Skip to main content
Log in

Review of Teledermatology: Lessons Learned from the COVID-19 Pandemic

  • Leading Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Utilization of telemedicine for dermatology has greatly expanded since the start of the COVID-19 pandemic, with over 500 new teledermatology studies published since 2020. An updated review on teledermatology is necessary to incorporate new findings and perspectives, and educate dermatologists on effective utilization. We discuss teledermatology in terms of diagnostic accuracy and clinical outcomes, patient and physician satisfaction, considerations for special patient populations, published practice guidelines, cost effectiveness and efficiency, as well as administrative regulations and policies. Our findings emphasize the need for dermatologist education, prioritization of reliable reimbursement systems, and technological innovations to support the continued development of teledermatology in the post-pandemic era.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. He A, Ti Kim T, Nguyen KD. Utilization of teledermatology services for dermatological diagnoses during the COVID-19 pandemic. Arch Dermatol Res. 2023;315(4):1059–62. https://doi.org/10.1007/s00403-022-02438-9.

    Article  PubMed  Google Scholar 

  2. Kennedy J, Arey S, Hopkins Z, et al. Dermatologist perceptions of teledermatology implementation and future use after COVID-19: demographics, barriers, and insights. JAMA Dermatol. 2021;157(5):595–7. https://doi.org/10.1001/jamadermatol.2021.0195.

    Article  PubMed  PubMed Central  Google Scholar 

  3. AMA Digital Health Research. Available from: https://www.ama-assn.org/system/files/ama-digital-health-study.pdf. Accessed 3 Apr 2023.

  4. Kimball AB, Porter ML. Impact of the COVID-19 pandemic on the delivery of dermatological care. Curr Dermatol Rep. 2022;11(4):313–7. https://doi.org/10.1007/s13671-022-00378-1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lee JJ, English JC 3rd. Teledermatology: a review and update. Am J Clin Dermatol. 2018;19(2):253–60. https://doi.org/10.1007/s40257-017-0317-6.

    Article  PubMed  Google Scholar 

  6. Wang RH, Barbieri JS, Kovarik CL, Lipoff JB. Synchronous and asynchronous teledermatology: a narrative review of strengths and limitations. J Telemed Telecare. 2022;28(7):533–8. https://doi.org/10.1177/1357633x221074504.

    Article  PubMed  Google Scholar 

  7. Falotico JM, Gu L, Lipner SR. Not just pimple popping: the utility of hybrid telemedicine models beyond acne management amidst the ongoing COVID-19 pandemic. J Cosmet Dermatol. 2022;21(10):4105–6. https://doi.org/10.1111/jocd.15256.

    Article  PubMed  Google Scholar 

  8. Gu L, Diaz SM, Lipner SR. Retrospective study of acne telemedicine and in-person visits at an academic center during the COVID-19 pandemic. J Cosmet Dermatol. 2022;21(1):36–8. https://doi.org/10.1111/jocd.14606.

    Article  PubMed  Google Scholar 

  9. Jacoby T, Woolard A, Chamoun S, Moy R. Asynchronous teledermatology assessment of young adult acne likely concordant with in-person evaluation. J Drugs Dermatol. 2021;20(4):432–5. https://doi.org/10.36849/jdd.2021.5688.

    Article  PubMed  Google Scholar 

  10. Moreno-Ramírez D, Duarte-Ferreras MA, Ojeda-Vila T, et al. Telemedicine management of systemic therapy with isotretinoin of patients with moderate-to-severe acne during the COVID-19 pandemic: a longitudinal prospective feasibility study. J Am Acad Dermatol. 2022;87(5):1186–9. https://doi.org/10.1016/j.jaad.2022.03.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Onyekweli T, Agarwal A, Jaklitsch E, et al. Teledermatology isotretinoin management for moderate-to-severe acne reveals similar outcomes to in-person management: a retrospective study. JAAD Int. 2023;2023(11):126–8. https://doi.org/10.1016/j.jdin.2023.02.009.

    Article  Google Scholar 

  12. US FDA. FDA briefing document: risk evaluation and mitigation strategy (REMS) for isotretinoin products “iPLEDGE REMS”. Available from: https://www.fda.gov/media/166485/download. Accessed 3 Apr 2023.

