Teledermatology Cost-Effective, Scalable as a Solution for Rural Dermatologic Care Disparities

Teledermatology is both a cost-effective and scalable approach to improving dermatologic disparities within rural communities, recent findings suggest, and increased education for providers and patients may be needed.1

Victoria Griffith, MD, of the Memorial Healthcare System in Hollywood, Florida, authored the analysis that led to these new findings. Griffith authored this paper alongside Valerie Foy, DO, of St. John's Episcopal Hospital in Far Rockaway, New York.

Griffith and Foy highlighted that rural regions of the US can face a scarcity of dermatologists as well as limited transportation options, potentially restricting patients' access to care. They noted that primary care physicians are more accessible in such regions but added that their diagnostic concordance with dermatologists may be lower than that of teledermatology.

“This review aims to identify effective strategies for delivering teledermatology to rural communities and explores their potential for managing rare skin conditions,” Griffith et al wrote. “Telemedicine is the use of electronic systems, also known as telecommunication, to communicate at a distance with a healthcare professional.”1,2

Trial Design Details

The investigative team conducted a comprehensive literature search using an available database for their systematic review. Griffith and Foy's search strategy in their review combined terms such as telehealth, telemedicine, telecare, teledermatology, or virtual with dermatology, skin condition, cutaneous, dermatological disease, or dermatological condition, as well as remote or rural.

The investigative team's literature search was carried out via the PubMed database, with their analysis encompassing peer-reviewed studies. These studies would have been published between January 1995 - December 31, 2024. There were 1111 articles which were initially retrieved by Griffith and Foy, with 1062 being excluded for not meeting relevance criteria. This left 49 studies for the team's detailed, full-text review.

The investigators' criteria for eligibility among the studies were those that involved evaluations of cutaneous conditions, addressed rural settings, and represented original peer-reviewed research. Their selection prioritized investigations examining telemedicine use in rural dermatologic care, treatment outcomes, diagnostic performance, and strategies to improve patients' access. The data drawn by Griffith and Foy was then synthesized qualitatively to identify recurring themes and impactful practices.

Findings on Teledermatology

There were 3 main models of teledermatology that emerged through the investigative team's search. The first was known as store-and-forward (SF), an asynchronous method in which clinical images are captured by patients or referring clinicians and forwarded for later review by dermatologists. The second model the team highlighted was known as synchronous teledermatology, a version relying on real-time video consultations. This would then allow for direct history-taking but requiring greater time and cost resources among patients and clinicians. The third was a hybrid model, integrating elements of both the SF and synchronous approaches.

Each of these 3 teledermatology methods—SF, synchronous, and hybrid—were shown to be effective in enhancing diagnostic accuracy and lowering the need for in-person referrals. Notably, the SF approach supported accurate identification of uncommon diseases such as morphea when primary care providers were trained in clinical photography as well as history documentation.

In their assessment of key barriers, Griffith and Foy identified several, including cross-state restrictions on licensing, poor broadband infrastructure, and added workload for care providers. However, they noted that several interventions improved feasibility in resource-limited regions: patient education through instructional videos, smartphone-friendly platforms, and primary care physician initiatives for training. Emerging technologies, especially AI-enabled mobile tools such as MoleMapper, were highlighted by the investigators as being currently assessed for triage support and self-monitoring. Nonetheless, Griffith and Foy pointed out that the data related to the utility of teledermatology for rare dermatologic conditions are still limited.

“With appropriate training for PCPs, standardizing imaging protocols, and integrating AI and mobile technologies, teledermatology can bridge gaps in specialist access for complex conditions,” the investigators concluded.1 “Further targeted research is essential to refine these approaches, understand their long-term impact, and ensure equitable access to dermatologic expertise for all, regardless of geographic location and skin condition.”

References

1. V Griffith and V Foy V. Teledermatology as a Solution for Rural and Rare Dermatologic Care: A Review of Strategies and Opportunities. Dermatological Reviews, 6: e70049. https://doi.org/10.1002/der2.70049.

2. D Jakhar, S Kaul, and I Kaur. “Whatsapp Messenger as a Teledermatology Tool During Coronavirus Disease (COVID-19): From Bedside to Phone-Side,” Clinical and Experimental Dermatology 45, no. 6 (2020): 739–740.