American Journal of Clinical Dermatology

, Volume 19, Issue 2, pp 253–260 | Cite as

Teledermatology: A Review and Update

  • Jonathan J. Lee
  • Joseph C. EnglishIII
Review Article


Telemedicine is slowly transforming the way in which healthcare is delivered and has the potential to improve access to subspecialty expertise, reduce healthcare costs, and improve the overall quality of care. While many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, dermatology is particularly suited for this care system as skin disorders are uniquely visible to the human eye. Through teledermatology, diagnostic images of skin disorders with accompanying clinical histories can be remotely reviewed by teledermatologists by any number of modalities, such as photographic clinical images or live video teleconferencing. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve. In this review, we examine the history, evidence, and administrative landscape surrounding teledermatology and discuss current practice guidelines and ongoing controversies.


Compliance with Ethical Standards

Conflict of interest

JJL and JCE have no conflicts of interest that are directly relevant to the content of this manuscript.


No sources of funding were used to conduct this study or prepare this manuscript.


  1. 1.
    Porter DP, Porter R. Patient’s progress: doctors and doctoring in eighteenth-century England. Cambridge: Polity Press and Basil Blackwell; 1989.Google Scholar
  2. 2.
    Einthoven W. Le télécardiogramme. Archives Internationales de Physiologie. 1906;4(2):132–64.Google Scholar
  3. 3.
    Brown SG. A telephone relay. J Inst Electr Eng. 1910;45:590–601.Google Scholar
  4. 4.
    Gershon-Cohen J, Cooley AG. Telognosis. Radiology. 1950;55(4):582–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Thrall JH. Teleradiology. Part I. History and clinical applications. Radiology. 2007;243(3):613–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Mullick FG, Fontelo P, Pemble C. Telemedicine and telepathology at the Armed Forces Institute of Pathology: history and current mission. Telemed J. 1996;2(3):187–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Vidmar DA. The history of teledermatology in the Department of Defense. Dermatol Clin. 1999;17(1):113–24 (ix).CrossRefPubMedGoogle Scholar
  8. 8.
    Rosenbaum BE, Campion CH, Cohen JM, Latkowski JA. The Department of Defense: pioneers of early teledermatology. Dermatol Online J. 2017;23(2).Google Scholar
  9. 9.
    Perednia DA, Brown NA. Teledermatology: one application of telemedicine. Bull Med Libr Assoc. 1995;83(1):42–7.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Brewer AC, Endly DC, Henley J, Amir M, Sampson BP, Moreau JF, Dellavalle RP. Mobile applications in dermatology. JAMA Dermatol. 2013;149(11):1300–4. doi: 10.1001/jamadermatol.2013.5517.CrossRefPubMedGoogle Scholar
  11. 11.
    Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: history, rationale, and current practice. J Am Acad Dermatol. 2015;72(4):563–74 (quiz 575–566).CrossRefPubMedGoogle Scholar
  12. 12.
    The World Bank. Mobile cellular subscriptions (per 100 people). 2015. Accessed 29 May 2017.
  13. 13.
    Edison KE, Ward DS, Dyer JA, Lane W, Chance L, Hicks LL. Diagnosis, diagnostic confidence, and management concordance in live-interactive and store-and-forward teledermatology compared to in-person examination. Telemed J E Health. 2008;14(9):889–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Lim AC, Egerton IB, See A, Shumack SP. Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George Teledermatology Project. Australas J Dermatol. 2001;42(4):247–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Pak HS, Welch M, Poropatich R. Web-based teledermatology consult system: preliminary results from the first 100 cases. Stud Health Technol Inform. 1999;64:179–84.PubMedGoogle Scholar
  16. 16.
    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):61–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Kvedar JC, Edwards RA, Menn ER, et al. The substitution of digital images for dermatologic physical examination. Arch Dermatol. 1997;133(2):161–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Zelickson BD, Homan L. Teledermatology in the nursing home. Arch Dermatol. 1997;133(2):171–4.CrossRefPubMedGoogle Scholar
  19. 19.
    High WA, Houston MS, Calobrisi SD, Drage LA, McEvoy MT. Assessment of the accuracy of low-cost store-and-forward teledermatology consultation. J Am Acad Dermatol. 2000;42(5 Pt 1):776–83.CrossRefPubMedGoogle Scholar
  20. 20.
