An overview of Teledermatology

1. Dr. Pradnya Londhe
Assistant Professor,
Department of Dermatology, Venereology and Leprosy,
Grant Government Medical College &
Sir J. J. Group of Hospitals,MUMBAI
.

3.  The study and practice of dermatology using interactive
audio, visual, and data communications from a distance is
called teledermatology1,2.
 A teledermatology tool refers to the technology or
modality used to deliver dermatology care.
 The application of teledermatology technology to deliver
dermatology care is called teledermatology practice (TP)3.

4. Teledermatology tools are broadly categorized as data sent
as
1. Static images, store-and-forward teledermatology
(SAFT);
2. Motion images or videoconferencing (VC);
3. A combination of both static and motion images, hybrid
teledermatology (HT). The above tools are called
stationary TP tools4-9.

5. Aims:
 To study the process of teledermatology to understand and
analyse the functioning of the telemedicine unit.
 To analyse the quantum of patient consultations and the
indications for consultation.
Objectives:
 To identify any lacunae in the functioning of the
teledermatology unit.
 To suggest possible measures for improvement.

6.  This retrospective study was carried out in the telemedicine
unit of J. J. Hospital in May 2015 for 2 weeks
 Patients referred between November 2014 to April 2015 were
studied.
 Sir J. J. Hospital is the nodal specialist centre.
 PROGNOSYS software – a SAFT developed by a vendor of the
ISRO.

7. Logging onto the website Opening the patient worksheet

8. Accessing and studying the clinical history and photographs

9. Giving treatment advice and completing the process of consultation

10.  Six hundred and fifty-eight respondents
 625 assessed by SAFT & 33 by VC
SAFT
95%
VC
5%
Proportion of SAFT versus VC

11. Male
53%
Female
47%
352 males and 306 females

12. 265
87
208
98
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adults Children
Females
Males

13. Sr. No. Referring Hospital SAFT VC Distance from Mumbai (kms)
1 BULDHANA (BULD) 1 - 530
2 ALIBAG (CHAL) 1 - 90
3 BEED (CHBD) 1 - 400
4 HINGOLI (CSHG) 207 - 560
5 NASHIK (CSNK) 6 - 170
6 BHANDARA (DHGB) 2 - 900
7 WASHIM (DHWM) 2 7 560
8 HINGANGHAT (HSDH) 2 - 760
9 KARANJA (KSDH) 166 8 600
10 GONDIA (KTSD) 3 - 1000
11 MALEGAON (MSDH) 2 - 270
12 THANE (RHWD) 1 - 80
13 BASMAT (SDHB) 33 1 552
14 DHARNI (SDHD) 7 - 595
15 KARAD (SDHK) 1 - 300
16 MANGAON (SDHM) 28 - 140
17 SHEGAON (SDHS) 1 14 560
18 UDGIR (SDHU) 16 - 530
19 WARORA (SDHW) 1 1 820
20 TUMSAR (SDTH) 103 1 950
21 SHIRPUR (SSDH) 35 - 375
22 TIRORA (GONDIA) (TSDH) 6 - 975
23 JALGAON(JALG) - 1 410
TOTAL 625 33 525 (Average)

14. 0
200
400
600
800
1000
1200
Approxima
te
Distance

15.  The average geographic distance of a teleconsultation was
525 km.
 The farthest referring centre was Gondia which is
approximately 1000 km from Mumbai, while the closest
referral came from Thane district.
 Hingoli, which is approximately 560 km from Mumbai, had the
largest number of referrals.

16. 174
108
53 51 51 47 43
33
26 24
16 15
8 5 2 1 10
20
40
60
80
100
120
140
160
180
200
Number

17.  Infections were the major cause of teledermatology referrals,
f/b inflammatory dermatoses like psoriasis and eczemas.
 Follow-up consultations: 137/ 658 (21%) followed up.
 Twelve (12) patients could not be offered consultation because
of poor quality of images, and have not been included in this
study.

18.  Patients consulted by store-and-forward teledematology
(SAFT) – 95%
 Our results correspond to those by Kantharaj3, Eedy4 and
Mahendran6 who also noted that SAFT is the most commonly
used and relevant teledermatology tool.
 However, the referring doctor has to take a proper history
with thorough emphasis on previous medical and drug history.
 A clear clinical photograph - most essential requirement of
the teledermatologist.

19.  The M:F ratio -1.15, which corresponds to the sex ratio of any
outpatient department in a government or civil hospital6. It
also corresponds to the sex ratio of the general population in
India12.
 The number of children respondents was 185 (28%).

20.  Teledermatology referrals were received from 23 districts,
the farthest being Gondia (1000 km) and closest Thane (80
km).
 The average distance thus calculated was 525 km. The
approximate time taken to travel this distance for a face-
to-face consultation is 10 hours. Thus teledermatology
saves significant amount of time as well as money.

21.  Infections, fungal (dermatophytosis and pityriasis versicolor) as
well as bacterial, are the commonest cause for referral. These
may be contagious as well as communicable.
 Hence teledermatology is also important in stressing the
importance of personal hygiene and preventing person-to-
person transmission.

22.  The inflammatory dermatoses (psoriasis, eczemas, acne etc.) are
extremely symptomatic and a great cause of psychological
distress.
 Patients suffering from these conditions constitute the most
regular patients, as well as the most dissatisfied patients.
 Good counselling is one of the pillars of management of these
conditions.
 VC or HT may prove better than SAFT because the specialist can
simultaneously counsel the patient.

