Objective: To examine a still-image store-and-forward teledermatology system for use in the care of nursing home residents. Design: Diagnosis and treatment plans made from a tele-dermatology system were compared with those made from an on-site dermatology consultation. Setting: This study involved the dermatologic care of nursing home residents. Patients: Dermatologic consultations sent to the senior author's office from the participating nursing home were eligible for the study. In a consecutive manner, 29 residents with a total of 30 skin conditions were enrolled. Intervention: A nurse collected and sent the histories and images using the teledermatology system. A diagnosis and treatment plan was determined by examining a transmitted still image and patient history alone and in combination by 2 to 3 dermatologists independently. An independent dermatologist made an on-site dermatologic consultation within 2 days after the images had been collected. Main Outcome Measurement: The diagnosis and treatment plans made from the teledermatology system were compared with those made by the on-site dermatologist. Results: Twenty-nine patients with 30 skin conditions were enrolled in the study. Correct diagnoses were made for 60 (67%) of 90, 51 (85%) of 60, and 53 (88%) of 60 patients given the history alone, image alone, and both, respectively. The correct treatment plan was seen in 63 (70%) of 90, 52 (87%) of 60, and 54 (90%) of 60 patients given the history alone, image alone, and both, respectively. No incorrect diagnoses or treatment plans would have given rise to substantial morbidity. The dermatologists felt comfortable in making a diagnosis and treatment plan in all cases in which they had access to both the image and patient history. Conclusions: This study provides evidence that nursing home teledermatology consults may replace some on-site consultations by offering quality care in a cost-effective manner.