Guidance Outlines Framework for Successful Telemedicine Use in Patients With Psoriasis

The National Psoriasis Foundation Telemedicine Task Force outlined its guidance for management of psoriatic disease via telemedicine in a new article published in JAAD International.

“Although the provision of telehealthcare should not completely replace high-quality, in-person dermatologic or rheumatologic visits, the convenience and collaborative nature of teledermatology may lead to expanded access and expedited care in the appropriate setting, whether it be in a virtual or in-person visit,” the authors wrote.

Throughout the COVID-19 pandemic, telemedicine utilization among dermatologists increased substantially, from under 15% to more than 95% following the global health emergency. The continued use of this technology highlights it can be used beyond COVID-19 and helps ensure continuity of care and improved access to health care more broadly, the authors said.

When it comes to diagnoses of inflammatory skin conditions like psoriasis, virtual visits rely in part on the quality of live video images and photographs patients provide. When these are properly provided, physicians can make assessments of disease severity using Psoriasis Area and Severity Index (PASI) scores. In addition, online training videos could be used to help patients asses PASI and body surface area (BSA) affected by psoriasis.

“Physicians may also guide patients to perform thorough self-evaluations of other areas of their body that might be difficult to appreciate on live video or photographs, such as the scalp and genitals,” the authors said.

Past research shows collaborative and efficient teledermatology models can equivalently improve PASI scores, BSA, and dermatology life quality index compared with in-person care. Moreover, distance, incapacity, and transportation costs can prevent many patients with psoriasis from seeking in-person care, while teledermatology can reduce travel costs and time to start of care.

The virtual care option also “allows physicians to reach patients with psoriasis in institutions with restricted access”; for example, those who are institutionalized for psychiatric reasons. It can also be beneficial for imprisoned patients. However, some limitations may prevent optimal care provision via telemedicine. These can include low quality of photos and videos and a lagging internet connection.

Regarding psoriatic arthritis, “accurate determinations of disease activity may be limited, in some cases of complex joint disease, without an in-person physical examination,” the authors cautioned. One way to overcome this barrier may be to employ a flexible approach to teledermatology for psoriatic arthritis. In this scenario, simpler and established cases could be managed via virtual visits and complex cases could be followed in an in-person fashion, they explained.

Teledermatology is also not a direct replacement for in-person care, the researchers added, but when used correctly, it can be a valuable tool for patients with psoriasis.

Investigators summed up their thoughts in 6 position statements:

• Teledermatology is a reasonable alternative for providing long-term management of patients with psoriasis
• It’s important to guarantee access to in-person care for patients with psoriasis and ensure that telemedicine does not replace this availability
• A discussion about available virtual evaluation tools should be completed to determine what form of teledermatology is best for a patient-physician encounter
• Developing better technology—allowing for reliable, high-quality image capture and appropriate workflows that emulate a dermatology in-person practice—is important in helping expand the applicability and utility of teledermatology
• A flexible approach to teledermatology for psoriatic arthritis proposes the efficient utilization of in-person and virtual care based on the severity and complexity of the disease
• Telemedicine has the potential to allow for collaborative connected-health models to expand the reach of experienced dermatologists to help comanage patients with primary care physicians and community dermatologists who may be uncomfortable with newer systemic treatments for the condition

Reference

Pelet del Toro N, Yahia R, Feldman SR, et al. National Psoriasis Foundation Telemedicine Task Force guidance for management of psoriatic disease via telemedicine. JAAD Int. Published online April 4, 2023. doi:10.1016/j.jdin.2023.02.018