Teledermatology for diagnosis and management of skin conditions: A systematic review

Erin M. Warshaw, Yonatan J. Hillman, Nancy L. Greer, Emily M. Hagel, Roderick MacDonald, Indulis R. Rutks, Timothy J. Wilt

Research output: Contribution to journalReview articlepeer-review

161 Scopus citations

Abstract

Objective: We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs. Methods: Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches. Results: Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met. Limitations: Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data. Conclusion: The benefits of teledermatology need to be evaluated in the context of potential limitations.

Original languageEnglish (US)
Pages (from-to)759-772.e21
JournalJournal of the American Academy of Dermatology
Volume64
Issue number4
DOIs
StatePublished - Apr 2011

Keywords

  • clinical outcomes
  • diagnostic accuracy
  • diagnostic concordance
  • live interactive
  • management accuracy
  • management concordance
  • store and forward
  • teledermatology

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