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Pediatric Teledermatology: a Review

  • Teledermatology (D Oh, Section Editor)
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Abstract

Purpose of Review

Only a small number of dermatologists are also certified in pediatric dermatology by the American Board of Dermatology, creating an access barrier that is amenable to teledermatology. More than 50% of pediatric dermatologists currently practice teledermatology, but there is a dearth of literature validating the collective experience. This article reviews teledermatology terminology and summarizes the recent literature supporting pediatric teledermatology’s diagnostic accuracy, efficacy, usability and cost-effectiveness.

Recent Findings

Diagnoses rendered using pediatric teledermatology share high concordance rates with in-person diagnoses. While most dermatologists prefer store and forward compared to real-time interactive teledermatology, a hybrid model may be advantageous for complex cases. Physician-to-physician teledermatology is ideal for pediatric inpatient and outpatient consultations, while direct-to-patient teledermatology may be more efficient for non-emergent pediatric outpatient visits. Eczema, acne, rashes and birthmarks lend themselves better to teledermatology than do pigmented lesions.

Summary

This article provides summarizes the recent literature addressing the current state of pediatric teledermatology and reviews terminology, care models, pediatric best practices and benefits as well as challenges.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fogel AL, Teng JM. The U.S. Pediatric Dermatology Workforce: An Assessment of Productivity and Practice Patterns. Pediatr Dermatol. 2015;32(6):825–9. doi:https://doi.org/10.1111/pde.12680. This electronic survey of U.S. board-certified pediatric dermatologists shows current practice patterns of academic and private pediatric dermatologists and supports the need to increase patient access in all settings.

  2. Prindaville B, Antaya RJ, Siegfried EC. Pediatric dermatology: past, present, and future. Pediatr Dermatol. 2015;32(1):1–12. https://doi.org/10.1111/pde.12362.

    Article  PubMed  Google Scholar 

  3. Hester EJ, McNealy KM, Kelloff JN, Diaz PH, Weston WL, Morelli JG, et al. Demand outstrips supply of US pediatric dermatologists: results from a national survey. J Am Acad Dermatol. 2004;50(3):431–4. https://doi.org/10.1016/j.jaad.2003.06.009.

    Article  PubMed  Google Scholar 

  4. Tunnessen WW Jr. A survey of skin disorders seen in pediatric general and dermatology clinics. Pediatr Dermatol. 1984;1(3):219–22. https://doi.org/10.1111/j.1525-1470.1984.tb01120.x.

    Article  PubMed  Google Scholar 

  5. Hayden GF. Skin diseases encountered in a pediatric clinic. A one-year prospective study. Am J Dis Child. 1985;139(1):36–8. https://doi.org/10.1001/archpedi.1985.02140030038023.

    Article  CAS  PubMed  Google Scholar 

  6. Krowchuk DP, Bradham DD, Fleischer AB Jr. Dermatologic services provided to children and adolescents by primary care and other physicians in the United States. Pediatr Dermatol. 1994;11(3):199–203. https://doi.org/10.1111/j.1525-1470.1994.tb00586.x.

    Article  CAS  PubMed  Google Scholar 

  7. Uddin S, O'Connor KS, Ashman JJ. Physician office visits by children for well and problem-focused care: United States, 2012. In: NCHS data brief, no 248. National Center for Health Statistics, Hyattsville, MD. 2016.

  8. Pletcher BA, Rimsza ME, Cull WL, Shipman SA, Shugerman RP, O'Connor KG. Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care. J Pediatr. 2010;156(6):1011–5 e1. https://doi.org/10.1016/j.jpeds.2009.12.032.

    Article  PubMed  Google Scholar 

  9. Fogel AL, Teng JM. Pediatric teledermatology: a survey of usage, perspectives, and practice. Pediatr Dermatol. 2015;32(3):363–8. doi:https://doi.org/10.1111/pde.12533. Assessed usage of pediatric teledermatology by survey of 226 board-certified pediatric dermatologists and found that 89% of respondents use pediatric teledermatology.

  10. Whited J. Teledermatology special interest group: summary of the status of teledermatology research. American Telemedicine Association; 2018.

    Google Scholar 

  11. Feigenbaum DF, Boscardin CK, Frieden IJ, Mathes EFD. Can You See Me Now? Video Supplementation for Pediatric Teledermatology Cases. Pediatr Dermatol. 2017;34(5):566–71. doi:https://doi.org/10.1111/pde.13210. Controlled trial which showed that dermatology residents scored higher on management accuracy of complex pediatric dermatology cases when provided with both still images and prerecorded video (mixed teledermatology).

