JMIR Publications

ABSTRACT

Background:

Teledermatology (TD) is a healthcare tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using TD, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As population around the world grows older, there will be even more demand for dermatologists in years to come. It is important to know which are the most prevalent skin conditions in primary care population and if they can be addressed through TD.

Objective:

Our main goal was to evaluate the proportion of lesions in individuals 60+ years old that could be managed using TD in conjuntion with primary care physians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients and the distribution and causes of referrals made by the teledermatologists.

Methods:

This was a retrospective cohort study, from July 2017–July 2018 in the city of São Paulo, Brazil. We included 6,633 individuals 60+ years old who presented 12,770 skin lesions. Teldermatologist had three options to refer the patients: 1) to undergo biopsy directly; 2) to undergo an in-presence dermatologist visit; and 3) to keep them assisted by the primary care physician, but providing diagnosis and management suggestions.

Results:

1) Teledermatology managed 8,408 (67%) dermatoses with the primary care physician without the need of in-presence visit; 3,419 (27%) were referred to dermatologists, and 787(6%) directly to biopsy. 2) The most frequent diseases were: seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leuchoderma and wart, with significant differences between sexes. Malignant tumors increased with age and were the main cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. 3) Emollient was the most frequent treatment prescribed, in 30% of the cases.

Conclusions:

Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity in a quick and convinent manner, together with the primary care physician, thus optimizing dermatological appointments for the most serious, surgical or complex diseases. Teledermatology does not aim to replace face-to-face visit with the dermatologist, but it might help to democratize the access for patients to dermatological treatments and to ameliorate health care expenses.