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DERMATOLOGY PRACTICE DURING COVID-19 PANDEMIC - ORIGINAL ARTICLES
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 20-23

Teledermatology during COVID era: Our experience


Skin, Cosmetic and ENT Care Centre, Bengaluru, Karnataka, India

Date of Submission27-May-2020
Date of Decision05-Jul-2020
Date of Acceptance13-Jul-2020
Date of Web Publication19-Feb-2021

Correspondence Address:
Amrutha N Bangera
Skin, Cosmetic and ENT Care Centre, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_83_20

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  Abstract 


Background: Telemedicine refers to “remote diagnosis and treatment of patients by means of telecommunication technology.” Dermatology has a unique place in telemedicine as a reasonably accurate diagnosis can be established by history, clinical images, and real-time video consultation. Objectives: The aim was to assess the merits and demerits of teleconsultation in the period of lockdown due to COVID-19. Materials and Methods: An analysis of data of teleconsultation done in 84 patients between April 08, 2020 and May 19, 2020 was assessed. Results: The age group of patients ranged from 1 month to 95 years, with a preponderance of females over males. The most common skin condition in the study was eczema, followed by acne, psoriasis, and vitiligo. Among the total 84 patients, three patients were called for in-person consultation to eliminate the margin of error and six patients voluntarily reported for the follow-up to the clinic. Conclusion: Teledermatology during the COVID era safeguards both patients and health-care workers from exposure to the virus. Although faced with several challenges, teleconsultation when judiciously used can be a boon in the diagnosis of dermatological disorders, especially in susceptible individuals.

Keywords: COVID-19, teledermatology, video consultation


How to cite this article:
Doddaballapur SA, Bangera AN, Kaujalgi RV, Dongare AA. Teledermatology during COVID era: Our experience. Clin Dermatol Rev 2021;5:20-3

How to cite this URL:
Doddaballapur SA, Bangera AN, Kaujalgi RV, Dongare AA. Teledermatology during COVID era: Our experience. Clin Dermatol Rev [serial online] 2021 [cited 2021 Sep 20];5:20-3. Available from: https://www.cdriadvlkn.org/text.asp?2021/5/1/20/309777




  Introduction Top


Telemedicine is defined as “the remote diagnosis and treatment of patients by means of telecommunication technology.”[1] Apart from radiology, dermatology has a unique place in telemedicine as the diagnosis can be quite accurately established by history and clinical images transmitted by telecommunication. With the sudden onset of a public health emergency in the form of COVID-19 leading to nationwide lockdown, teledermatology will help in maintaining continuity of care for our patients through technology. Till now, telemedicine was not approved by the Government of India. The Board of Governors in the supersession of the Medical Council of India in partnership with NITI Aayog has now approved and published guidelines[2] for the practice of telemedicine in India in the wake of COVID-19 pandemic (Vide Notice) No. MCI-211 (2)/2019(Ethics)/201858 dated March 25, 2020).

Several state medical councils such as the Karnataka Medical Council, Tamil Nadu Medical Council, Gujarat Medical Council, and Punjab Medical Council have now allowed the practice of telemedicine.

The academy of the Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) has published online consultation guidelines at www.iadvl.org on April 06, 2020,[3] which is an abridged version of the NITI Aayog document, for ready reference. Teledermatology during this period will definitely minimize the infectious transmission of the coronavirus. A descriptive study was conducted at the Skin, Cosmetic and ENT Care Centre to describe the method of teleconsultation and the nature of dermatological conditions for which consultation was sought during the lockdown period.


  Materials and Methods Top


During the lockdown period, due to COVID-19, phone calls made to the Skin, Cosmetic and ENT Care Centre clinic by patients seeking a dermatology consultation were answered by a receptionist. If the caller asked for an alternative choice to consult the doctor, they were explained about the teleconsultation and a disclaimer was conveyed to them at the same time.

Disclaimer

  1. A teleconsult is not intended to replace an in-person consultation, and the medical advice rendered by the doctor is subject solely to his/her professional judgment based on the information provided by the patient; the absence of a physical evaluation may affect his/her assessment/diagnosis and the treatment recommended
  2. There are risks and limitations of a teleconsult, and the patient may benefit from the same, but the results cannot be guaranteed or assured
  3. Teleconsultation will not be offered in an emergency situation where the patient has to immediately approach a nearby hospital
  4. The patient will not hold the doctor, or the clinic/hospital that he/she practices in, responsible for any damage or loss he/she might suffer, whether physical, emotional, psychological, or financial, on account of the teleconsult.