    Whited JD, Hall RP, Simel DL, et al. Reliability and accuracy of dermatologists’ clinic-based and digital image consultations. J Am Acad Dermatol. 1999;41(5 Pt 1):693–702.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    Warshaw EM, Gravely AA, Nelson DB. Reliability of store and forward teledermatology for skin neoplasms. J Am Acad Dermatol. 2015;72(3):426–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Gilmour E, Campbell SM, Loane MA, et al. Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study. Br J Dermatol. 1998;139(1):81–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Lowitt MH, Kessler II, Kauffman CL, Hooper FJ, Siegel E, Burnett JW. Teledermatology and in-person examinations: a comparison of patient and physician perceptions and diagnostic agreement. Arch Dermatol. 1998;134(4):471–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Nami N, Massone C, Rubegni P, Cevenini G, Fimiani M, Hofmann-Wellenhof R. Concordance and time estimation of store-and-forward mobile teledermatology compared to classical face-to-face consultation. Acta Derm Venereol. 2015;95(1):35–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Mahendran R, Goodfield MJ, Sheehan-Dare RA. An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management. Clin Exp Dermatol. 2005;30(3):209–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Oakley AM, Reeves F, Bennett J, Holmes SH, Wickham H. Diagnostic value of written referral and/or images for skin lesions. J Telemed Telecare. 2006;12(3):151–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Krupinski EA, LeSueur B, Ellsworth L, et al. Diagnostic accuracy and image quality using a digital camera for teledermatology. Telemed J. 1999;5(3):257–63.CrossRefPubMedGoogle Scholar
  29. 29.
    Moreno-Ramirez D, Ferrandiz L, Bernal AP, Duran RC, Martin JJ, Camacho F. Teledermatology as a filtering system in pigmented lesion clinics. J Telemed Telecare. 2005;11(6):298–303.CrossRefPubMedGoogle Scholar
  30. 30.
    Rios-Yuil JM. Correlation between face-to-face assessment and telemedicine for the diagnosis of skin disease in case conferences. Actas Dermosifiliogr. 2012;103(2):138–43.CrossRefPubMedGoogle Scholar
  31. 31.
    Lozzi GP, 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):30–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Warshaw EM, Lederle FA, Grill JP, et al. Accuracy of teledermatology for nonpigmented neoplasms. J Am Acad Dermatol. 2009;60(4):579–88.CrossRefPubMedGoogle Scholar
  33. 33.
    Warshaw EM, Lederle FA, Grill JP, et al. Accuracy of teledermatology for pigmented neoplasms. J Am Acad Dermatol. 2009;61(5):753–65.CrossRefPubMedGoogle Scholar
  34. 34.
    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):576–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Rubegni P, Nami N, Cevenini G, et al. Geriatric teledermatology: store-and-forward vs. face-to-face examination. J Eur Acad Dermatol Venereol. 2011;25(11):1334–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Romero G, Sanchez P, Garcia M, Cortina P, Vera E, Garrido JA. Randomized controlled trial comparing store-and-forward teledermatology alone and in combination with web-camera videoconferencing. Clin Exp Dermatol. 2010;35(3):311–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Pak HS, Harden D, Cruess D, Welch ML, Poropatich R, National Capital Area Teledermatology Consortium. Teledermatology: an intraobserver diagnostic correlation study, Part II. Cutis. 2003;71(6):476–80.PubMedGoogle Scholar
  38. 38.
    Shapiro M, James WD, Kessler R, et al. Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology. Arch Dermatol. 2004;140(5):525–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Whited JD, Mills BJ, Hall RP, Drugge RJ, Grichnik JM, Simel DL. A pilot trial of digital imaging in skin cancer. J Telemed Telecare. 1998;4(2):108–12.CrossRefPubMedGoogle Scholar
  40. 40.
    Ferrandiz L, Moreno-Ramirez D, Nieto-Garcia A, et al. Teledermatology-based presurgical management for nonmelanoma skin cancer: a pilot study. Dermatol Surg. 2007;33(9):1092–8.PubMedGoogle Scholar
  41. 41.
    Barbieri JS, Nelson CA, James WD, et al. The reliability of teledermatology to triage inpatient dermatology consultations. JAMA Dermatol. 2014;150(4):419–24.CrossRefPubMedGoogle Scholar
  42. 42.
    Loane MA, Bloomer SE, Corbett R, et al. A randomized controlled trial to assess the clinical effectiveness of both realtime and store-and-forward teledermatology compared with conventional care. J Telemed Telecare. 2000;6(Suppl 1):S1–3.CrossRefPubMedGoogle Scholar
  43. 43.
    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):1058–65.CrossRefPubMedGoogle Scholar
  44. 44.
    Morton CA, Downie F, Auld S, et al. Community photo-triage for skin cancer referrals: an aid to service delivery. Clin Exp Dermatol. 2011;36(3):248–54.CrossRefPubMedGoogle Scholar
  45. 45.
    Datta SK, Warshaw EM, Edison KE, et al. Cost and utility analysis of a store-and-forward teledermatology referral system: a randomized clinical trial. JAMA Dermatol. 2015;151(12):1323–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Eminovic 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.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Ferrandiz L, Moreno-Ramirez D, Ruiz-de-Casas A, et al. An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer. Actas Dermosifiliogr. 2008;99(10):795–802.CrossRefPubMedGoogle Scholar
  48. 48.
