November 2023

What is teledermatology, who offers it and what does it cover?

Online dermatology, also known as ‘teledermatology’ harnesses modern digital technology to deliver expert skincare remotely. Teledermatology has been around for decades but recently has seen a huge increase in usage across the globe. 

There are around 2000 different dermatological diseases, and teledermatology can address around 90% of them, even skin cancer. It is however not a replacement for in-person review, rather a convenient and more accessible option that removes the need to travel or even leave your own home. It’s perfect for people who live in remote areas, have poor access to healthcare, have mobility issues or who live busy lives and cannot get to a doctor easily.

What is teledermatology not good for?

Sometimes you may need to see a dermatologist in person. This may be because you need a physical examination, your issue requires a special medical device where simple photographs are not enough or simply your dermatology problems are so severe, they need urgent action e.g., admission into a hospital.

Are there different types of teledermatology?

Yes, they can be simplified into:

Store-and-forward (SAF) – Photographs are bundled together with a patient-completed questionnaire and any other information; these are then reviewed asynchronously (not in real time) to provide rapid management of one’s dermatology issues.

Live consultation (LC) – A real time consultation delivered via a video conferencing platform, e.g., Zoom or MS Teams. An encrypted link to join a meeting can be accessed on any number of devices e.g., personal computers (PC), laptop, tablet, or smartphone.

Hybrid (a bit of both SAF and LC) – Images (if applicable) are bundled together with a patient-completed questionnaire and any other information. You are then reviewed virtually via a video-based appointment with the clinician having all your information to hand. This is best form of teledermatology.

Who is teledermatology available to?

Many NHS dermatology units have adopted teledermatology but most services around the UK are in their infancy. Unsurprisingly, the private sector has been much faster to develop teledermatology services. One such service is skindoc, the first CQC-regulated online dermatology service in the UK and one which is leading the way in online skincare, having successfully treated thousands of patients already.

How to prepare for a teledermatology appointment

Firstly, you need to know which type of teledermatology you are going to receive but the main thing is to ensure good photos. That means good lighting, wipe creams off your skin, have a neutral background etc. It’s best to ask someone to help you and use the best quality camera you can.

For the video appointments you want a quiet, private space and don’t use a public wi-fi network. Its’s also helpful to prepare a list of questions for your doctor and the plan your session to get the most out of it.

To read more in-depth guides see below:

1.    How to take good photos (of a rash)
2.    How to take good photos (of moles, lumps & bumps)
3.    How to prepare for a Live Video Consultation

Dr James Denny, Consultant Dermatologist

Tips to ensure you find a consultant dermatologist-led service.

This is mainly about research and not being afraid to ask questions.

Unfortunately, there are several services out there that do not use consultant dermatologists and either claim to (falsely) or will simply not advertise it which you should always approach with a high degree of suspicion.

Only consultant dermatologists have adequate training in managing the full range of possible skin conditions. We have seen a lot of services refer to their staff as ‘skin doctors’ or ‘skincare professionals’ – these are not the same thing as a dermatologist as they are not protected titles. Often, they are not even doctors.

The best ways to judge a service on its merit and appropriate use of doctors is to look at two things:

1.    Is the service reviewed by the Care Quality Commission (CQC). If not, steer well away as they are operating without regulation and are effectively cowboys.
2.    Is the doctor on the General Medical Council’s (GMC) ‘Specialist Register’ for Dermatology. If you think you are seeing a dermatologist, before you do always request your doctor’s GMC number. Doctors are legally obliged to provide it and if they are not on the Specialist Register, they are not a qualified dermatologist.

OK, but do we really need teledermatology? Come on, hit me with some numbers.

We desperately do. The amount of skin disease in the UK is at an all-time high and we need to innovate to help treat the population. Here are some of the issues:

There are not many of us…

-    To date, there are only about 650 consultant dermatologists in England and there are about 160 vacant NHS posts.
-    The average is one full time dermatology consultant to every 111,000 people in England.
-    No region in England meets the Royal College of Physicians recommendation on the number needed to serve its population adequately.

Skin issues carry a huge burden of disease and affects massive numbers of people.

-    54% of the population are affected by skin disease each year. This equates to about 40 million people and at any one time, 9.2 - 13.2 million of those affected would benefit from medical care.
-    Approximately 4 million working days are lost annually in the UK due to skin issues.
-    The annual cost of skin disease to the NHS is approximately £2 billion.

Is there anything else you want to add?

Teledermatology is better for our environment. It helps save time, energy, raw materials (such as paper and plastic), and fuel for journeys to a clinic, thereby lowering the health industry’s carbon footprint.

It’s been shown that if every consultant dermatologist in the UK were to substitute just one face-to-face clinic per week to a remote teledermatology clinic it would reduce the UKs carbon footprint enough to save the equivalent of 765 around the world flights.

Other studies have even shown it to decrease carbon emissions by 40–70 times!

Dr James Denny, Consultant Dermatologist 

Find Dr Denny on Instagram here.

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