  13. Johnson H, Ranum A, Mansh M, Farah RS, Pearson DR. Falsification of at-home isotretinoin pregnancy testing during the COVID-19 pandemic: a case series and proposal of mitigation strategies. JAAD Case Rep. 2022;28:49–53. https://doi.org/10.1016/j.jdcr.2022.07.045.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shah VK, English JC 3rd. Store-and-forward outpatient teledermatology improves care for patients with periorificial dermatitis after an initial primary care consultation: a retrospective study. J Am Acad Dermatol. 2023;88(4):904–6. https://doi.org/10.1016/j.jaad.2022.10.036.

    Article  PubMed  Google Scholar 

  15. Giavina-Bianchi M, Giavina-Bianchi P, Santos AP, Rizzo LV, Cordioli E. Accuracy and efficiency of telemedicine in atopic dermatitis. JAAD Int. 2020;1(2):175–81. https://doi.org/10.1016/j.jdin.2020.08.002.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Armstrong AW, Johnson MA, Lin S, Maverakis E, Fazel N, Liu FT. Patient-centered, direct-access online care for management of atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2015;151(2):154–60. https://doi.org/10.1001/jamadermatol.2014.2299.

    Article  PubMed  Google Scholar 

  17. Chiricozzi A, Talamonti M, De Simone C, et al. Management of patients with atopic dermatitis undergoing systemic therapy during COVID-19 pandemic in Italy: data from the DA-COVID-19 registry. Allergy. 2021;76(6):1813–24. https://doi.org/10.1111/all.14767.

    Article  CAS  PubMed  Google Scholar 

  18. Matricardi PM, Dramburg S, Alvarez-Perea A, et al. The role of mobile health technologies in allergy care: an EAACI position paper. Allergy. 2020;75(2):259–72. https://doi.org/10.1111/all.13953.

    Article  PubMed  Google Scholar 

  19. Pelet del Toro N, Yahia R, Feldman SR, et al. National Psoriasis Foundation Telemedicine Task Force guidance for management of psoriatic disease via telemedicine. JAAD Int. 2023. https://doi.org/10.1016/j.jdin.2023.02.018.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dahy A, El-Qushayri AE, Mahmoud AR, Al-Kelany TA, Salman S. Telemedicine approach for psoriasis management, time for application? A systematic review of published studies. Dermatol Ther. 2020;33(6): e13908. https://doi.org/10.1111/dth.13908.

    Article  PubMed  Google Scholar 

  21. Armstrong AW, Chambers CJ, Maverakis E, et al. Effectiveness of online vs in-person care for adults with psoriasis: a randomized clinical trial. JAMA Netw Open. 2018;1(6): e183062. https://doi.org/10.1001/jamanetworkopen.2018.3062.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tinio PA, Melendres JM, Chavez CP, et al. Clinical profile and response to treatment of patients with psoriasis seen via teledermatology during the COVID-19 pandemic in the Philippines. JAAD Int. 2022;7:35–7. https://doi.org/10.1016/j.jdin.2022.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Marasca C, Annunziata MC, Camela E, et al. Teledermatology and inflammatory skin conditions during COVID-19 era: new perspectives and applications. J Clin Med. 2022;11(6):1511. https://doi.org/10.3390/jcm11061511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Wu J, Petto H, Dutronc Y, Burkhardt N, Gebauer K, Gooderham M. Development and validation of a new method for potential use of Psoriasis Area and Severity Index in teledermatology. Australas J Dermatol. 2021;62(1):e114–7. https://doi.org/10.1111/ajd.13412.

    Article  PubMed  Google Scholar 

  25. Chuchu N, Dinnes J, Takwoingi Y, et al. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev. 2018;12(12):CD013193. https://doi.org/10.1002/14651858.

    Article  CAS  PubMed  Google Scholar 

  26. Jobbágy A, Kiss N, Meznerics FA, et al. Emergency use and efficacy of an asynchronous teledermatology system as a novel tool for early diagnosis of skin cancer during the first wave of COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(5):2699. https://doi.org/10.3390/ijerph19052699.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Giavina-Bianchi M, Azevedo MFD, Sousa RM, Cordioli E. Part II: accuracy of teledermatology in skin neoplasms. Front Med (Lausanne). 2020;7: 598903. https://doi.org/10.3389/fmed.2020.598903.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Beer J, Hadeler E, Calume A, Gitlow H, Nouri K. Teledermatology: current indications and considerations for future use. Arch Dermatol Res. 2021;313(1):11–5. https://doi.org/10.1007/s00403-020-02145-3.

