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.

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 cross-sectional retrospective study, from July 2017–July 18 in the city of São Paulo, Brazil. We included 6,633 individuals 60+ years old who presented 12,770 skin lesions. Teldermatologist had the three options to refer them: 1) to undergo biopsy directly, 2) to an in-presence dermatologist visit and 3) to formulate diagnosis and management suggestions for the primary care physician. We assessed the frequency and the causes of the referrals to biopsy, to in-presence dermatologist or to be managed at primary care; the most frequent skin conditions (according to age and sex) and the treatments suggested by TD.

Results:

Teledermatology managed 67% of the dermatoses with the primary care physician without the need of in-presence visit; 27% were referred to dermatologists, and 6% directly to biopsy. 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. The treatment most prescribed was emollient.

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.