Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review

Authors

  • Wynanda A. van Enst Dutch Society for Dermatology and Venereology, Utrecht, The Netherlands https://orcid.org/0000-0003-2679-5844
  • Ying Chao Weng Dutch Society for Dermatology and Venereology, Utrecht, The Netherlands
  • Sophie A. C. Wanten Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
  • Marieke M.B. Seyger Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands https://orcid.org/0000-0003-0516-8294
  • Ewout M. Baerveldt IJsselland Medical Centre, Capelle a/d IJssel, the Netherlands
  • Bernd W.M. Arents Dutch Association for People with Atopic Dermatitis, Nijkerk, The Netherlands https://orcid.org/0000-0001-6884-8014
  • Elke M.G.J. de Jong Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands https://orcid.org/0000-0003-3872-5704
  • Juul M.P.A. van den Reek Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands https://orcid.org/0000-0002-3642-2673

DOI:

https://doi.org/10.2340/actadv.v104.23901

Keywords:

telemedicine, chronic inflammatory skin conditions, remote healthcare, atopic dermatitis, psoriasis, patient-friendly care, dermatology, IMIDs, biologics, systemic treatment

Abstract

Telemedicine, the provision of remote healthcare, has gained prominence, accelerated by the COVID-19 pandemic. It has the potential to replace routine in-person follow-up visits for patients with chronic inflammatory skin conditions. However, it remains unclear whether telemedicine can effectively substitute in-person consultations for this patient group. This systematic review assessed the effectiveness and safety of telemedicine compared with traditional in-person care for chronic inflammatory skin diseases. A comprehensive search in various databases identified 11 articles, including 5 randomized controlled trials (RCTs) and 1 clinical controlled trial (CCT). These studies evaluated telemedicine’s impact on patients with psoriasis and atopic dermatitis, with varying methods like video consultations and digital platforms. The findings tentatively suggest that telemedicine does not seem to be inferior compared with in-person care, particularly in terms of condition severity and quality of life for patients with chronic inflammatory skin diseases. However, these results should be interpreted with caution due to the inherent uncertainties in the evidence. There are indications that telemedicine can offer benefits such as cost-effectiveness, time savings, and reduced travel distances, but it is important to recognize these findings as preliminary, necessitating further validation through more extensive research.

Downloads

Download data is not yet available.

References

Trettel A, Eissing L, Augustin M. Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review. J Eur Acad Dermatol Venereol 2018; 32: 215-224.

https://doi.org/10.1111/jdv.14341 DOI: https://doi.org/10.1111/jdv.14341

Lee JJ, English JC. Teledermatology: a review and update. Am J Clin Dermatol 2018; 19: 253-260.

https://doi.org/10.1007/s40257-017-0317-6 DOI: https://doi.org/10.1007/s40257-017-0317-6

Elsner P. Teledermatology in the times of COVID-19: a systematic review. J Dtsch Dermatol Ges 2020; 18: 841-845.

https://doi.org/10.1111/ddg.14180 DOI: https://doi.org/10.1111/ddg.14180

Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA 2020; 323: 1945-1960.

https://doi.org/10.1001/jama.2020.4006 DOI: https://doi.org/10.1001/jama.2020.4006

Ständer S. Atopic dermatitis. N Engl J Med 2021; 384: 1136-1143.

https://doi.org/10.1056/NEJMra2023911 DOI: https://doi.org/10.1056/NEJMra2023911

Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80: 1029-1072.

https://doi.org/10.1016/j.jaad.2018.11.057 DOI: https://doi.org/10.1016/j.jaad.2018.11.057

Marasca C, Annunziata MC, Camela E, Di Guida A, Fornaro L, Megna M, et al. Teledermatology and inflammatory skin conditions during COVID-19 era: new perspectives and applications. J Clin Med 2022; 11: 1511.

