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When a Selfie Can Replace an Office Visit

About a year ago, I began using a prescription topical gel called Aczone to treat my cystic acne. I’d already tried a number of acne drugs, but none of them succeeded in preventing deep, under-the-skin pimples from erupting right before my period. Then I discovered Aczone, and my monthly breakouts ceased. 

Unfortunately, I ran out of prescription refills by the beginning of the summer. That meant I had to see my doctor again to replenish my supply of Aczone. For various reasons, I had trouble finding an appointment time that worked. To my surprise, my doctor offered me another option: teledermatology. 

Teledermatology is a form of telemedicine, which allows patients to exchange information with doctors via email, video chat or online patient portals. The past five years have seen a notable uptick in telederm services: Between 2011 and 2016, the number of healthcare practices offering teledermatology in the United States increased from 37 to 102. For patients in rural areas, where physician shortages are common, teledermatology is an especially valuable innovation.

So what does using a telederm service entail? Casually sending off selfies to your dermatologist whenever complexion concerns arise? Not quite. Dr. Jules Lipoff, a dermatologist and professor at the University of Pennsylvania Perelman School of Medicine, helped us put together a primer on the process. 

Teledermatology vs. IRL appointments

While it sounds newfangled, teledermatology has been around for almost 25 years; the term was first coined in 1995. Under certain circumstances, research shows, teledermatology is as effective as an office visit. One 2018 study supports the use of telederm for management of psoriasis; multiple studies say the same thing regarding follow-up care for eczema. 

“Teledermatology can transcend barriers to care if you don’t have access to specialists or live in a rural area,” Lipoff says. “It also allows doctors to treat less urgent cases without an office visit, which frees up more appointments for patients who really need [them].”

While Lipoff supports teledermatology in many instances, he doesn’t endorse it in the event of an emergency or the sudden onset of an adverse drug reaction. Teledermatology should also be avoided any situations where a physician needs to palpate (physically examine) the skin. And it can’t replace an in-person full-body skin exam. “A follow-up visit with a patient dealing with acne who has just started medication is a perfect example of when teledermatology should be used,” he says. “There’s no need to make someone come to the office for a 10- to 15-minute visit in that instance.”

The American Telemedicine Association suggests that in-person examinations are especially valuable for certain skin issues, including scalp conditions and a few types of lesions. The American Academy of Dermatology, however, recommends that a patient and provider always meet in person at least once before switching to virtual visits — no matter what the issue is. So doctors may vary in how, and when, they incorporate teledermatology into care. 

Live interactive v. store and forward

There are two main forms of teledermatology. The first is called “live interactive,” where the patient and the provider interact via live video. The second, more common method is known as “store and forward,” where the patient sends digital images or other data to their provider.

Both methods have advantages. During live interactive sessions, patients can ask clarifying questions to providers who can, in turn, give them direct instructions in real time. However, live-session videos may have worse image quality than static pictures sent via store and forward. In either instance, Lipoff stresses, the effectiveness of either telederm method depends on the patient being honest and as accurate as possible. 

While live interactive sessions sometimes take longer than in-person appointments, patients save time on travel. That’s one of several benefits cited in telederm research. Patients also say they get treatment faster and take less time off from work with virtual visits.  

The telederm approach hinges on both providers and patients having the right equipment. Doctors can only make diagnoses based on high-quality images — a blurry rash pic won’t cut it. For store and forward sessions, per the AAD, a patient needs a digital camera (whether integrated into another device or stand-alone) with a minimum 800×600 pixel resolution. For live interactive sessions, a patient needs a high-resolution video camera with a minimum resolution of 800×600 pixels, as well as a high-speed internet connection. The AAD last updated these requirements in 2016. 

Be aware of the privacy concerns 

Teledermatology isn’t as casual as snapping a zit pic and texting it to your derm. For the sake of protecting your privacy, photos need to be exchanged through secure channels.  “When a patient reaches out to me via text,” Lipoff says, “I always remind him or her to send pictures through my office’s patient portal, because it’s a more secure method of sending sensitive information.” Dermatologists who provide either form of teledermatology are required to make sure their services comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which protects the confidentiality of health information. Additionally, in order to furnish treatment, teledermatology providers are required to collect written or verbal consent from patients. 

Check your insurance plan first

Insurance coverage for teledermatology varies. Currently, 12 states have passed laws that require private insurance plans to cover and reimburse telemedicine services — including but not limited to teledermatology– at the same rate as in-person care. However, if you have private insurance you should always check the specifics of your plan since the specifics of what is covered can vary. As of October 2019, Medicaid covers live interactive sessions in D.C. all states except Massachusetts. Fourteen states and D.C. cover store and forward with no limitations. Medicare coverage is much more restrictive. Among other things, there’s no coverage for store-and-forward sessions, and patients in rural areas must conduct live interactive sessions from qualifying health centers, i.e. sessions can not be conducted from home. Despite some limitations, teledermatology has proven to be a viable alternative to in office visits. For non-urgent skin care matters, consider FaceTiming your dermatologist in 2020.

Update (4/26/20): In response to COVID-19, both private insurance companies and government health plans have temporarily loosened restrictions on telehealth coverage. Here’s more info.

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