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 Table of Contents  
DERMATOLOGY PRACTICE DURING COVID-19 PANDEMIC - LETTER TO EDITOR
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 34-35

COVID-19: A wake-up call for teledermatology in India


1 Department of Dermatology, Dr. Shenoy's CARE Hospital, Kochi, Kerala, India
2 Department of Dermatology, Military Hospital, Dimapur, Nagaland, India
3 Department of Dermatology, Government Victoria (Women and Child) Hospital, Kollam, Kerala, India

Date of Submission31-May-2020
Date of Decision13-Jul-2020
Date of Acceptance18-Jul-2020
Date of Web Publication19-Feb-2021

Correspondence Address:
V Sandeep Lal
Shangrila, Bodhi Nagar 131, Thattamala, Kollam - 691 020, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_84_20

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How to cite this article:
Aarya S, Janney MS, Lal V S. COVID-19: A wake-up call for teledermatology in India. Clin Dermatol Rev 2021;5:34-5

How to cite this URL:
Aarya S, Janney MS, Lal V S. COVID-19: A wake-up call for teledermatology in India. Clin Dermatol Rev [serial online] 2021 [cited 2021 Apr 18];5:34-5. Available from: https://www.cdriadvlkn.org/text.asp?2021/5/1/34/309778



Sir,

Coronavirus disease (COVID-19) is an alarming on-going pandemic caused by novel severe acute respiratory syndrome coronavirus 2. It has become a significant pathogen causing emergency respiratory disease outbreak, which spreads by droplet infection while infected patient sneezes or coughs and also by aerosol transmission in closed spaces through microdroplets. Studies show that non-pharmacological interventions such as social distancing, handwashing, closure of crowded places, and restriction of travel will reduce the impact of COVID-19.[1] While the world is restrained due to COVID-19 and its impacts on the health-care system, teledermatology emerges as an effective alternative to conventional consultation.

Initially, the idea of telemedicine was published in a Radio News Magazine as a cover story-”The Radio Doctor-May be” and also envisioned by Dr Gernsbak as teledactyl.[2] Over the years, it has evolved into a cost-effective, easily accessible, patient friendly system of practice. Teledermatology refers to delivery of services by dermatologists on a virtual platform using information and communication technology (ICT) to exchange valid information for diagnosis, treatment, follow-up, research, prevention, and education, where distance is a critical factor.

The basic requirement for teledermatology is appropriate use of ICT at the originating site (patient end) and the distant site (dermatologist) through high speed uninterrupted internet.[3] Although it is ideal to connect to patients on trusted telemedicine platforms where the data is safely stored and easily retrieved for future references, modern applications such as WhatsApp, Facebook messenger, and Google meet have revolutionized how individuals communicate with each other and can also be utilized effectively for teledermatology by the common man.

Various models of teledermatology are being successfully practiced by dermatologists worldwide. A live interactive video-based consultation helps the dermatologist to elicit history better. “Store and forward” technique enables the dermatologist to respond at convenience and facilitates in storing electronic medical records. Most of the dermatologists prefer hybrid technique wherein the clinical images and a brief history is sent by patients initially which is later followed by a video consultation.[4]

In teledermatology, the patient consent is implied when a patient seeks consult. However, if the dermatologist intends to use the data for discussion on social websites/research, written consent has to be obtained. The dermatologist is responsible to protect patient's privacy and confidentiality and would be required to abide by the codes of professional conduct, etiquette, and ethics laid down by local regulatory authorities. Model consent and case record forms for teledermatology consultations are available on the official website of IADVL.[5],[6] One should verify patient's identity before starting a consultation and it is mandatory for the dermatologist to disclose his identity and registration number in prescriptions. During tele-assessment, if treating dermatologist feels a direct examination is required in patient's best interest, it has to be conveyed to the patient. It is not safe to prescribe medicines with serious adverse effects, abuse potential, and those requiring continuous monitoring. Furthermore, medicines listed in Schedule X of Drug and Cosmetic Act, 1940 and Rules (1945) or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985 should not be prescribed through teleconsultations. In the recent “Telemedicine Practice Guidelines” by the Board of Governors of Medical Council of India on March 25, 2020, a detailed directive to practice telemedicine is elaborated.[7] These guidelines give freedom to both practitioner and patient to discontinue with the teleconsultation at any time. It also gives liberty to practitioners to choose whether or not to offer consultations at odd hours.

Several common dermatoses such as acne, dermatophytosis, androgenetic alopecia, eczema, psoriasis, lichen planus, vitiligo, warts, and molluscum contagiosum can be easily diagnosed through teledermatology as dermatological diagnosis mainly relies on visual cues. Many studies depicted that the diagnostic accuracy (DA) varies from 54% to 88% while comparing face to face consultation and teledermatology.[8] The inconsistency of DA in different studies might be due to lack of uniformity in methodology, nonstandardisation of camera quality or resolution, inter-observer error and lack of training and expertise. Hence, advances in image quality, dermoscopy, utilisation of best telemedicine apps in market and incorporation of 3D-image app in mobile phones can improve DA to a great extent.

Teledermatology offers qualified specialist services to common man and with easy accessibility and awareness amongst the public, quackery in dermatology can be brought down. In the COVID era, it saves time, helps avoid frequent hospital visits for follow-ups and is also cost-effective. It indirectly improves compliance rate of patients as scheduling an online consult at convenience is considered hassle free. This interface can be used to train and evaluate residents, seek advice from experts across the borders to manage difficult cases and to educate health-care providers in periphery. However, minor technical glitches, slow internet speed, poor quality of images, data security, and payment of fees are some of the areas of teledermatology that need streamlining.

Teledermatology is an evolving domain and is soon anticipated to be included in the training curriculum. Teledermatology-aided dermatopathology and dermatosurgeries are also being envisaged. It offers quality dermatology care while maintaining the social norms of distancing in the prevailing pandemic era. Hence, it would not be an exaggeration to conclude that teledermatology is the future of dermatology practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prem K, Liu Y, Russell TW, Kucharski AJ, Eggo RM, Davies N, et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: A modelling study. Lancet Public Health 2020;5:e261-e270.  Back to cited text no. 1
    
2.
Lee JJ, English JC 3rd. Teledermatology: A review and update. Am J Clin Dermatol 2018;19:253-60.  Back to cited text no. 2
    
3.
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. 3
    
4.
World Health Organization, editor. Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth (Global Observatory for eHealth Series). Geneva, Switzerland: World Health Organization; 2010. p. 93.  Back to cited text no. 4
    
5.
Teledermatology Case Record Form. Available form: https://www.iadvl.org/announcements.php?AnnouncementId=5ed3a6d89f2d292bc3618a54. [Last accessed on 2020 Jul 14].  Back to cited text no. 5
    
6.
Teledermatology Consent Form. Available form: https://www.iadvl.org/announcements.php?AnnouncementId=5ed3a6d89f2d292bc3618a54. [Last accessed on 2020 Jul 14].  Back to cited text no. 6
    
7.
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare using Telemedicine. Available form: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Jun 2].  Back to cited text no. 7
    
8.
Kanthraj GR. A longitudinal study of consistency in diagnostic accuracy of teledermatology tools. Indian J Dermatol Venereol Leprol 2013;79:668-78.  Back to cited text no. 8
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