JMIR Publications

ABSTRACT

Background:

Psoriasis is a chronic inflammatory skin disease requiring long-term management. Telemedicine may improve continuity of care, treatment adherence, and self-management; however, evidence regarding its effectiveness across clinical and patient-centered outcomes remains inconsistent.

Objective:

To systematically evaluate the effectiveness and safety of telemedicine-based interventions for patients with psoriasis across multiple clinical, psychological, behavioral, and patient-reported outcomes.

Methods:

We searched 10 databases, including PubMed, Embase, the Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, CBM, CNKI, and Wanfang, from inception to March 31, 2026. Randomized controlled trials comparing telemedicine-based interventions with routine care or conventional follow-up were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted using mean differences (MD), standardized mean difference (SMD), or risk ratio (RR), with corresponding 95% confidence intervals (CI). Subgroup analyses were performed to explore potential sources of heterogeneity. Sensitivity analyses were conducted using the leave-one-out method, in which each study was sequentially excluded to assess the robustness of the pooled estimates. Publication bias was assessed using Egger’s and Begg’s tests.

Results:

Twenty-four articles involving 2546 patients were included. Risk of bias assessment identified some concerns in 11 studies and high risk in 9, with no studies rated as having a low overall risk of bias. Telemedicine significantly reduced PASI scores (MD=−2.97, 95% CI −5.69 to −0.25; P=.03; I²=98.6%; P<.001) and DLQI scores (MD=−2.29, 95% CI −3.79 to −0.79; P=.003; I²=84.0%; P<.001). Self-management ability (SMD=1.21, 95% CI 0.44 to 1.98; P<.001; I²=93.6%; P<.001) and psoriasis-related health behaviors (SMD=1.46, 95% CI 0.81 to 2.11; P<.001; I²=85.7%; P=.01) also improved significantly. Treatment adherence rates increased (RR=1.17, 95% CI 1.07 to 1.27; P<.001; I²=27.9%; P=.24), whereas adherence scores (SMD=3.88, 95% CI: 0.23 to 7.54; P=.04; I²=98.8%, P<.001) showed substantial heterogeneity and limited robustness. Anxiety assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale improved significantly (MD=−1.56, 95% CI −2.73 to −0.39; P=.01; I²=0%; P=.45). Depression and patient satisfaction did not improve significantly overall (SMD=−0.66, 95% CI: −1.59 to 0.27; P=.16; I²=95.4%; P<.001). However, Social functioning-related outcomes improved (SMD=−2.45, 95% CI −4.49 to −0.41; P=.02; I²= 98.1%). The pooled incidence of adverse events was lower in the intervention groups (RR=0.74, 95% CI 0.56 to 0.99; P=.04; I²=0.0%, P=0.41), although sensitivity analysis indicated limited robustness. One study suggested potential cost savings with online care.

Conclusions:

Telemedicine may improve psoriasis severity, quality of life, self-management, health-related behaviors, and treatment adherence. However, its effects on psychological outcomes and patient satisfaction remain uncertain, and evidence regarding safety and cost-effectiveness is limited. Substantial heterogeneity and methodological limitations warrant cautious interpretation. Future trials should use standardized outcome measures, longer follow-up, and rigorous assessments of safety and economic outcomes. Clinical Trial: International Prospective Register of Systematic Reviews CRD420261294958; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261294958