الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Teledermatology (TD) uses the information and communications technologies to diagnose, monitor, treat, prevent, research, and educate over a distance. It was demonstrated to be more efficient and cost effective in certain settings, such as travel times. It was reported to be reliable and diagnostically accurate for a variety of dermatologic complaints and was shown to reduce wait times, increase access, and improve patient satisfaction and quality of life.
Implementation of TD has faced obstacles related to shortage of technical skills and resource limitations. Doctors and patients may experience challenges using this technology. Patients will require specialized guidance before virtual visits. Even with proper instruction, patients may struggle to display lesions properly, and visits may lag due to technologic malfunctions and bandwidth limitations. “Store and forward” formats alleviates these challenges, but dermatologists may encounter workflow disruptions.
In our study we evaluated the efficiency of TD as a patient-doctor communication channel. We enrolled 100 cases presented with different dermatoses, aiming to assess patients’ presentation of their complaints to a teledermatologist, compared to dermatologist presentation.
Expectedly, dermatologist presentation of cases showed great history and image appropriateness (89.3%, 93.4% respectively), hence high percentage of clue to diagnosis (94.3%). However, teledermatologists needed in-person evaluation in about third of cases (35.9%).
Obviously, in-person consultation is still irreplaceable in certain conditions. This is acceptable and should be encouraged to avoid missing critical conditions, such as skin malignancy. However, such need is expected to, eventually, decrease with the continuously growing photography technologies, progress of online communication, as well as the training of dermatolgists on medical photography and its updates.
As regards cases presented by the patients, they were significantly less appropriate than those presented by the dermatologist as regards history and photo appropriateness (31.0%, 31.4% respectively), hence lower percentage of clue to diagnosis (59.1%). Consequently, the majority (71.5%) of the cases needed in-person evaluation.
As regards diseases specifications (macular, papular, scaly, of special configurations, of special distribution, generalized, and localized), results were in parallel to the general results.
Patient-dermatologist teledermatology is expected to show some limitations. Further clinical examination may be required, such as whole-body check, palpation, and bedside tools. Certain anatomical sites may also be difficult to photograph, such as intimate areas (due to cultural and religious factors), mucosal lesions (due to inappropriate lighting), and sites hard to shoot, such as the back, buttocks, and posterior aspect of extremities. Further techniques and tools may also be required such as dermoscopy, and histopathology.
Obviously, the difference between patients and dermatologists presentation of skin diseases is statistically significant. Interestingly, the gap presented in this study is much lower than those reported earlier within the past two decades. Apparently, the gap between dermatologists and patients is decreasing over time. This may be attributed to the continuous development of the technologies and systems serving teledermatology.
Through this study, unclear images and those out of focus represented the main causes of inappropriateness in images presented by patients. When this was accompanied with an inappropriate history being incomplete in about half of cases and vague in one third of them, the outcome was, expectedly, failure to reach a clue of diagnosis by teledermatologists in most of cases.
It is worth mentioning that the advances continuously introduced to cameras, to upgrade the quality and automate most of photography parameters, will, relatively, decrease the need for photographer personal skills. This may eventually decrease the differences between dermatologists and patients as regards the outcomes of their images. Nevertheless, training should continue for dermatologists on technology updates, as well as for population to learn the requirements for getting appropriate images for medical communication.
Attention should also be paid for improving population linguistic skills for more appropriate expression about their complaints. Dermatologists should also be trained on the community slang language to overcome such a communication barrier.
To conclude, TD is the future of dermatology practice. Although it cannot substitute traditional in-person practice; at least for now, it represents the sole way of managing populations that are getting more numerous and older. With a stagnant number of dermatologists worldwide and their urban clustering, an in-person consultation with each patient may not be possible.