Once the patient agreed, a time for teleconsultation was fixed; detailed history was taken, and patient was told to send the pictures of the skin problem and previous prescriptions if any, on WhatsApp messenger service; the patient paid consultation fees on Google Pay or Paytm payment gateways; the patient or caregiver then did a WhatsApp video consultation following which an e-prescription in pdf format was sent; the records were stored in an encrypted format. Since the patient initiated the consultation, the consent is implied and not taken in writing.[2]


  Results Top


A total of 84 patients teleconsulted in 30 working days between April 08, 2020 and May 19, 2020. Among the callers, 53 patients consulted for themselves and 31 caregivers called on behalf of children and elderly patients. The number of new patients was 49 (58.33%) and follow-ups were 35 (41.67%). About 58.33% (49) of the patients were female and 41.67% (35) were male [Figure 1]. Majority of patients (26) were in the age group of 31–50 years (30.95%). There were ten patients (11.9%) above the age of 70 years and six children (7.14%) below 14 years [Figure 2].
Figure 1: Sex distribution

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Figure 2: Age groups

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The youngest patient was a 1-month-old child and the eldest was 95-year old. Furthermore, there were three lactating women who consulted.

The most common dermatological condition for which patients consulted was eczema (17%–20.24%). This was followed by acne (15%–17.86%), psoriasis (7%–8.33%), vitiligo (6%–7.14%), lichen planus (3%–3.57%), tinea corporis (3%–3.57%), xerosis (3%–3.57%), diffuse hair fall (3%–3.57%), pityriasis versicolor (3%–3.57%), prurigo (3%–3.57%), seborrheic dermatitis/dandruff (2%–2.38%), insect bite (2%–2.38%), balanoposthitis (2%–2.38%), alopecia areata (2%–2.38%), urticaria (2%–2.38%), and scrotal dermatitis (2%–2.38%), as depicted in [Figure 3] and [Table 1]. There was one patient each of melasma, lichen planus pigmentosus, furuncle, fixed drug eruption, allergic vasculitis, photosensitive light eruption, papular urticaria, pemphigus foliaceus, and herpes zoster [Table 1]. The youngest patient of 1 month had neonatal acne. Three patients with a tentative diagnosis of allergic vasculitis, axillary dermatitis, and nummular eczema were called for in-person consultation once the clinic was reopened, to eliminate any margin of error and for further evaluation. However, the diagnosis in these patients was not revised during the face-to-face consultation. Six patients voluntarily reported for follow-ups 2 weeks after online consultation, as they preferred in-person consultation and counseling. However, the diagnosis remained unchanged in these six patients.
Figure 3: Diagnose

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Table 1: Other diagnoses (number of patients)

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  Discussion Top


Teledermatology in the outpatient and inpatient dermatology clinics has been widely practiced in the COVID era.[4],[5],[6],[7],[8],[9],[10],[11],[12] The scope of teledermatology and its current perspective has been reported.[13],[14]

The merits of teledermatology during the COVID era are plenty. The major advantage is that it safeguards both patients and health-care workers from exposure to the virus and thereby reduces the risk of transmission. With lockdown, requiring people to stay at home, lack of public transport, and patients stuck outside the city and state, teledermatology offers access and continuity of care for dermatology patients. Teledermatology takes care of the safety of susceptible individuals such as the elderly, children, pregnant and lactating women, and patients on immunosuppressive and anticancer medication. Even with the relaxation of lockdown, continuation of teleconsultation helps to prevent crowding in clinics, maintain social distancing, and avoiding unnecessary visits.

Dermatology being a “visual” specialty and with advancements in technology, a reasonably accurate diagnosis was established by history, clinical images, and real-time video consultation in 84 patients using WhatsApp messenger service. WhatsApp was preferred by both patient and treating dermatologist due to its widespread usage, encrypted technology, and user friendly nature of the service.

The guidelines for teledermatology as published by NITI Aayog[2] were strictly followed during this study. Out of 84 patients, there was a preponderance of new patients (58.33%) over follow-ups (41.67%). Females outnumbered males, and majority of the patients were in the age group of 31–50 years. The youngest patient was a 1-month-old child with neonatal acne and the eldest was a 95-year-old man with senile purpura. Eczema and acne were the top two conditions diagnosed in the study, followed by psoriasis and vitiligo. Most of the other diseases diagnosed [Table 1] were common conditions encountered in day-to-day practice. Reasonably accurate diagnosis could be established in 81 out of 84 patients (96.43%).

