(Reuters Health) - With a few exceptions, a dermatologist was just as accurate in diagnosing children’s skin conditions from smartphone photos taken by parents as the doctors who saw the kids in person, a small U.S. study found.
Along with some basic clinical information, a high-quality photo taken with a modern smartphone can be a reliable way to get an accurate dermatologic diagnosis, the study team argues in JAMA Dermatology.
Two categories of skin conditions could be more difficult to diagnose remotely: hair disorders, such as alopecia, and deeper skin lesions, including nodules and cysts, senior study author Dr. Patrick McMahon of the Children’s Hospital of Philadelphia said by email.
“We have also found that we cannot make specific diagnoses on some images, but those images can be helpful in deciding if urgent office visits are necessary,” said Dr. Lawrence Eichenfield, chief of pediatric and adolescent dermatology at Rady Children’s Hospital- San Diego, who wasn’t involved in the study.
Despite the increasing popularity of telemedicine as a way to reduce costs, improve time efficiencies and tackle geographic barriers to care, adoption of this kind of remote care has been slowed by barriers to reimbursement, cross-state licensing requirements and uncertainty about privacy regulations, the authors and other experts said.
In the current study, a dermatologist assessed 87 images from 40 parent-patient pairs who also were seen in person by a different dermatologist. Overall, the doctor who viewed photos and the doctors who saw the same patients in person came to the same diagnosis 83 percent of the time.
“While the authors did not test the usefulness of complete teledermatology visits, which would include treatment plans, prescribing medications, and giving patient educational materials, they strongly showed diagnostic consistency within limits,” Eichenfield said.
The greatest number of incorrect diagnoses occurred in cases of alopecia, but since one of the in-person clinicians specializes in pediatric hair conditions, the study included an above-average proportion of such cases, the researchers note. Such diagnoses can also be difficult to differentiate without dermoscopy and a thorough case history, they add.
Prior studies of adults have found that so-called store-and-forward teledermatology generates accurate diagnoses, improves access to specialty care and reduces time to treatment, McMahon and colleagues point out. Pediatric dermatologists are also in short supply, with “fewer than 300 board-certified physicians serving the nearly 75 million children in the United States,” they write.
The authors acknowledge that the small trial simulated, rather than performed, an actual teledermatology encounter. Another limitation is that the study was conducted in a setting that was urban, academic and clinic-based, and used a solitary pediatric dermatologist to provide remote diagnoses.
“The patient population was very small to base any real conclusions so it was more of a pilot study,” Dr. Bruce A. Brod, clinical professor of dermatology at University of Pennsylvania Perelman School of Medicine in Philadelphia, said by email. “The pediatric dermatologists at CHOP function at the highest level, so the question is whether this translates at the community level,” said Brod, who wasn’t involved in the study.
McMahon said he was confident the study could be reproduced on a larger scale, and if they decided to exclude certain conditions like hair disorders and nodules, “we could exceed 90 percent in our diagnostic accuracy.”
A study published in 2016 in the same journal raised concerns about direct-to-consumer teledermatology websites, including the risk for incorrect diagnoses, inappropriate treatments, a lack of information about possible side-effects and a lack of transparency about a doctor’s credentials (bit.ly/1srMuYU).
“I think more work needs to be done to assess the accuracy of teledermatology and to determine the optimal type of care episodes where this can be best utilized,” Brod said.
SOURCE: bit.ly/2AkpaBi JAMA Dermatology, online November 15, 2017.
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