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Treating Skin Problems Remotely: What to Know About Teledermatology

If you’re among the millions of Americans asked to stay home during the COVID-19 pandemic and you’re having an active skin problem - or need care or medicine for a chronic condition, you may be concerned about getting the care you need. Your dermatologist’s office may be temporarily closed or may be restricting appointments to emergencies. Or perhaps you just aren’t comfortable going to the doctor’s office during the current health crisis. Thankfully, there’s another option that’s becoming increasingly available: teledermatology, a personalized, real-time video conference with your dermatologist.An increasing number of dermatologists nationwide have started offering virtual appointments to help their patients during the COVID-19 crisis. This is partly because many of us feel a responsibility to continue caring for our patients in whatever way we can - even if it’s through a smartphone or computer screen. 
If you’re interested in a virtual visit with your dermatologist, here are several key points to keep in mind.
  • Call your dermatologist’s office or check their website to see if they’re offering teledermatology. If they’re not yet, keep checking; unfortunately, the pandemic isn’t likely to end quickly, so they may begin online appointments soon. 
  • Yes, it is necessary to schedule an appointment. Typically, your dermatologist will contact you at your designated appointment time.
  • Most teledermatology visits don't require you to be particularly tech-savvy. Many doctors will contact you directly on your smart phone or through your email, and can help guide and connect with you at the click of a button.  
  • You do need to have a camera enabled on your device. By definition, a regular phone call is not teledermatology - your doctor needs to be able to see your skin so that they can discuss their findings and make treatment recommendations.
  • Know that teledermatology visits are usually billed to insurance, just like regular office visits. That means copays apply, and the cost of the encounter may go toward your deductible, if you have one.
  • Make sure you’re in a quiet, well-lit space for your appointment, and wear loose clothing if you have a particular spot that needs evaluation - don’t, say, take the call while sitting in your car, bundled up in a coat, with the stereo blaring.
  • Maintain reasonable expectations, since online visits have limitations. Dermatologists often need to see, feel, and study your skin up close, ideally with the assistance of a dermatoscope (a handheld tool that increases diagnostic accuracy). A clear diagnosis often cannot be made when your doctor’s squinting at a fuzzy image on a computer screen. That's why, at the end of your virtual visit, your dermatologist may suggest an in-person visit to evaluate a spot, consider a biopsy or provide treatment.
  • Skin issues that are well suited to virtual dermatology include acne, rosacea, psoriasis, eczema, mild skin rashes, checks of 1-3 individual spots of concern, and routine visits for medication refills.
  • Concerns that are not well-suited to virtual dermatology include full skin exams (they simply are not possible), complicated rashes and conditions that require up-close evaluation or skin biopsies, and examination of multiple moles or small skin lesions.
  • Pictures are worth a thousand words, and to a dermatologist, they are actually much more helpful than video for accurately diagnosing skin lesions and rashes. Your doctor can help you more efficiently if you send or upload any photos of your spots, rash, or concern before your virtual appointment. 
  • While your doctor remains committed to patient privacy, it’s important to know that not all teledermatology platforms strictly adhere to patient privacy laws (HIPAA). For the pandemic, the government has temporarily eased restrictions on privacy rules to allow more patients and physicians to connect virtually. Currently-acceptable channels include Google hangouts, Skype, Facebook messenger, FaceTime, and more. A number of teledermatology platforms are secure and HIPAA compliant, however; these include doxy.me, Epic, Azova, Medweb, Epic, and Zoom for Healthcare. If you have specific concerns about privacy, be sure to ask your dermatologist’s office what platform they are using for teledermatology and whether it’s HIPAA-compliant. 
Finally, if you don’t have a dermatologist, but are looking for an online consultation, be aware that not all online or virtual appointments are staffed by a board-certified dermatologist (even if “dermatology” is in the name of the app or website). Some sites rely on nurse practitioners, physician assistants, or other healthcare providers whose level of dermatologic education may vary. Dermio.com and DirectDerm.com are among web sites staffed by board-certified dermatologists, who have completed and passed the board-certification exam and 3+ years of intensive, dermatology-only training after medical school and internship.  
From; Web MD