    Article  PubMed  Google Scholar 

  29. Wilson BN, McMichael A, Alexis A, et al. Telemedicine alopecia assessment: highlighting patients with skin of color. Cutis. 2022;109(1):40–2. https://doi.org/10.12788/cutis.0419.

    Article  PubMed  Google Scholar 

  30. Randolph M, Al-Alola A, Tosti A. Diagnosis of hair disorders during the COVID-19 pandemic: an introduction to teletrichoscopy. J Eur Acad Dermatol Venereol. 2021;35(3):e167–8. https://doi.org/10.1111/jdv.16989.

    Article  CAS  PubMed  Google Scholar 

  31. Chang MJ, Stewart CR, Lipner SR. Retrospective study of nail telemedicine visits during the COVID-19 pandemic. Dermatol Ther. 2021;34(1): e14630. https://doi.org/10.1111/dth.14630.

    Article  CAS  PubMed  Google Scholar 

  32. Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient teledermatology: a review. Curr Dermatol Rep. 2022;11(2):52–9. https://doi.org/10.1007/s13671-022-00360-x.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gabel CK, Nguyen E, Karmouta R, et al. Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease. J Am Acad Dermatol. 2021;84(6):1547–53. https://doi.org/10.1016/j.jaad.2020.04.171.

    Article  PubMed  Google Scholar 

  34. Tan WH, Loh CH, Chai ZT, et al. Early experience of inpatient teledermatology in Singapore during COVID-19. Ann Acad Med Singap. 2021;50(6):487–9. https://doi.org/10.47102/annals-acadmedsg.202130.

    Article  PubMed  Google Scholar 

  35. Liu Y, Jain A, Eng C, et al. A deep learning system for differential diagnosis of skin diseases. Nat Med. 2020;26(6):900–8. https://doi.org/10.1038/s41591-020-0842-3.

    Article  CAS  PubMed  Google Scholar 

  36. Vodrahalli K, Ko J, Chiou AS, et al. Development and clinical evaluation of an artificial intelligence support tool for improving telemedicine photo quality [published online ahead of print, 2023 Mar 15]. JAMA Dermatol. 2023;159(5):496–503. https://doi.org/10.1001/jamadermatol.2023.0091.

    Article  PubMed  Google Scholar 

  37. Young AT, Xiong M, Pfau J, Keiser MJ, Wei ML. Artificial intelligence in dermatology: a primer. J Invest Dermatol. 2020;140(8):1504–12. https://doi.org/10.1016/j.jid.2020.02.026.

    Article  CAS  PubMed  Google Scholar 

  38. Muñoz-López C, Ramírez-Cornejo C, Marchetti MA, et al. Performance of a deep neural network in teledermatology: a single-centre prospective diagnostic study. J Eur Acad Dermatol Venereol. 2021;35(2):546–53. https://doi.org/10.1111/jdv.16979.

    Article  PubMed  Google Scholar 

  39. Miller J, Jones E. Shaping the future of teledermatology: a literature review of patient and provider satisfaction with synchronous teledermatology during the COVID-19 pandemic. Clin Exp Dermatol. 2022;47(11):1903–9. https://doi.org/10.1111/ced.15320.

    Article  PubMed  Google Scholar 

  40. Moore B, Washington A, Butt M, Silva C, Green B, Helm M. Patient satisfaction of real-time teledermatology: a cross-sectional survey. Int J Dermatol. 2022;61(2):e69-71. https://doi.org/10.1111/ijd.15618.

    Article  PubMed  Google Scholar 

  41. Kaunitz G, Yin L, Nagler AR, Sicco KL, Kim RH. Assessing patient satisfaction with live-interactive teledermatology visits during the COVID-19 pandemic: a survey study. Telemed J E Health. 2022;28(4):591–6. https://doi.org/10.1089/tmj.2021.0200.

    Article  PubMed  Google Scholar 

  42. Leal-Costa C, Lopez-Villegas A, Perez-Heredia M, Baena-Lopez MA, Hernandez-Montoya CJ, Lopez-Liria R. Patients’ experiences and communication with teledermatology versus face-to-face dermatology. J Clin Med. 2022. https://doi.org/10.3390/jcm11195528.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gu L, Xiang L, Lipner SR. Analysis of availability of online dermatology appointments during the COVID-19 pandemic. J Am Acad Dermatol. 2021;84(2):517–20. https://doi.org/10.1016/j.jaad.2020.10.069.