Several challenges and disadvantages of teleconsultations were noticed in this study. An experienced dermatologist is required to make a fairly accurate diagnosis through teledermatology. Expertise is required by the patients and caregivers in taking good-quality pictures with a decent camera phone. High-speed Internet is a prerequisite for a quality video consultation at both the patient's and the doctor's ends. Follow-ups are easier to manage than new patients during a teleconsult. It may not be possible to establish a diagnosis in certain situations which will need an in-clinic visit as was seen in three of our patients.

Inaccessible areas such as the oral cavity, genitals, and covered areas, especially in women cannot be visualized. Some patients may need more detailed examination such as palpation of lesions, lymph nodes, and peripheral nerves and systemic examination. For dermatosurgery and esthetic procedures, patient must visit the clinic. Patients may prefer face-to-face consultation which is time honored and has better scope for counseling, especially in new patients. Data privacy and digital record keeping has to be strictly followed as per the guidelines. Aggregator platforms using business modules can be irksome for both patients and doctors, so it is better to have one's own module.


  Conclusion Top


With government approval for telemedicine in the COVID-19 era, teledermatology forms a useful tool to safeguard patients and doctors from the virus and maintain continuity of treatment. The merits and demerits of teleconsultation are many. Teleconsultation cannot be a substitute for in-clinic consultation. However, judicious use of teleconsultation can be a boon for visually diagnosable skin conditions as established in this study, especially in susceptible individuals. However, it is important to follow guidelines as advocated, including strict maintenance of data privacy and digital record keeping.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chuchvara N, Patel R, Srivastava R, Reilly C, Rao BK. The growth of teledermatology: Expanding to reach the underserved. J Am Acad Dermatol 2020;82:1025-33.  Back to cited text no. 1
    
2.
Telemedicine Practice Guidelines. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Apr 6].  Back to cited text no. 2
    
3.
IADVL Academy: Online Consultation Guidelines. Available from: https://www.iadvl.org. [Last accessed on 2020 Apr 06].  Back to cited text no. 3
    
4.
Ashrafzadeh S, Nambudiri VE. The COVID-19 crisis: A unique opportunity to expand dermatology to underserved populations. J Am Acad Dermatol 2020;83;e83-4.  Back to cited text no. 4
    
5.
Kovarik C, Lee I, Tejasvi T, Lipoff JB. Invited commentary on the letter “The COVID-19 crisis: A unique opportunity to expand dermatology to underserved populations.” J Am Acad Dermatol 2020;83;e85-6.  Back to cited text no. 5
    
6.
Trinidad J, Kroshinsky D, Kaffenberger BH, Rojek NW. Telemedicine for inpatient dermatology consultations in response to the COVID-19 pandemic. J Am Acad Dermatol 2020;83:e69-71.  Back to cited text no. 6
    
7.
Gupta R, Ibraheim MK, Doan HQ. Teledermatology in the wake of COVID-19: Advantages and challenges to continued care in a time of disarray. J Am Acad Dermatol 2020;83:168-9.  Back to cited text no. 7
    
8.
Perkins S, Cohen JM, Nelson CA, Bunick CG. Teledermatology in the era of COVID-19: Experience of an academic department of dermatology. J Am Acad Dermatol 2020;83:e43-4.  Back to cited text no. 8
    
9.
Oldenburg R, Marsch A. Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic. J Am Acad Dermatol 2020;82:e229.  Back to cited text no. 9
    
10.
Price KN, Thiede R, Shi VY, Curiel-Lewandrowski C. Strategic dermatology clinical operations during the coronavirus disease 2019 (COVID-19) pandemic. J Am Acad Dermatol 2020;82:e207-9.  Back to cited text no. 10
    
11.
Lee I, Kovarik C, Tejasvi T, Pizarro M, Lipoff JB. Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation. J Am Acad Dermatol 2020;82:1213-4.  Back to cited text no. 11
    
12.
Pathoulas JT, Stoff BK, Lee KC, Farah RS. Ethical outpatient dermatology care during the coronavirus (COVID-19) pandemic.J Am Acad Dermatol 2020;82:1272-3.  Back to cited text no. 12
    
13.
Thomas J, Kumar P. The scope of teledermatology in India. Indian Dermatol Online J 2013;4:82-9.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Thomas J. Teledermatology: The rule rather than an exception. Lecture presented at IADVL-KT State Conference; 2009..  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Teledermatology During COVID-19: An Updated Review
Morgan A. Farr,Madeleine Duvic,Tejas P. Joshi
American Journal of Clinical Dermatology. 2021;
[Pubmed] | [DOI]



 

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