https://doi.org/10.3390/jcm11061511 DOI: https://doi.org/10.3390/jcm11061511

Snoswell C, Finnane A, Janda M, Soyer HP, Whitty JA. Cost-effectiveness of store-and-forward teledermatology: a systematic review. JAMA Dermatol 2016; 152: 702-708.

https://doi.org/10.1001/jamadermatol.2016.0525 DOI: https://doi.org/10.1001/jamadermatol.2016.0525

López-Liria R, Valverde-Martínez MÁ, López-Villegas A, Bautista-Mesa RJ, Vega-Ramírez FA, Peiró S, et al. Teledermatology versus face-to-face dermatology: an analysis of cost-effectiveness from eight studies from Europe and the United States. Int J Environ Res Public Health 2022; 19: 2534.

https://doi.org/10.3390/ijerph19052534 DOI: https://doi.org/10.3390/ijerph19052534

Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32: 657-682.

https://doi.org/10.1111/jdv.14891 DOI: https://doi.org/10.1111/jdv.14891

Nast A, Spuls PI, van der Kraaij G, Gisondi P, Paul C, Ormerod AD, et al. European S3-Guideline on the systemic treatment of psoriasis vulgaris - Update Apremilast and Secukinumab - EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2017; 31: 1951-1963.

https://doi.org/10.1111/jdv.14454 DOI: https://doi.org/10.1111/jdv.14454

El Komy MHM, Chiricozzi A, van de Kerkhof P, Armstrong A, Diamei V, Hsu C, et al. Telemedicine and psoriasis: a review based on statements of the telemedicine working group of the International Psoriasis Council. JEADV Clin Practice 2023; 2: 19-31.

https://doi.org/10.1002/jvc2.93 DOI: https://doi.org/10.1002/jvc2.93

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.

https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: 4898.

https://doi.org/10.1136/bmj.l4898 DOI: https://doi.org/10.1136/bmj.l4898

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926.

https://doi.org/10.1136/bmj.39489.470347.AD DOI: https://doi.org/10.1136/bmj.39489.470347.AD

Van Os-Medendorp H, Koffijberg H, Eland-De Kok PCM, Van Der Zalm A, De Bruin-Weller MS, Pasmans SGMA, et al. E-health in caring for patients with atopic dermatitis: a randomized controlled cost-effectiveness study of internet-guided monitoring and online self-management training. Br J Dermatol 2012; 166: 1060-1068.

https://doi.org/10.1111/j.1365-2133.2012.10829.x DOI: https://doi.org/10.1111/j.1365-2133.2012.10829.x

Parsi K, Chambers CJ, Armstrong AW. Cost-effectiveness analysis of a patient-centered care model for management of psoriasis. J Am Acad Dermatol 2012; 66: 563-570.

https://doi.org/10.1016/j.jaad.2011.02.022 DOI: https://doi.org/10.1016/j.jaad.2011.02.022

Chambers CJ, Parsi KK, Schupp C, Armstrong AW. Patient-centered online management of psoriasis: a randomized controlled equivalency trial. J Am Acad Dermatol 2012; 66: 948-953.

https://doi.org/10.1016/j.jaad.2011.05.047 DOI: https://doi.org/10.1016/j.jaad.2011.05.047

Bergmo TS, Wangberg SC, Schopf TR, Solvoll T. Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trial. Acta Paediatr 2009; 98: 316-320.

https://doi.org/10.1111/j.1651-2227.2008.01033.x DOI: https://doi.org/10.1111/j.1651-2227.2008.01033.x

Ford AR, Gibbons CM, Torres J, Kornmehl HA, Singh S, Young PM, et al. Access to dermatological care with an innovative online model for psoriasis management: results from a randomized controlled trial. Telemed J E Health 2019; 25: 619-627.

https://doi.org/10.1089/tmj.2018.0160 DOI: https://doi.org/10.1089/tmj.2018.0160

Armstrong AW, Chambers CJ, Maverakis E, Cheng MY, Dunnick CA, Chren MM, et al. Effectiveness of online vs in-person care for adults with psoriasis: a randomized clinical trial. JAMA Netw Open 2018; 1: e183062.