    Article  CAS  PubMed  Google Scholar 

  44. Santiago S, Lu J. Patient satisfaction in teledermatology: an updated review. Curr Dermatol Rep. 2023;12(1):23–6. https://doi.org/10.1007/s13671-023-00382-z.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Eberly LA, Kallan MJ, Julien HM, et al. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic [published correction appears in JAMA Netw Open. 2021 Feb 1;4(2):e211913]. JAMA Netw Open. 2020;3(12): e2031640. https://doi.org/10.1001/jamanetworkopen.2020.31640.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Gronbeck C, Grant-Kels JM, Lu J, Feng H. Increased utilization of teledermatology among Medicare Part B beneficiaries during the COVID-19 pandemic. Clin Dermatol. 2022;40(6):760–3. https://doi.org/10.1016/j.clindermatol.2022.09.004.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Harper KK, Wang L, James AJ. Bridging the digital divide in teledermatology usage: a retrospective review of patient visits. Cutis. 2023;111(3):160–3. https://doi.org/10.12788/cutis.0722.

    Article  PubMed  Google Scholar 

  48. Chang M, Lipner S. Disparities in telemedicine satisfaction among older and non-white dermatology patients: a cross-sectional study. J Drugs Dermatol. 2022;21(2):210–4. https://doi.org/10.36849/jdd.6410.

    Article  PubMed  Google Scholar 

  49. Lipner SR, Ouchida K. Novel solutions for dermatologic care of geriatric patients and the role of the dermatology house call. J Am Acad Dermatol. 2020;83(6): e419. https://doi.org/10.1016/j.jaad.2020.07.128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Lam K, Lu AD, Shi Y, Covinsky KE. Assessing telemedicine unreadiness among older adults in the United States during the COVID-19 pandemic. JAMA Intern Med. 2020;180(10):1389–91. https://doi.org/10.1001/jamainternmed.2020.2671.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. de Vere HI, van Egmond S, Nava V, et al. Telehealth for older adults with skin disease: a qualitative exploration of dermatologists’ experiences and recommendations for improving care. Br J Dermatol. 2022;186(4):731–3. https://doi.org/10.1111/bjd.20891.

    Article  Google Scholar 

  52. Duan G, Lambert R, Hight R, Rosenblatt A. Comparison of pediatric dermatology conditions across telehealth and in-person visits during the COVID-19 pandemic. J Drugs Dermatol. 2022;21(11):1260–3. https://doi.org/10.36849/jdd.6843.

    Article  PubMed  Google Scholar 

  53. Kohn LL, Pickett K, Day JA, et al. When is synchronous telehealth acceptable for pediatric dermatology? Pediatr Dermatol. 2022;39(2):236–42. https://doi.org/10.1111/pde.14919.

    Article  PubMed  Google Scholar 

  54. Clark JJ, Snyder AM, Sreekantaswamy SA, et al. Dermatologic care of incarcerated patients: a single-center descriptive study of teledermatology and face-to-face encounters. J Am Acad Dermatol. 2021;85(6):1660–2. https://doi.org/10.1016/j.jaad.2020.12.076.

    Article  PubMed  Google Scholar 

  55. Zarca K, Charrier N, Mahé E, et al. Tele-expertise for diagnosis of skin lesions is cost-effective in a prison setting: a retrospective cohort study of 450 patients. PLoS ONE. 2018;13(9): e0204545. https://doi.org/10.1371/journal.pone.0204545.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Fortugno AP, Dellavalle RP. Implementation of a patient-assisted teledermatology model in the Veteran Health Administration. Dermatol Online J. 2019;25(11):13030/qt6xh9p2nn.

  57. Castillo F, Peracca S, Oh DH, Twigg AR. The utilization and impact of live interactive and store-and-forward teledermatology in a Veterans Affairs Medical Center during the COVID-19 pandemic. Telemed J E Health. 2022;28(8):1186–92. https://doi.org/10.1089/tmj.2021.0275.

    Article  PubMed  Google Scholar 

  58. Baranowski MLH, Balakrishnan V, Chen SC. Patient satisfaction with the Veteran’s Administration Teledermatology Service [published online ahead of print, 2019 Jan 28]. J Am Acad Dermatol. 2019. https://doi.org/10.1016/j.jaad.2019.01.036.

