Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise | Dermatology | JAMA Dermatology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Schofield  JK, Fleming  D, Grindlay  D, Williams  H.  Skin conditions are the commonest new reason people present to general practitioners in England and Wales.  Br J Dermatol. 2011;165(5):1044-1050.PubMedGoogle ScholarCrossref
Kramkimel  N, Soussan  V, Beauchet  A,  et al.  High frequency, diversity and severity of skin diseases in a paediatric emergency department.  J Eur Acad Dermatol Venereol. 2010;24(12):1468-1475.PubMedGoogle ScholarCrossref
Shivaram  V, Christoph  RA, Hayden  GF.  Skin disorders encountered in a pediatric emergency department.  Pediatr Emerg Care. 1993;9(4):202-204.PubMedGoogle ScholarCrossref
Wang  E, Lim  BL, Than  KY.  Dermatological conditions presenting at an emergency department in Singapore  . Singapore Med J. 2009;50(9):881-884.PubMedGoogle Scholar
Jack  AR, Spence  AA, Nichols  BJ,  et al.  Cutaneous conditions leading to dermatology consultations in the emergency department.  West J Emerg Med. 2011;12(4):551-555.PubMedGoogle ScholarCrossref
Federman  DG, Concato  J, Kirsner  RS.  Comparison of dermatologic diagnoses by primary care practitioners and dermatologists: a review of the literature.  Arch Fam Med. 1999;8(2):170-172.PubMedGoogle ScholarCrossref
Warshaw  EM, Hillman  YJ, Greer  NL,  et al.  Teledermatology for diagnosis and management of skin conditions: a systematic review.  J Am Acad Dermatol. 2011;64(4):759-772.PubMedGoogle ScholarCrossref
Muir  J, Xu  C, Paul  S,  et al.  Incorporating teledermatology into emergency medicine.  Emerg Med Australas. 2011;23(5):562-568.PubMedGoogle ScholarCrossref
Lamel  S, Chambers  CJ, Ratnarathorn  M, Armstrong  AW.  Impact of live interactive teledermatology on diagnosis, disease management, and clinical outcomes.  Arch Dermatol. 2012;148(1):61-65.PubMedGoogle ScholarCrossref
Lasierra  N, Alesanco  A, Gilaberte  Y, Magallón  R, García  J.  Lessons learned after a three-year store and forward teledermatology experience using internet: strengths and limitations.  Int J Med Inform. 2012;81(5):332-343.PubMedGoogle ScholarCrossref
Berghout  RM, Eminović  N, de Keizer  NF, Birnie  E.  Evaluation of general practitioner’s time investment during a store-and-forward teledermatology consultation.  Int J Med Inform. 2007;76(suppl 3):S384-S391.PubMedGoogle ScholarCrossref
Braun  RP, Vecchietti  JL, Thomas  L,  et al.  Telemedical wound care using a new generation of mobile telephones: a feasibility study.  Arch Dermatol. 2005;141(2):254-258.PubMedGoogle ScholarCrossref
Chung  P, Yu  T, Scheinfeld  N.  Using cellphones for teledermatology, a preliminary study.  Dermatol Online J. 2007;13(3):2.PubMedGoogle Scholar
Ebner  C, Wurm  EM, Binder  B,  et al.  Mobile teledermatology: a feasibility study of 58 subjects using mobile phones.  J Telemed Telecare. 2008;14(1):2-7.PubMedGoogle ScholarCrossref
Lamel  SA, Haldeman  KM, Ely  H, Kovarik  CL, Pak  H, Armstrong  AW.  Application of mobile teledermatology for skin cancer screening.  J Am Acad Dermatol. 2012;67(4):576-581.PubMedGoogle ScholarCrossref
Eminović  N, de Keizer  NF, Wyatt  JC,  et al.  Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial.  Arch Dermatol. 2009;145(5):558-564.PubMedGoogle ScholarCrossref
van der Heijden  JP, de Keizer  NF, Bos  JD, Spuls  PI, Witkamp  L.  Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.  Br J Dermatol. 2011;165(5):1058-1065.PubMedGoogle ScholarCrossref
Eminović  N, Dijkgraaf  MG, Berghout  RM, Prins  AH, Bindels  PJ, de Keizer  NF.  A cost minimisation analysis in teledermatology: model-based approach.  BMC Health Serv Res. 2010;10:251. doi:10.1186/1472-6963-10-251.PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Comment: Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise
    Monika Janda (1), Anna Finnane (2), H Peter Soyer (2). | (1) School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (2) Dermatology Research Centre, The University of Queensland, Scho
    We read with interest the article Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise by Duong et al. (1) who found that dermatology remote consultation confirmed 31% of the diagnosis, and changed, enlarged or clarified the dermatological diagnosis by emergency department physicians in 35%, 14%, and 18% of cases, respectively. They found that videoconferencing rather than discussing a still image improved the diagnostic performance in 57 of 83 cases (however only 83 of the 111 consultations also proceeded to videoconferencing). Videoconferencing may be beneficial, but is often not feasible as it lengthens the time of consultations, and has many technological challenges, both when used to aid communication between two doctors (2), or patients and doctors (3). Similar in the present study, unreachable network, poor image quality, and patients’ impatience were reasons for 25% of patients not continuing with the videoconferencing. Store and forward methods are much more likely to succeed, but need optimal picture quality and sufficient information about the condition history to be accurate (4). Could Duong et al comment on the picture quality in their study? We recently conducted an audit of 167 store and forward teledermatological consultations to emergency departments in Queensland, Australia, during the year of 2012 (5). The main referring condition was rash (65%), followed by skin lesions (13%), and we were able to provide a telediagnosis for 56% of cases within 3 hours. Our teledermatological diagnosis consisted of dermatitis/eczema, infection and drug eruption in 23%, 20%, and 17% of cases, respectively. Most of the doctors requesting a teledermatology were recent graduates, 85% were seeking assistance with obtaining, 35% confirmation of diagnosis. Duong et al. estimate that teledermatologists consultation saved some patients from hospital admission, and cost savings which could contribute to funding teleconsultations. Adequate compensation for consultant teledermatologists is a major issue holding back teledermatology (6). In Australia, current Medicare reimbursement items reimburse real-time videoconferencing, a proposal for store and forward dermatology is pending (7). Store and forward teledermatology could be particularly beneficial for rural and remote patients, who currently do not have access to specialist dermatology services to the same degree as urban residents (3).References1. Duong TA, Cordoliani F, Julliard C, et al. Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise. JAMA Dermatol. 2014.2. Chao JT 2nd, Loescher LJ, Soyer HP, Curiel-Lewandrowski C. Barriers to mobile teledermoscopy in primary care. J Am Acad Dermatol. 2013;69(5):821-824.3. Consumers Health Forum of Australia. Our Health, Our Community 2014. http://ourhealth.org.au/ Accessed May 20, 2014.4. Janda M, Loescher LJ, Banan P, Horsham C, Soyer HP. Lesion Selection by Melanoma High-Risk Consumers During Skin Self-examination Using Mobile Teledermoscopy. JAMA Dermatol. 2014.5. Biscak TM, Biscak TM, Eley R, Manoharan S, Sinnott M, Soyer HP. Audit of a state-wide store and forward teledermatology service in Australia. J Telemed Telecare. 2013;19(7):362-366.6. Lozzi, G.P, Soyer HP, Massone C, et al. The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases: a best practice model in dermatology? J Eur Acad Dermatol Venereol. 2007;21(1):30-34.7. Australian Government, Department of Health. Consultation Protocol to guide the assessment of asynchronous specialist dermatology services delivered by telecommunications. 2014. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1360. Accessed May 20, 2014.
    CONFLICT OF INTEREST: HP Soyer is a shareholder of E-derm Consult GmbH and MoleMap by Dermatologists Ltd.
    Original Investigation
    July 2014

    Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise

    Author Affiliations
    • 1Department of Dermatology, Hôpital Henri Mondor, AP-HP, Créteil, France
    • 2Department of Design Engineering, Ecole Centrale Paris, Chatenay-Malabry, France
    • 3Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France
    • 4Emergency Department, Hôpital Jean Verdier, Bondy, France
    • 5Emergency Department, Hôpital Louis Mourier, AP-HP, Colombes, France
    • 6Emergency Department, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France
    • 7Emergency Department, Hôpital Saint Antoine, AP-HP, Paris, France
    JAMA Dermatol. 2014;150(7):743-747. doi:10.1001/jamadermatol.2013.7792

    Importance  Skin conditions are a common reason for patients to consult emergency department (ED) physicians.

    Objective  To evaluate real-time teledermatologic expertise with the use of mobile telephones for the diagnosis and management of skin conditions in patients seen in the ED.

    Design, Setting, and Participants  This observational study of adults who consecutively consulted in the ED for a dermatologic condition was conducted under routine conditions in the ED from May 1, 2008, through June 30, 2010.

    Main Outcomes and Measures  Diagnosis agreement and management concordance.

    Results  One hundred eleven patients were enrolled in the study. Eighty-three patients (74.8%) were evaluated using videoconferencing. Dermatologic remote expertise invalidated, enlarged, or clarified ED physicians’ diagnosis and management in 75 of 110 cases (68.2%). Videoconferencing improved the diagnostic performance in 57 of 83 cases (68.7%) (P < 10−4). Management concordance was moderate between ED physicians and dermatologists for specialist consultation within 24 hours (κ, 0.49; 95% CI, 0.14-0.84) and immediate hospitalization (κ, 0.49; 95% CI, 0.41-0.57). Patients were significantly more often discharged by dermatologists (46.8% vs 39.1%) (P < 10−4).

    Conclusions and Relevance  Compared with standard hardware, new-generation mobile devices reduce the cost of videoconferencing, increase the versatility of teledermatology, and decrease general practitioner investment time.