  12. Barbieri JS, Nelson CA, James WD, Margolis DJ, Littman-Quinn R, Kovarik CL, et al. The reliability of teledermatology to triage inpatient dermatology consultations. JAMA Dermatol. 2014;150(4):419–24. https://doi.org/10.1001/jamadermatol.2013.9517.

    Article  PubMed  Google Scholar 

  13. Lasierra N, Alesanco A, Gilaberte Y, Magallon R, Garcia J. Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations. Int J Med Inform. 2012;81(5):332–43. doi:https://doi.org/10.1016/j.ijmedinf.2012.02.008. 3-year summary of a physician-to-physician teledermatology experience in Spain that included 82 pediatric and 28 adult patients and showed high concordance rates for pediatric inflammatory dermatoses but discovered that time (19 minutes per teleconsultation) was a barrier to primary care physician participation.

  14. Chen TS, Goldyne ME, Mathes EF, Frieden IJ, Gilliam AE. Pediatric teledermatology: observations based on 429 consults. J Am Acad Dermatol. 2010;62(1):61–6. doi:https://doi.org/10.1016/j.jaad.2009.05.039. Descriptive retrospective cohort of 429 pediatric physician-to-physician SAF teledermatology consultations which revealed that in 48% of cases the primary care provider and the pediatric teledermatologist agreed on diagnosis but in only 28% of cases did they agree on management.

  15. Karlsson MA, Lindelof B, Wahlgren CF, Wiklund K, Rodvall Y. Mobile teledermatology is a valid method to estimate prevalence of melanocytic naevi in children. Acta Derm Venereol. 2015;95(3):303–6. doi:https://doi.org/10.2340/00015555-1950. Used mobile teledermatology to capture and analyze images of children’s back to estimate the total number of nevi in order to help survey trends in sun exposure.

  16. Heffner VA, Lyon VB, Brousseau DC, Holland KE, Yen K. Store-and-forward teledermatology versus in-person visits: a comparison in pediatric teledermatology clinic. J Am Acad Dermatol. 2009;60(6):956–61. doi:https://doi.org/10.1016/j.jaad.2008.11.026. Enrolled 135 patients at Children’s Hospital of Wisconsin and determined that pediatric dermatologists could effective diagnose rashes based on history and digital images with a diagnostic concordance rate of 82%.

  17. Philp JC, Frieden IJ, Cordoro KM. Pediatric teledermatology consultations: relationship between provided data and diagnosis. Pediatr Dermatol. 2013;30(5):561–7. doi:https://doi.org/10.1111/pde.12180. Retrospective cohort study of 395 cases from UCSF’s SAF pediatric teledermatology service which found that pediatric dermatologists were able to make a diagnosis in the majority of cases even if history and image quality was suboptimal; they hypothesized that both extra photography training and use of standardized templates could be helpful.

  18. Naka F, Makkar H, Lu J. Teledermatology: kids are not just little people. Clin Dermatol. 2017;35(6):594-600. Doi:https://doi.org/10.1016/j.clindermatol.2017.08.009. Highlights the differences between pediatric and adult teledermatology and the need for future pediatric focused research.

  19. Gehris RP. Pediatric Teledermatology: Improving Access in an Academic Children’s Hospital. American Telemedicine Association. 2018. https://www.americantelemed.org/wp-content/themes/ata-custom/download.php?id=1089. Accessed 2020 Jan 15. Summarizes inpatient and emergency room SAF pediatric teledermatology experience of 492 consultations at Children’s Hospital of Pittsburgh and highlights the most common diagnoses, the rapid response times and the potential cost savings of such a program.

  20. Dinulos JG. Pediatric dermatology: past, present and future. Curr Opin Pediatr. 2007;19(4):417–9. https://doi.org/10.1097/MOP.0b013e328220ea39.

    Article  PubMed  Google Scholar 

  21. Champagne T, Rossos PG, Kirk V, Seto E. Impact of an Intrainstitutional Teledermatology service: mixed-methods case study. JMIR Dermatology. 2018;1(2):e11923. https://doi.org/10.2196/11923.

