Faculty Bibliography

Systemic Sclerosis (SSc) is an autoimmune condition characterized by cutaneous sclerosis and the potential for internal organ involvement.¹ Given the multisystem nature of SSc, multiple disciplines are often involved in its management. However, while the skin is affected in more than 90% of patients,² dermatologists are variably involved in the management of SSc, potentially first evaluating patients only late in the disease course, or at times not at all.

BACKGROUND:Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data. METHODS:This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic. RESULTS:There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS/CONCLUSIONS:Selection bias and single-center nature. CONCLUSIONS:Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.