of cancerous skin lesions. In teledermoscopy, digital images of lesions can be electronically transmitted to a specialist via a digital camera attached to the dermascope.

• Teledermatopathology – Dermatopathology combines the fields of dermatology, pathology and sometimes surgical pathology in the microscopic and molecular study of skin disease. Dermatologists use the information a doctor shares with them about a patient’s skin condition and consults with them as necessary, which helps to ensure the most accurate diagnosis and treatment recommendations. Images are transmitted using either the SAF mode or the real-time mode.

For the SAF method, a relatively recent development is the creation of virtual slide systems. Here, a glass slide is digitally scanned at high resolution to create virtual slides which are then sent to a storage unit, where they can be accessed and viewed using a computer screen that is similar to a conventional microscope. The pathologist can maneuver the images to visualize different parts of the slide at magnifications of their choice.