    Article  Google Scholar 

  22. Tollefson MM, Frieden IJ. Early growth of infantile hemangiomas: what parents' photographs tell us. Pediatrics. 2012;130(2):e314-20. Doi:https://doi.org/10.1542/peds.2011-3683. This is one of the earliest reports establishing the utility of parental photos to help pediatric dermatologists monitor skin conditions. in this case infantile hemangiomas.

  23. Bianciardi Valassina MF, Bella S, Murgia F, Carestia A, Prosseda E. Telemedicine in pediatric wound care. Clin Ter. 2016;167(1):e21-3. Doi:https://doi.org/10.7417/T.2016.1915. This study of 19 patients in Rome. Italy is the first to validate the use of SAF direct-to-patient teledermatology to improve the care of pediatric wounds.

  24. O'Connor DM, Jew OS, Perman MJ, Castelo-Soccio LA, Winston FK, McMahon PJ. Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial. JAMA Dermatol. 2017;153(12):1243–8. doi:https://doi.org/10.1001/jamadermatol.2017.4280. Prospective study at Children’s Hospital of Philadelphia that demonstrated a high diagnostic concordance rate of 83–89% between direct-to-patient SAF teledermatology using parental smartphone photos and in-office diagnosis.

  25. Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Research Center. 2016;22:1–44.

    Google Scholar 

  26. Fogel AL, Teng J, Sarin KY. Direct-to-consumer teledermatology services for pediatric patients: room for improvement. J am Acad Dermatol. 2016;75(5):887-8. Doi:https://doi.org/10.1016/j.jaad.2016.08.002. Highlights the important differences between pediatric and adult direct-to-consumer teledermatology and the need for higher standards and specific guidelines for the pediatric patient.

  27. Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med. 2016;375(2):154–61. https://doi.org/10.1056/NEJMra1601705.

    Article  PubMed  Google Scholar 

  28. Fiks AG, Fleisher L, Berrigan L, Sykes E, Mayne SL, Gruver R, et al. Usability, acceptability, and impact of a pediatric Teledermatology Mobile health application. Telemed J E health. 2018;24(3):236-45. Doi:https://doi.org/10.1089/tmj.2017.0075. First study of its kind examining the use of and satisfaction with a direct-to-patient mobile application between families and a single board-certified pediatric dermatologist.

  29. Uscher-Pines L, Mulcahy A, Cowling D, Hunter G, Burns R, Mehrotra A. Access and quality of Care in Direct-to-Consumer Telemedicine. Telemed J E Health. 2016;22(4):282–7. https://doi.org/10.1089/tmj.2015.0079.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Uscher-Pines L, Mulcahy A, Cowling D, Hunter G, Burns R, Mehrotra A. Antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine visits. JAMA Intern Med. 2015;175(7):1234–5. https://doi.org/10.1001/jamainternmed.2015.2024.

    Article  PubMed  Google Scholar 

  31. Chaudhry SB, Armbrecht ES, Shin Y, Matula S, Caffrey C, Varade R et al. Pediatric access to dermatologists: Medicaid versus private insurance. J Am Acad Dermatol. 2013;68(5):738–48. doi:https://doi.org/10.1016/j.jaad.2012.10.034. This secret-shopped telephone survey of 723 dermatologists listed as accepting Medicaid found that 44% refused a new pediatric patient with eczema and highlights the access barrier for these pediatric patients.

  32. Stephens MR, Murthy AS, McMahon PJ. Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic. Pediatr Dermatol. 2019;36(6):893–7. doi:https://doi.org/10.1111/pde.13943. Review of 250 patient records at Children’s Hospital of Philadelphia that demonstrates higher non-attendance rates and increased use of other inappropriate visits to non-dermatologists when wait times to see the pediatric dermatologist were long.

  33. Khorsand K, Sidbury R. The shadow clinic: Emails, "curbsides," and "quick peeks" in pediatric dermatology. Pediatr Dermatol. 2019;36(5):607–10. doi:https://doi.org/10.1111/pde.13854. Summarizes the challenges presented by “curbside consults” in pediatric dermatology and emphasized the need for a more standardized manner to meet help our colleagues that does not increase risk and liability.

  34. Fieleke DR, Edison K, Dyer JA. Pediatric teledermatology--a survey of current use. Pediatr Dermatol. 2008;25(2):158–62. doi:https://doi.org/10.1111/j.1525-1470.2008.00624.x. This 2006 survey of pediatric dermatologists at the Society for Pediatric Dermatology Annual Meeting found that over 50% of respondents practiced some type of usually SAF teledermatology but most were not reimbursed.

