Gone are the days of setting aside an entire chunk of the day to wait in your doctor's office. Thanks to 21st-century technology, virtual dermatology appointments are now an official thing. Known as teledermatology, these services provide care for patients in a way that does not require an in-person exam.
For people with chronic conditions like psoriasis, virtual appointments are the next best thing to having a derm on 24-hour call. While they can't fully replace face-to-face visits--you still need those in-person full-body cancer checks and they aren't appropriate for actual skin emergencies--they can make managing your symptoms a whole lot easier. But are they effective? In short, yes. A study published in the Archives of Internal Medicine found that for certain routine illnesses, an online doctor appointment could be just as effective as seeing a physician in real life.
“Dermatology is a field in which we rely on visual examinations more than anything else, so it makes sense for us to strongly consider adding this technology into our practices,” explains Erum Ilyas, M.D., a dermatologist at Montgomery Dermatology in King of Prussia, PA. It doesn't hurt, either, that most smart phones today come with high-quality cameras that can literally be your doctor's eyes.
The Benefits of Virtual Dermatology
When it comes to chronic skin diseases (like psoriasis and eczema), virtual appointments are clutch, since they can provide closer--and quicker--surveillance of progress. “Normally, when a new psoriasis patient is seen, topical prescription medications are the first-line treatment depending on the severity of their condition,” explains Dr. Ilyas. “If these work, improvement is typically noted by the patient within two to three weeks; however, if the treatment is not working effectively or quickly enough, it can be frustrating and very uncomfortable for patients to wait for their next appointment to establish a new course of treatment.”
And, if you live in a rural area? Wait times for appointments can be on the order of months for specialist care, which can unfortunately lead some patients to seek care through urgent-care centers or even the ER. “The problem our psoriatic patients find is that dermatologists don't really work in urgent care," says Dr. Ilyas. "The doctors there will often attempt to give patients fast relief by offering oral steroids, and while these drugs might initially clear their flare up they also have a high risk of ‘rebound psoriasis,’ where symptoms come back with a vengeance.” Teledermatology improves accessibility, especially among Medicaid participants, according to a study published in JAMA Dermatology. And when you can see the right doctor at the right time, there's a darn good chance you'll get the right treatment too.
Even for people who live in metro areas with lots of doctors, getting an appointment isn't always easy...and that can be a problem when a flare strikes. With teledermatology, they're able to receive care within hours, as opposed to the weeks it would take them to get into a physical clinic. And that's not even including the hours it can take for the appointment itself. “My patients are often taking a half-day or even the entire day off to come see me in clinic with Bay Area traffic,” says Justin Ko, M.D., director and chief of medical dermatology at Stanford Health Care in Palo Alto, whose practice offers virtual visits to established patients in the practice and e-consults with other physicians in the network.
In many circumstances, the timeliness of care translates into faster diagnosis and treatment, which can make a big difference when it comes to serious skin conditions like skin cancer and melanoma. In fact, Dr. Ko and his team have made many diagnoses of skin cancers including melanoma as a result of these virtual- care interactions.
How to Schedule Your Virtual Dermatologist Appointment
A virtual visit with a dermatologist can be made in one of several ways. Many practices use their patient portal to "see" you. Dr. Ilyas uses this type of platform to monitor medication usage, evaluate efill requests, and help triage skin lesions between skin-exam appointments for established patients.
Since there is no specific threshold a psoriasis patient must meet to dictate when they switch from topical therapy, phototherapy or systemic therapy, Dr. Ilyas encourages patients to communicate as much information as possible in regards to their lifestyle, pain or discomfort level, whether the psoriasis is affecting sensitive areas such as under the arms, under the breasts, groin or face, and what treatments they’ve tried in the past.
Another viable method is using an app, such as DermatologistOnCall, First Derm, SkyMD, or Spruce. You'll complete a personal health history, upload photos of your skin (they guide you through the process), and then wait for a dermatologist to respond to both the photos as well as any additional questions you may have had. Many of these apps are free to download, but require a fee for the visit itself, which can sometimes be covered by insurance. Though most apps discourage using FaceTime, they do provide a HIPAA-secure method for texting.
No matter which app you choose, you’ll want to verify the physician’s credentials beforehand. Find their website and look up their certifications to make sure they are, in fact, board-certified. You can do this by visiting the American Academy of Dermatology or American Board of Dermatology websites. Then, follow these steps to secure your consultation.
Step 1: Log into the platform.
Whether you’re using a mobile app or signing up for your visit through a patient portal, create a profile and fill out all the necessary forms required.
Step 2: Read the fine print.
It’s important that you thoroughly understand what coverage options and expectations exist before scheduling your virtual dermatology visit. First, find out if your insurance will cover the appointment. There is an evolving recognition of the value of care delivered in this way, and many insurance companies are providing reimbursement. Still, not all do, so make sure you know ahead of time what your financial responsibility will be, says Dr. Ko.
Step 3: Follow the instructions on taking photos.
Most teledermatology apps and portals offer recommendations or guidance for how to take photos. They also include what kind of information patients should send. Be sure that the photos you take are of high enough quality and appropriate for your physician to be able to make an assessment. When Dr. Ko performs virtual visits for his established patients, he provides a tip sheet on how to take photos that makes it easier for him to assess and help with next steps: “Use good lighting, ideally natural lighting, keep areas of interest in focus, and take photos of both affected and unaffected areas if different areas of the body are involved (for example, the elbow that has a rash and the other that's clear),” he says. Additionally, include all relevant information, such as your health history, family health history, and chief concerns.
Step 4: Check back with the app or platform for guidance from your dermatologist.
Don’t be afraid to check in and message the dermatologist if you haven’t heard back in the time expected. “There can sometimes be technical issues, or messages can get stuck in in-baskets or work queues,” says Dr. Ko. If all the information and situation is appropriate for a treatment plan to be started or modified, these prescriptions or labs/diagnostics can be ordered in the same way as for an in-clinic visit.
Step 5: Follow recommendations from your virtual derm.
After you receive an assessment and/or next steps, it’s important to try to follow the recommendations, or follow up if you have any questions or don’t agree with the plan. Dr. Ko also suggests utilizing the app to update your physician or their team on how things are going. “If there is any concern or things are not going according to plan, make sure to check in and let your care team know!” he says.
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