23.  These conditions do not require any investigations, and can be
safely diagnosed by clinical examination of the photographs.
 Teledermatology also assisted greatly in the diagnosis of
chronic and insidious conditions. These include leprosy,
cutaneous TB, BCC and LE.
 Teledermatology may assist the referring doctor to create a
management algorithm for these patients, so that quality of
life is maintained.

24.  In cases of photodermatoses, explaining to the patient the need
for strict photoprotection is a very important part of treatment.
VC or HT may play an important role in this.
 Only 137/658 (21%) of patients had a follow-up. More than half
of the patients sought treatment for infections, which resulted
in complete cure.
 However, in inflammatory skin conditions, the patients prefer to
follow up with the referring doctor because he can attend to
them in person. In such cases, VC or HT may make a positive
difference10,11.

25.  12 patients were not included because the photographs were
poor and unclear. This can be rectified by standardisation in
capturing clinical photographs.
 Telemedicine and teledermatology undoubtedly embody the
virtues of ‘TRANSPARENCY’ and ‘ACCOUNTABILITY’. It is thus a
good example of an ideal and successful e-governance
project.

26.  Fewer numbers of follow-ups in the study
 Feedback from many patients could not be elicited
 A larger sample size (longer duration with larger number of
respondents) may provide more relevant data to
strengthen the teledermatology services.

27.  A SAFT generated diagnosis and management plan is good and
teledermatology benefits remote geographic regions.
 SAFT is the most cost-effective and convenient teledermatology
tool.
 The time taken for consultation is least for SAFT and more in VC
and HT.
 It is very important that the photographs be taken properly.
 VC using a webcam is not very useful because the poor resolution
reduces the chances of a correct diagnosis.
 Conversely, patient satisfaction is highest with a hybrid
teledermatology (HT) protocol.

28.  VC needs appropriate equipment and is expensive. However,
better communication can result in a better history and
diagnoses.
 Teledermatology is not very useful in difficult to manage cases
(DMC) such as erythroderma,VBDs etc. However, the
development of an online discussion group (ODG) may result in
a consensual treatment algorithm.
 Mobile teledermatology (MT) provides access to patient data
anywhere without requiring the physical presence of the
dermatologist at the telemedicine unit. This ensures optimal
use of resources and time.
 Telepathology and teledermoscopy can also be assimilated in
the protocol.

30.  Kanthraj GR. Newer insights in teledermatology practice. Indian J DermatolVenereolLeprol 2011;77:276-87.
 Perednia DA, Brown NA. Teledermatology: One application of telemedicine. Bull Med Libr Assoc.1995; 83:42- 47.
 Kanthraj GR. Classification and design of teledermatology practice: What dermatoses? Which technology to apply? J
EurAcadDermatolVenereol 2009;23:865-75.
 Eedy DJ, Wootton R. Teledermatology: A review. Br J Dermatol 2001;144:696-707.
 Massone C, Wurm EM, Hofmann-Wellenhof R, Soyer HP. Teledermatology: An update. SeminCutan Med Surg
2008;27:101-5.
 Mahendran R, Goodfield MJ, Sheehan-Dare RA. An evaluation of the role of a store-and-forward teledermatology
system in skin cancer diagnosis and management. ClinExpDermatol 2005;30:209-14.
 Whited JD, Hall RP, Simel DL, Foy ME, Stechuchak KM, Drugge RJ, et al. Reliability and accuracy of dermatologists’
clinic-based and digital image consultations. J Am AcadDermatol 1999;41:693-702.
 High WA, Houston MS, Calobrisi SD, Drage LA, McEvoy MT. Assessment of the accuracy of low-cost store and forward
teledermatology consultation. J Am AcadDermatol 2000;42:776-83.
 Tucker WF, Lewis FA. Digital imaging: A diagnostic screening tool? Int J Dermatol 2005;44:479-81.
 Wootton R, Blooomer SE, Corbet R, Eedy DJ, Hicks N, Lotery HE, et al. Multicenter randomized control trial
comparing real time teledermatology with conventional outpatient dermatological care: Societal cost benefits
analysis. BMJ 2000;320:1252-6.
 Baba M, Seçkin D, Kapdagli S. A comparison of teledermatology using store-and-forward methodology alone, and in
combination with Web camera videoconferencing. J TelemedTelecare 2005;11:354-60.
 Government of India Census 2011. Accessed on 17/05/2015 at http://www.census2011.co.in/sexratio.php
 Kansal S, Kumar A, Singh I, Mohapatra S. A Study on Morbidity Pattern in Rural Community of Eastern Uttar Pradesh.
Indian J PrevSoc Med 2008;39(3-4):184-88.
 Baur B, Sarkar J, Manna N, Bandyopadhyay L. The Pattern of Dermatological Disorders among Patients Attending the
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31.  Dr. Ratnakar Kamath
 Dr. M.M. Kura
 Dr. Nitin Bavdekar , Medical superintendent & in-charge of
telemedicine, Sir J.J. hospital
 MR. SAYED MAHEDI A., State Coordinator
 MS. PRIYANKA KAMBLE, Facility Manager
Of the Telemedicine Unit, Sir J. J. Hospital

32. THANK YOU FOR
YOUR PATIENCE