Virtual dermatology assessments appear as reliable as in-person consults for atopic dermatitis and psoriasis, according to an Australian review of teledermatology studies.

However, the analysis found the reliability of digital consultations depended on the dermatological condition being assessed. In an era where many dermatologists take images using commercial smartphones, the research also highlighted a need for standardised image capture procedures.

The Sydney-based research team analysed 16 papers comparing in-person and virtual assessments of dermatology conditions, including 927 patients overall. Six studies focused on atopic dermatitis consults, five on plaque psoriasis, three on patch testing and two on acne vulgaris.

The investigators looked at reliability metrics in the studies to assess how accurately teledermatology assessments were found to be when compared with in-person patient reviews.

Pooled ICCs showed excellent reliability for atopic dermatitis, at 0.90, and psoriasis, at 0.87.

“These findings suggest that teledermatology appears as reliable as in-person review for atopic dermatitis and psoriasis, supporting its role in clinical practice,” the authors wrote in Australasian Journal of Dermatology [link here].

There was substantial heterogeneity among the reliability grades in different studies for both conditions.

While there were fewer studies reviewed on acne and patch testing, these studies showed a lower level of agreement between teledermatology and in-person symptom review.

“This variability is likely multifactorial and may be inherent to the dermatological condition being studied, methodological design, and image capture system used,” the review’s authors said.

Conditions that require a tactile assessment, like patch testing, present challenges for assessing patients remotely, they said.

“The inability to perform palpation is an inherent limitation of any imaging system; however, this may be mitigated by capturing surface architecture through modalities such as 3D photography.”

Studies which included full-body photography appeared to outperform lesion-specific images. All the studies reviewed used photos from handheld devices like smartphones, which likely had an impact on the variable results seen between the papers.

“To address this, future research should utilise standardised full body photography systems, which may help mitigate variances in image quality.”

Broadening the evidence base

The research was not confined to inflammatory dermatological conditions, but the authors found the majority of research done into teledermatology focused on AD and psoriasis.

This was “likely due to the availability of validated scoring systems such as EASI and PASI”, they said.

There had been no studies done on the use of virtual consults for conditions like bullous pemphigoid or mycosis fungoides, highlighting a need for broader research into teledermatology for less common conditions in future.

Despite this, overall the review suggested “asynchronous teledermatology scoring using standardised scoring tools, such as PASI or EASI, is reliable and can be integrated into clinical practice”.

“Future research should utilise standardised image acquisition methods, investigate the impact of patient demographics on scoring reliability, and explore the integration of AI-assisted scoring technologies to enhance consistency and clinical utility,” the authors wrote.