    Lim D, Oakley AM, Rademaker M. Better, sooner, more convenient: a successful teledermoscopy service. Australas J Dermatol. 2012;53(1):22–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Moreno-Ramirez D, Ferrandiz L. A 10-year history of teledermatology for skin cancer management. JAMA Dermatol. 2015;151(12):1289–90.CrossRefPubMedGoogle Scholar
  50. 50.
    Pak HS, Datta SK, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Cost minimization analysis of a store-and-forward teledermatology consult system. Telemed J E Health. 2009;15(2):160–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Parsi K, Chambers CJ, Armstrong AW. Cost-effectiveness analysis of a patient-centered care model for management of psoriasis. J Am Acad Dermatol. 2012;66(4):563–70.CrossRefPubMedGoogle Scholar
  52. 52.
    Whited JD, Hall RP, Foy ME, et al. Teledermatology’s impact on time to intervention among referrals to a dermatology consult service. Telemed J E Health. 2002;8(3):313–21.CrossRefPubMedGoogle Scholar
  53. 53.
    Armstrong AW, Dorer DJ, Lugn NE, Kvedar JC. Economic evaluation of interactive teledermatology compared with conventional care. Telemed J E Health. 2007;13(2):91–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Bergmo TS. A cost-minimization analysis of a realtime teledermatology service in northern Norway. J Telemed Telecare. 2000;6(5):273–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Chan HH, Woo J, Chan WM, Hjelm M. Teledermatology in Hong Kong: a cost-effective method to provide service to the elderly patients living in institutions. Int J Dermatol. 2000;39(10):774–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Dekio I, Hanada E, Chinuki Y, et al. Usefulness and economic evaluation of ADSL-based live interactive teledermatology in areas with shortage of dermatologists. Int J Dermatol. 2010;49(11):1272–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Lamminen H, Tuomi ML, Lamminen J, Uusitalo H. A feasibility study of realtime teledermatology in Finland. J Telemed Telecare. 2000;6(2):102–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Loane MA, Bloomer SE, Corbett R, et al. A comparison of real-time and store-and-forward teledermatology: a cost-benefit study. Br J Dermatol. 2000;143(6):1241–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Loane MA, Oakley A, Rademaker M, et al. A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand. J Telemed Telecare. 2001;7(4):233–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Wootton R, Bloomer SE, Corbett R, et al. Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis. BMJ. 2000;320(7244):1252–6.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Snoswell C, Finnane A, Janda M, Soyer HP, Whitty JA. Cost-effectiveness of store-and-forward teledermatology: a systematic review. JAMA Dermatol. 2016;152(6):702–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Hsiao JL, Oh DH. The impact of store-and-forward teledermatology on skin cancer diagnosis and treatment. J Am Acad Dermatol. 2008;59(2):260–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Wootton R, Bahaadinbeigy K, Hailey D. Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review. BMC Health Serv Res. 2011;11:185.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Ferrandiz L, Ojeda-Vila T, Corrales A, et al. Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: a randomized teledermoscopy trial. J Am Acad Dermatol. 2017;76(4):676–82.CrossRefPubMedGoogle Scholar
  65. 65.
    Resneck JS Jr, Abrouk M, Steuer M, 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.CrossRefPubMedGoogle Scholar
  66. 66.
    Thompson JN. Statement of the FSMB. Rogue online pharmacies: the growing problem of internet drug trafficking. Federation of State Medical Boards;2007. Accessed 1 June 2017.
  67. 67.
    US Teledermatology Survey 2012. American Telemedicine Association. Accessed 1 June 2017
  68. 68.
    McKoy K, Antoniotti NM, Armstrong A, et al. Practice guidelines for teledermatology. Telemed J E Health. 2016;22(12):981–90.CrossRefPubMedGoogle Scholar
  69. 69.
  70. 70.
    American Academy of Dermatology. Position statement on teledermatology. Accessed 1 June 2017.
  71. 71.
    Scheinfeld N. Solving issues in teledermatology. Dermatologist. 2003;11(6). Accessed 1 June 2017.
  72. 72.
  73. 73.
    Kassianos AP, Emery JD, Murchie P, Walter FM. Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review. Br J Dermatol. 2015;172(6):1507–18.CrossRefPubMedGoogle Scholar
  74. 74.
    Wolf JA, Moreau JF, Akilov O, et al. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol. 2013;149(4):422–6.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Moreno-Ramirez D, Ferrandiz L, Ruiz-de-Casas A, et al. Economic evaluation of a store-and-forward teledermatology system for skin cancer patients. J Telemed Telecare. 2009;15(1):40–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of Pittsburgh Medical Center (UPMC)PittsburghUSA
  2. 2.TeledermatologyUPMC North Hills DermatologyWexfordUSA

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