Teledermatology

=Definition=

Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. [ see http://www.atmeda.org/icot/sigtelederm.htm] In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education. [ Wooton et al. 2005 Roy soc of med press; Wurm et al. 2007 JDDG; Burg et al. 2005 Teledermatology]

The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists. [ Perednia, Brown 1995 Bull Med Libr Assoc ]

Modes of data transmission

Teledermatology (as telemedicine) is practised on the basis of two concepts: Store-and-forward (SAF) and real time/live interactive teledermatology. Hybrid modes also exist (combining SAF and real time applications).

The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment.

In real-time/ live interactive teledermatology applications, provider and individuals usually interact via live videoconferencing. It may also involve remote surgery and the use of telerobotic microscopes in dermatopathology. This mode generally requires more sophisticated and costly technology than used in the SAF mode. Both participants must be available at the same time.

Areas of application

Health care management

Direct consultation involves an individual with a skin condition contacting a dermatologist via telecommunication to request diagnosis and treatment. In this field, mobile applications of teledermatology gain importance.

Telediagnosis in the absence of personal contact with health care workers to the individual is complex. It requires active participation of the individual and without appropriate guidance may lead to improper management. However, as a triage tool, leading the individual directly to the appropriate specialist for his/her disease, it could be very valuable in the near future.

Specialist referral is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication in order to get a second opinion. The specialist then helps the GP in rendering a diagnosis, providing management options et cetera. [ Soyer et al. 2005 PLoS Med ]

Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as crural ulcers. Crural ulcers are a common skin condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. Teledermatology can help to reduce the time and costs involved in the follow up of such conditions. [ Binder et al. 2008, Arch Derm]

(Continuous) education and information

Medical education/continuous education are a major advantage of telemedicine/e-health. Numerous universities offer online courses, computer based training and Web applications in this field principally aimed at medical students. Specialist training courses via internet are also available, particularly in dermoscopy. [ see http://www.medunigraz.at/IDD ]

General medical/health information may be accessed by non-professionals, such as individuals affected by a skin condition, and their relatives, through the internet. They are also able to join peer support groups with others affected by the same condition. [ see http://www.dermnetnz.org ]

Domains with special interest

Teledermoscopy

In teledermoscopy, digital dermoscopic lesion images (with or without clinical images) are transmitted electronically to a specialist for examination.

Dermoscopy (dermatoscopy, epiluminescence microscopy) is the technical field of using an epiluminescence microscope for viewing skin lesions in magnification in-vivo. It is particularly useful in the early detection of malignant skin lesions (i.e., melanoma). Digital dermoscopic images can be taken with a digital camera attached to a dermatoscope or special video cameras suited for dermoscopy. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology.

Teledermatopathology

Teledermatopathology is the transmission of dermatopathologic images.

Mobile Teledermatology

Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor, for instance) uses wireless or mobile equipment (i.e. mobile phones, handheld devices).

Itemization

Bibliography

* R Wootton R, Oakley A: Teledermatology. Royal Society of Medicine Press Ltd, 2002

* Burg G, Soyer H.P, Chimenti S. (2005): Teledermatology In: Frisch P, Burgdorf W.: EDF White Book, Skin Diseases in Europe. Berlin, 130-133

* Perednia DA, Brown NA.: Teledermatology: one application of telemedicine. Bull Med Libr Assoc. 1995; 83(1): 42–47

* Wurm EM, Hofmann-Wellenhof R, Wurm R, Soyer HP.: Telemedizin und Teledermatologie: Vergangenheit Gegenwart und Zukunft. JDDG 6:106-12, 2007

* Soyer HP,Hofmann-Wellenhof R,Massone C,Gabler G, Dong H, Fezal Ozdemir F, Argenziano G: telederm.org: Freely Available Online Consultations in Dermatology. PLoS Med 2005, 2(4): e87

* Binder B, Hofmann-Wellenhof R, Salmhofer W, Okcu A, Kerl H, Soyer HP.:Arch Dermatol. 2007 Dec;143(12):1511-4. Teledermatological monitoring of leg ulcers in cooperation with home care nurses.