Teledermatology: Clearly Superior

Traffic is beyond brutal around the University of Southern California’s Keck School of Medicine. So when dermatologists at Keck offered psoriasis patients a chance to be treated remotely, there were plenty of volunteers.

Keck researchers found that patients treated via telehealth had the same or slightly better outcomes as those making in-person visits. The USC study involved asynchronous (or store-and-forward) telehealth treatment where either the patient or a primary care physician (PCP) took a photograph of the affected skin, then uploaded the image to a secure site for review by a dermatologist.

Most primary care docs don’t understand all the nuances of psoriasis, and for years they’ve referred patients to specialists, clogging the system with a lot of unnecessary visits. The key to making teledermatology successful is to use high-resolution graphics so that the specialist can get a detailed look. As one PCP cracked, “You can’t do that with an iPhone.”

A recent RAND Institute study found that teledermatology dramatically increases access for patients who don’t typically see doctors for skin conditions, including many Medicaid patients. For example, a Medi-Cal patient in Simi Valley, California is unlikely to make a two-hour car trip to USC to see a skin specialist. With telehealth, the patient can go to a local physician and get connected to the same expert care.

The proliferation of TV ads for drugs that treat plaque psoriasis suggests that many skin patients are being encouraged to “ask your doctor whether [X prescription] is right for you.” That’s probably not the most effective way to treat this chronic condition, which has a number of complicated co-morbidities.

Teledermatology relieves the primary care physician of the responsibility of making the wrong call about serious skin ailments. It’s well known that stress can make these conditions worse, so eliminating a long drive may be just what the doctor ordered.