Teledermatology
Encyclopedia
Teledermatology is a subspecialty in the medical field of dermatology
and probably one of the most common applications of telemedicine
and e-health. In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin
conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education.
The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
(SAF) and real time/live interactive teledermatology. Hybrid modes also exist (combining SAF and real time applications).
The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment.
In real-time/ live interactive teledermatology applications, provider and individuals usually interact via live videoconferencing
. It may also involve remote surgery
and the use of telerobotic microscopes in dermatopathology. This mode generally requires more sophisticated and costly technology than used in the SAF mode. Both participants must be available at the same time.
to request diagnosis and treatment. In this field, mobile applications of teledermatology gain importance.
Telediagnosis in the absence of personal contact with health care workers to the individual is complex. It requires active participation of the individual and without appropriate guidance may lead to improper management. However, as a triage
tool, leading the individual directly to the appropriate specialist for his/her disease, it could be very valuable in the near future.
Specialist referral is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication
in order to get a second opinion. The specialist then helps the GP in rendering a diagnosis, providing management options et cetera.
Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as crural ulcers. Crural ulcers are a common skin
condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. Teledermatology can help to reduce the time and costs involved in the follow-up of such conditions.
General medical/health information may be accessed by non-professionals, such as individuals affected by a skin condition, and their relatives, through the internet
. They are also able to join peer support groups with others affected by the same condition.
images (with or without clinical images) are transmitted electronically to a specialist for examination. This can be done on the web-based telediagnostic network Campus Medicus
Dermoscopy (dermatoscopy, epiluminescence microscopy) is the technical field of using an epiluminescence microscope
for viewing skin lesions in magnification in-vivo. It is particularly useful in the early detection of malignant skin lesions (i.e., melanoma). Digital dermoscopic images can be taken with a digital camera
attached to a dermatoscope or special video cameras suited for dermoscopy, e.g. the FotoFinder
. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology.
Virtual slides are made by digitally scanning an entire glass slide at a high resolution
and then sending the images to a storage system. These can be then assessed on a computer screen similar to conventional microscopy, allowing the pathologist to maneuver around the image and view every part of the slide at any magnification.
In the everyday clinical setting, skin biopsies are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person. These limitations can be overcome by teledermoscopically-aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of diagnosis
.
Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists.
platforms. Travellers who develop skin lesions as well as doctors who are on the move in hospital/non-hospital area can benefit from this new development in teledermatology. In order to facilitate access to medical advice and enable individuals to play a more active role in managing their own health status, mobile teledermatology seems to be especially suited for patient filtering or triage
. (i.e. referral based on the severity and character of their skin condition). Another possible practical application is for follow-up of individuals with chronic skin conditions mentioned above (see home care).
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and probably one of the most common applications of telemedicine
Telemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
and e-health. In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education.
The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
Modes of data transmission
Teledermatology (as telemedicine) is practised on the basis of two concepts: Store and forwardStore and forward
Store and forward is a telecommunications technique in which information is sent to an intermediate station where it is kept and sent at a later time to the final destination or to another intermediate station. The intermediate station, or node in a networking context, verifies the integrity of...
(SAF) and real time/live interactive teledermatology. Hybrid modes also exist (combining SAF and real time applications).
The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment.
In real-time/ live interactive teledermatology applications, provider and individuals usually interact via live videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
. It may also involve remote surgery
Remote surgery
Remote surgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements...
and the use of telerobotic microscopes in dermatopathology. This mode generally requires more sophisticated and costly technology than used in the SAF mode. Both participants must be available at the same time.
Health care management
Direct consultation involves an individual with a skin condition contacting a dermatologist via telecommunicationTelecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
to request diagnosis and treatment. In this field, mobile applications of teledermatology gain importance.
Telediagnosis in the absence of personal contact with health care workers to the individual is complex. It requires active participation of the individual and without appropriate guidance may lead to improper management. However, as a triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
tool, leading the individual directly to the appropriate specialist for his/her disease, it could be very valuable in the near future.
Specialist referral is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication
Telecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
in order to get a second opinion. The specialist then helps the GP in rendering a diagnosis, providing management options et cetera.
Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as crural ulcers. Crural ulcers are a common skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. Teledermatology can help to reduce the time and costs involved in the follow-up of such conditions.
Education and information
Medical education/continuous education are a major advantage of telemedicine/e-health. Numerous universities offer online courses, computer based training and Web applications in this field principally aimed at medical students. Specialist training courses via internet are also available, particularly in dermoscopy.General medical/health information may be accessed by non-professionals, such as individuals affected by a skin condition, and their relatives, through the internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
. They are also able to join peer support groups with others affected by the same condition.
Teledermoscopy
In teledermoscopy, digital dermoscopic lesionLesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
images (with or without clinical images) are transmitted electronically to a specialist for examination. This can be done on the web-based telediagnostic network Campus Medicus
Dermoscopy (dermatoscopy, epiluminescence microscopy) is the technical field of using an epiluminescence microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
for viewing skin lesions in magnification in-vivo. It is particularly useful in the early detection of malignant skin lesions (i.e., melanoma). Digital dermoscopic images can be taken with a digital camera
Digital camera
A digital camera is a camera that takes video or still photographs, or both, digitally by recording images via an electronic image sensor. It is the main device used in the field of digital photography...
attached to a dermatoscope or special video cameras suited for dermoscopy, e.g. the FotoFinder
Fotofinder
FotoFinder is a worldwide brand for medical imaging systems. The German company FotoFinder Systems GmbH was founded in 1991 and has developed imaging solutions for the early detection of melanoma and non-melanoma skin cancer....
. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology.
Teledermatopathology
Teledermatopathology is the transmission of dermatopathologic images either in real-time with the aid of a robotic microscope or using a store-and-forward system (transmission as a single file). In the latter method (SAF) a rather new development is the introduction of virtual slide systems (VSS).Virtual slides are made by digitally scanning an entire glass slide at a high resolution
Image resolution
Image resolution is an umbrella term that describes the detail an image holds. The term applies to raster digital images, film images, and other types of images. Higher resolution means more image detail....
and then sending the images to a storage system. These can be then assessed on a computer screen similar to conventional microscopy, allowing the pathologist to maneuver around the image and view every part of the slide at any magnification.
Teledermoscopically-aided dermatopathology
This is the transmission of crucial medical data and dermoscopic as well as clinical images to a pathologist who renders the conventional histopathologic diagnosis.In the everyday clinical setting, skin biopsies are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person. These limitations can be overcome by teledermoscopically-aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
.
Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists.
Mobile Teledermatology
Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor, for instance) uses wireless or mobile equipment (i.e. mobile phones, handheld devices), in contrast to conventional stationary telemedicineTelemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
platforms. Travellers who develop skin lesions as well as doctors who are on the move in hospital/non-hospital area can benefit from this new development in teledermatology. In order to facilitate access to medical advice and enable individuals to play a more active role in managing their own health status, mobile teledermatology seems to be especially suited for patient filtering or triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
. (i.e. referral based on the severity and character of their skin condition). Another possible practical application is for follow-up of individuals with chronic skin conditions mentioned above (see home care).