It’s Never Been Easier to See a Derm—but There Are Limitations to What Teledermatology Can Do

The first thing board-certified dermatologist Joshua Zeichner, MD, does when he logs onto Zoom for the day is change his background to a picture of an exam room. "It gives my patients a sense of consistency," he says. Nine out of ten times, they'll ask him if he's in his New York City office, when in reality, he's on his couch at home.

Dr. Zeichner is one of a number of dermatologists who have brought their practices online in the wake of COVID-19, making it possible for them to continue to see patients from the safe social distance of six feet. While teledermatology—which allows doctors to diagnose patients using either video conferencing or high-resolution photos—has seen an immense rise over the last few years thanks to platforms like SkinIO, DermatologistOnCall, and Curology, the pandemic has motivated a number of private practitioners (who are currently unable to see patients in their offices) to go digital.

Apostrophe, a fully-integrated teledermatology platform that allows dermatologists to use high-definition photos to diagnose conditions via email for a flat fee of $20, now has a waiting list of derms looking to offer their services via the site, and RealSelf launched a virtual dermatology platform in early April that saw more than 1,500 doctors sign up in the first month.

Plenty of other skin docs, like Dr. Zeichner, board-certified dermatologist Mona Gohara, MD, and board-certified dermatologist Ronald Moy, MD, have begun conducting appointments via video chat, seeing patients via Zoom and Facetime. These services have become so popular, the American Academy of Dermatology has even put together a "teledermatology toolkit," including an hour-long webinar educating practitioners on how best to bring their services online. Because when the pandemic subsides and we go back out into the world, dermatology, no doubt, will have pivoted.

The rise of teledermatology during COVID-19

COVID-19 has given rise to telemedicine practices across the entire healthcare industry, but dermatology has been one of the easiest to adapt to the digital age. Because it's such a visual field, Apostrophe co-founder Ben Holber believes that "teledermatology is poised to do really well with the rise of telemedicine, particularly for things like acne and general skin lesions," says Holber. Unlike a heart or lung condition, for example, you can actually see most skin conditions in a photograph, which makes them much easier to diagnose from afar.

As the  Journal of the American Academy of Dermatology" puts it, COVID-19 has removed "many restrictions that have roadblocked telehealth adoption." To make appointments more affordable,  the Centers for Medicare & Medicaid Services broadened access to telehealth services and many private insurers have relaxed their policies to include telemedicine services, which means that any appointments that weren't previously covered now are (at least for the time being).

In March, 2020, the Whitehouse enacted emergency legislation to temporarily allow out-of-state physicians to provide care, whether or not it relates to COVID-19, in 13 states. Because of this, dermatologists are now able to treat patients across the U.S. (previously they could only offer care in the states they were licensed in), and this is a BFD.

There has historically been an immense shortage of dermatologists in the U.S. A 2017 estimate found that there were only 3.4 dermatologists per 100,000 people nationwide, and the average wait time to see one of them is 32.3 days. The most expansive care has only been available in major metros. Now, though, people from across the country are able to access derms from places where they are plentiful, such as New York, Miami, and Los Angeles.

What teledermatology can (and can't) do

With quarantine-induced skin issues (like stress acne and rosacea) on the rise, patients have increasingly begun to seek these easier-to-access teledermatology services. Apostrophe has seen a "massive increase in volume" (over 50 percent) in its appointments since the pandemic hit, according to Holber. He estimates that between 60 and 70 percent of these new patients have never seen a dermatologist until now, and the large majority of them are dealing with acne and other stress-related skin concerns.

While these cosmetic issues can be diagnosed via video chat, there are still certain limits that dermatologists have when working with patients digitally. "Things like skin cancer and things that require procedures or medications that require lab testing to make sure they're safe to use will always require in-person visits," says Holber. And obviously, cosmetic procedures like skin-smoothing neurotoxins, skin-plumping filler, and hyperpigmentation-busting lasers and peels can't happen online.

Even with all of the obvious checks in the "pro" column—affordability, convenience, and accessibility—teledermatology still isn't perfect. "As much as I try to hold the syringe up to the telephone, the cortisone isn't making it through to the other side," says Dr. Zeichner. "I can't freeze a wart on Zoom." He adds that evaluating atypical moles is also challenging, because it makes it harder to "directly evaluate a spot when a person isn't right in front of you,'" and of course, any actual treatment, like skin-smoothing neurotoxins, skin-plumping filler, and hyperpigmentation-busting lasers and peels, is impossible to do via Zoom.

"Teledermatology is best for one complaint, whether its' acne, rosacea, a rash, dermatitis, or reviewing skin-care routines," says Dr. Zeichner. "I think this is a great opportunity to be discussing face care... we can't inject Botox, but we can tell people what the best anti-aging routine for their skin would be."

But now that dermatologist appointments have become accessible and affordable, though, it's the perfect time to get the skin-care consult you've been putting off for the last six months. You can work directly with a derm to fine tune your routine, and you'll feel like you and your doctor are together in an exam room... without either one of you having to leave the house.

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