    Article  PubMed  PubMed Central  Google Scholar 

  59. McKoy K, Antoniotti NM, Armstrong A, 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 

  60. Abbott LM, Miller R, Janda M, et al. Practice guidelines for teledermatology in Australia. Australas J Dermatol. 2020;61(3):e293-302. https://doi.org/10.1111/ajd.13301.

    Article  PubMed  PubMed Central  Google Scholar 

  61. AAD. AAD teledermatology standards. Available from: https://www.aad.org/member/practice/telederm/standards. Accessed 18 Oct 2023.

  62. Deda LC, Goldberg RH, Jamerson TA, Lee I, Tejasvi T. Dermoscopy practice guidelines for use in telemedicine. NPJ Digit Med. 2022;5(1):55. https://doi.org/10.1038/s41746-022-00587-9.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Dovigi E, Lee I, Tejasvi T. Evaluation of teledermatology practice guidelines and recommendations for improvement. Telemed J E Health. 2022;28(1):115–20. https://doi.org/10.1089/tmj.2021.0011.

    Article  PubMed  Google Scholar 

  64. López-Liria R, Valverde-Martínez M, López-Villegas A, et al. Teledermatology versus face-to-face dermatology: an analysis of cost-effectiveness from eight studies from Europe and the United States. Int J Environ Res Public Health. 2022;19(5):2534. https://doi.org/10.3390/ijerph19052534.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Zhang AJ, Johnson D, Ghatnekar S, Drake L, Shlager G, Yang FS. Operational impact of teledermatology and considerations for reimbursement. J Am Acad Dermatol. 2022;87(4):930–2. https://doi.org/10.1016/j.jaad.2021.12.046.

    Article  PubMed  Google Scholar 

  66. Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers’ perspective. Telemed J E Health. 2012;18(8):580–4. https://doi.org/10.1089/tmj.2011.0241.

    Article  PubMed  Google Scholar 

  67. Wang RH, Barbieri JS, Nguyen HP, et al. Clinical effectiveness and cost-effectiveness of teledermatology: where are we now, and what are the barriers to adoption? J Am Acad Dermatol. 2020;83(1):299–307. https://doi.org/10.1016/j.jaad.2020.01.065.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Han G. Reimbursement for teledermatology during the COVID-19 public health emergency: change has come, but will it stay? Cutis. 2021;107(2):61–70. https://doi.org/10.12788/cutis.0171.

    Article  PubMed  Google Scholar 

  69. Telehealth. Telehealth policy changes after the COVID-19 public health emergency. Updated August 31, 2023. Available from: https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency. Accessed 4 Sept 2023.

  70. AMA. AMA telehealth policy, coding & payment. Updated July 19, 2023. Available from: https://www.ama-assn.org/practice-management/digital/ama-telehealth-policy-coding-payment. Accessed 4 Sep 2023.

  71. AMA. May 2023: CPT® editorial summary of panel actions. Available from: https://www.ama-assn.org/system/files/cpt-summary-panel-actions-may-2023.pdf. Accessed 4 Sep 2023.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shari R. Lipner.

Ethics declarations

Funding

No sources of funding were used for the preparation of this study/article.

Conflict of interest

Jonathan K. Hwang, Natalia Pelet del Toro, and Dennis H. Oh have no conflicts of interest that are directly relevant to the content of this article. George Han reports honoraria or research grants from AbbVie, Amgen, Arcutis, Athenex, Bausch Health, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene Corporation, Dermavant, DermTech, Eli Lilly and Company, EPI Health, Janssen Pharmaceuticals, LEO Pharma, MC2 Therapeutics, Novartis, Ortho Dermatologics, PellePharm, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, SUN Pharmaceutical Industries Ltd, and UCB. Trilokraj Tejasvi serves on the board of the International Society of Teledermatology. Shari R. Lipner has served as a consultant for Eli Lilly, Ortho-Dermatologics, Belle Torus Corporation, and Moberg Pharmaceuticals.

Ethics approval

Institutional review board approval was not required for this study.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and material

All data supporting the findings of this article are available within this paper.

Code availability

Not applicable.

Author contributions

JKH, NPT, GH, DHO, TT, and SRL have all made substantial contributions to aspects of the work. All authors have read and approved the final version.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hwang, J.K., del Toro, N.P., Han, G. et al. Review of Teledermatology: Lessons Learned from the COVID-19 Pandemic. Am J Clin Dermatol 25, 5–14 (2024). https://doi.org/10.1007/s40257-023-00826-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-023-00826-z

Navigation