https://doi.org/10.1001/jamanetworkopen.2018.3062 DOI: https://doi.org/10.1001/jamanetworkopen.2018.3062

Armstrong AW, Johnson MA, Lin S, Maverakis E, Fazel N, Liu FT. Patient-centered, direct-access online care for management of atopic dermatitis: a randomized clinical trial. JAMA Dermatol 2015; 151: 154-160.

https://doi.org/10.1001/jamadermatol.2014.2299 DOI: https://doi.org/10.1001/jamadermatol.2014.2299

Kornmehl H, Singh S, Johnson MA, Armstrong AW. Direct-access online care for the management of atopic dermatitis: a randomized clinical trial examining patient quality of life. Telemed J E Health 2017; 23: 726-732.

https://doi.org/10.1089/tmj.2016.0249 DOI: https://doi.org/10.1089/tmj.2016.0249

Young PM, Chen AY, Ford AR, Cheng MY, Lane CJ, Armstrong AW. Effects of online care on functional and psychological outcomes in patients with psoriasis: a randomized controlled trial. J Am Acad Dermatol 2023; 88: 364-370.

https://doi.org/10.1016/j.jaad.2019.05.089 DOI: https://doi.org/10.1016/j.jaad.2019.05.089

Armstrong AW, Ford AR, Chambers CJ, Maverakis E, Dunnick CA, Chren MM, et al. Online Care Versus In-Person Care for Improving Quality of Life in Psoriasis: A Randomized Controlled Equivalency Trial. J Invest Dermatol 2019; 139: 1037-1044.

https://doi.org/10.1016/j.jid.2018.09.039 DOI: https://doi.org/10.1016/j.jid.2018.09.039

Oostveen AM, Beulens CA, Van De Kerkhof PCM, De Jong EMGJ, Seyger MMB. The effectiveness and safety of short-contact dithranol therapy in paediatric psoriasis: a prospective comparison of regular day care and day care with telemedicine. Br J Dermatol 2014; 170: 454-457.

https://doi.org/10.1111/bjd.12621 DOI: https://doi.org/10.1111/bjd.12621

Kohn LL, Pickett K, Day JA, Torres-Zegarra C, Plost G, Gurnee E, et al. When is synchronous telehealth acceptable for pediatric dermatology? Pediatr Dermatol 2022; 39: 236-242.

https://doi.org/10.1111/pde.14919 DOI: https://doi.org/10.1111/pde.14919

Mossfeldt Nickelsen NC. The infrastructure of telecare: implications for nursing tasks and the nurse-doctor relationship. Sociol Health Illn 2019; 41: 67-80.

https://doi.org/10.1111/1467-9566.12781 DOI: https://doi.org/10.1111/1467-9566.12781

Vittrup I, Andersen YMF, Skov L, Wu JJ, Agner T, Thomsen SF, et al. The association between atopic dermatitis, cognitive function and school performance in children and young adults. Br J Dermatol 2023; 188: 341-349

https://doi.org/10.1093/bjd/ljac058 DOI: https://doi.org/10.1093/bjd/ljac058

Benedetto V, Filipe L, Harris C, Spencer J, Hickson C, Clegg A. Analytical frameworks and outcome measures in economic evaluations of digital health interventions: a methodological systematic review. Med Decis Making 2023; 43: 125-138.

https://doi.org/10.1177/0272989X221132741 DOI: https://doi.org/10.1177/0272989X221132741

Published

2024-05-15

How to Cite

van Enst, W. A., Weng, Y. C., Wanten, S. A. C., Seyger, M. M. ., Baerveldt, E. M., Arents, B. W., … van den Reek, J. M. (2024). Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review. Acta Dermato-Venereologica, 104, adv23901. https://doi.org/10.2340/actadv.v104.23901

Funding data

  • ZonMw
    Grant numbers 80-83900-98-20013