  35. Batalla A, Suh-Oh HJ, Abalde T, Salgado-Boquete L, de la Torre C. [Teledermatology in Paediatrics. Observations in daily clinical practice]. An Pediatr (Barc). 2016;84(6):324–30. doi:https://doi.org/10.1016/j.anpedi.2015.07.005.

  36. Warshaw EM, Gravely AA, Nelson DB. Reliability of store and forward teledermatology for skin neoplasms. J Am Acad Dermatol. 2015;72(3):426–35. https://doi.org/10.1016/j.jaad.2014.11.001.

    Article  PubMed  Google Scholar 

  37. Warshaw EM, Lederle FA, Grill JP, Gravely AA, Bangerter AK, Fortier LA, et al. Accuracy of teledermatology for pigmented neoplasms. J Am Acad Dermatol. 2009;61(5):753–65. https://doi.org/10.1016/j.jaad.2009.04.032.

    Article  PubMed  Google Scholar 

  38. Rajda J, Seraly MP, Fernandes J, Niejadlik K, Wei H, Fox K, et al. Impact of direct to consumer store-and-forward Teledermatology on access to care, satisfaction, utilization, and costs in a commercial health plan population. Telemed J E Health. 2018;24(2):166–9. https://doi.org/10.1089/tmj.2017.0078.

    Article  PubMed  Google Scholar 

  39. Bender MS, Choi J, Arai S, Paul SM, Gonzalez P, Fukuoka Y. Digital technology ownership, usage, and factors predicting downloading health apps among caucasian, filipino, korean, and latino americans: the digital link to health survey. JMIR Mhealth Uhealth. 2014;2(4):e43. https://doi.org/10.2196/mhealth.3710.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Holmes AN, Chansky PB, Simpson CL. Teledermatology consultation can optimize treatment of cutaneous disease by nondermatologists in under-resourced clinics. Telemed J E Health. 2019. https://doi.org/10.1089/tmj.2019.0217.

  41. Noda S, Suarez-Farinas M, Ungar B, Kim SJ, de Guzman SC, Xu H, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254–64. https://doi.org/10.1016/j.jaci.2015.08.015.

    Article  CAS  Google Scholar 

  42. Janumpally SR, Feldman SR, Gupta AK, Fleischer AB Jr. In the United States, blacks and Asian/Pacific islanders are more likely than whites to seek medical care for atopic dermatitis. Arch Dermatol. 2002;138(5):634–7. https://doi.org/10.1001/archderm.138.5.634.

    Article  PubMed  Google Scholar 

  43. McKoy K, Antoniotti NM, Armstrong A, Bashshur R, Bernard J, Bernstein D, et al. Practice guidelines for Teledermatology. Telemed J E Health. 2016;22(12):981–90. https://doi.org/10.1089/tmj.2016.0137.

    Article  PubMed  Google Scholar 

  44. Moreno L, Peikes D, Krilla A. Necessary but not sufficient: the HITECH act and health information Technology's potential to build medical homes. Agency for Healthcare Research and Quality: Rockville, MD; 2010.

    Google Scholar 

  45. Resneck JS Jr, Abrouk M, Steuer M, Tam A, Yen A, Lee I, et al. Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease. JAMA Dermatol. 2016;152(7):768–75. https://doi.org/10.1001/jamadermatol.2016.1774.

    Article  PubMed  Google Scholar 

  46. Lacktman NM, Acosta JN, Levine SJ. 50-state survey of Telehealth commercial payer statutes. Foley & Lardner LLP; 2019.

    Google Scholar 

  47. Improving Health Care Interoperability: Are we making Progress? : Center for Connected Medicine; 2019.

    Google Scholar 

  48. Rubin CB, Kovarik CL. The nuts and bolts of teledermatology: preventing fragmented care. J Am Acad Dermatol. 2015;73(5):886–8. https://doi.org/10.1016/j.jaad.2015.06.046.

    Article  PubMed  Google Scholar 

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Correspondence to Robin P. Gehris.

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Robin P. Gehris holds less than 1% stock in Iagnosis, a direct-to-patient teledermatology platform.

Edward I. X. Herman declares no conflicts of interest.

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Gehris, R.P., Herman, E.I.X. Pediatric Teledermatology: a Review. Curr Derm Rep 9, 114–122 (2020). https://doi.org/10.1007/s13671-020-00294-2

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