FROM JAMA DERMATOLOGY
Parents generally can take photographs of good enough quality to allow accurate teledermatology diagnoses to be made of many pediatric skin conditions, said Daniel M. O’Connor, MD, of the Children’s Hospital of Philadelphia, and his associates.
Skin conditions make up 10%-30% of the approximately 200 million pediatric outpatient visits each year, Dr. O’Connor and his colleagues said. But there are fewer than 300 board-certified U.S. pediatric dermatologists for the nation’s nearly 75 million children. So, the possibility of using photos taken by parents for distant pediatric dermatologists to assess is an attractive one.
In a study of 40 patient-parent dyads, parents took photos of their child’s lesions with smartphones and sent the images to pediatric dermatologists. The children’s lesions were later assessed in person by a pediatric dermatologist.
Concordance between photograph-based vs. in-person diagnosis was 83%. In three cases, diagnoses could not be made by the remote dermatologist because of poor photograph quality. When those cases were excluded, concordance was 89% between photograph-based vs. in-person diagnosis. Concordance for birthmarks was 100%, 92% for rashes, and 64% for alopecia-related diagnoses. Of four cases that were misdiagnosed, there were three cases of alopecia and one nodule.
Half the parents received a simple, three-step instruction sheet on smartphone photography. There was no statistical difference in diagnostic concordance between the parents who received the instruction sheet and those who didn’t.
“When dealing with categories with low concordance, such as alopecia and nodules and tumors, teledermatology practitioners may need to be cautious about attempting definitive diagnoses in some cases, and may need to refer patients for in-person consultation,” Dr. O’Connor and his associates wrote. “For these cases, teledermatology may still serve as a triage tool. For example, patients with suspicious nodules could be referred for expedited appointments in specialty clinics, whereas patients with isolated alopecia could be scheduled for routine visits. Conversely, in diagnostic categories with high concordance, such as birthmarks and rashes, certain cases could be definitively diagnosed and treated exclusively using teledermatology (for example, mild acne).”
Read more in JAMA Dermatology (2017 Nov 15. doi: 10.1001/jamadermatol.2017.4280 ).