Researchers laid out 6 position statements for the technology in this patient population.
“Although the provision of telehealthcare should not completely replace high-quality, in-person dermatologic or rheumatologic visits, the convenience and collaborative nature of teledermatology may lead to expanded access and expedited care in the appropriate setting, whether it be in a virtual or in-person visit,” the authors wrote.
Throughout the COVID-19 pandemic, telemedicine utilization among dermatologists increased substantially, from under 15% to more than 95% following the global health emergency. The continued use of this technology highlights it can be used beyond COVID-19 and helps ensure continuity of care and improved access to health care more broadly, the authors said.
When it comes to diagnoses of inflammatory skin conditions like psoriasis, virtual visits rely in part on the quality of live video images and photographs patients provide. When these are properly provided, physicians can make assessments of disease severity using Psoriasis Area and Severity Index (PASI) scores. In addition, online training videos could be used to help patients asses PASI and body surface area (BSA) affected by psoriasis.
“Physicians may also guide patients to perform thorough self-evaluations of other areas of their body that might be difficult to appreciate on live video or photographs, such as the scalp and genitals,” the authors said.
Past research shows collaborative and efficient teledermatology models can equivalently improve PASI scores, BSA, and dermatology life quality index compared with in-person care. Moreover, distance, incapacity, and transportation costs can prevent many patients with psoriasis from seeking in-person care, while teledermatology can reduce travel costs and time to start of care.
The virtual care option also “allows physicians to reach patients with psoriasis in institutions with restricted access”; for example, those who are institutionalized for psychiatric reasons. It can also be beneficial for imprisoned patients. However, some limitations may prevent optimal care provision via telemedicine. These can include low quality of photos and videos and a lagging internet connection.
Regarding psoriatic arthritis, “accurate determinations of disease activity may be limited, in some cases of complex joint disease, without an in-person physical examination,” the authors cautioned. One way to overcome this barrier may be to employ a flexible approach to teledermatology for psoriatic arthritis. In this scenario, simpler and established cases could be managed via virtual visits and complex cases could be followed in an in-person fashion, they explained.
Teledermatology is also not a direct replacement for in-person care, the researchers added, but when used correctly, it can be a valuable tool for patients with psoriasis.
Investigators summed up their thoughts in 6 position statements:
Pelet del Toro N, Yahia R, Feldman SR, et al. National Psoriasis Foundation Telemedicine Task Force guidance for management of psoriatic disease via telemedicine. JAAD Int. Published online April 4, 2023. doi:10.1016/j.jdin.2023.02.018