Teledermatology: current perspectives

João Antonio de Queiroz Oliveira,1,2 Iago Souza Wolff,1,2 Laura Defensor Ribeiro,1,2 Maíra Viana Rego Souza e Silva,1,2 Leonardo Teixeira Domingos Silva,1,2 Milena Soriano Marcolino1,2 1Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; 2Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil Purpose: The purpose of this study was to update the current status on accuracy, reliability, and clinical outcomes and establish barriers and perspectives of teledermatology strategies.Methods: MEDLINE was searched to identify relevant studies published until April 2017, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Quality assessment was performed. Results: Of the 2,525 articles retrieved, 45 manuscripts (44 studies, 7,033 patients) were included in the review, 42 of them in developed countries. The studies were organized in three groups, according to their content: clinical outcomes (n=16), diagnostic accuracy (n=9), and diagnostic reliability (n=19).Teledermatology diagnosis is accurate, with sensitivity and specificity ranging from 73% to 97% and 73% to 83%, respectively, when compared to face-to-face (FTF) diagnosis and/or histopathological results. The diagnostic agreement between teledermatologists and FTF dermatologists showed high variability, from fair (kappa 0.35) to almost perfect (kappa 0.91), but in most of the studies the agreement was almost perfect. Studies that used educational teledermatology strategies showed benefits in improvement of severity of skin conditions, adherence to therapy, and higher quality-of-life score; and anxiety reduction in patients with psoriasis, when compared to usual care. Overall, interventions focused on clinical outcomes showed at least similar results when compared to usual care. Interventions connecting patients to specialists or health care practitioners to specialists did not show statistical difference in the rate of healing, severity, and/or clinical evolution of skin conditions when compared to usual care, except for one study with methodological issues.Conclusion: Overall, teledermatology demonstrated good performance in comparison to conventional consultations for diagnostic agreement and diagnostic accuracy. The evidence suggests there is no difference in clinical outcomes with teledermatology in most cases, but adequately powered studies for subgroups of skin conditions are needed. Keywords: telemedicine, dermatology, review, health impact assessmen