Impact of store-and-forward consumer to physician teledermatology as compared to in-person visits for patients with periorificial dermatitis: A retrospective study

• DOI: 10.1016/j.jaad.2024.07.1462
• Publication Date: 2024-07-20T23:10:16Z
• Authors: Vrusha K. Shah; Alexandria Tso; Deesha D. Desai; Joseph C. English
• Keywords: Teledermatology; Medical record

To the Editor: Periorificial dermatitis is a common, often chronic inflammatory skin condition appearing in ocular, nasal, and oral facial regions predominately women.1Lipozencic J. Ljubojevic S. Perioral dermatitis.Clin Dermatol. 2011; 29: 157-161https://doi.org/10.1016/j.clindermatol.2010.09.007Abstract Full Text PDF PubMed Scopus (35) Google Scholar Previously, we showed that store-and-forward physician to outpatient teledermatology (TD) improves provides proper diagnoses treatment/management recommendations aligned with established standard of care.2Shah V.K. English 3rd, J.C. Store-and-forward care for patients periorificial after an initial primary consultation: retrospective study.J Am Acad 2023; 88: 904-906https://doi.org/10.1016/j.jaad.2022.10.036Abstract (2) This analysis extends upon our previous study by evaluating impact another unique TD modality, consumer TD, on diagnosis management through direct comparison seen in-person. Data investigated University Pittsburgh Medical Center (UPMC) Health System Epic electronic medical record revealed 394 250 in-person cases from 2016 2023. Patients residing Pennsylvania using uploaded images eruption completed survey secure, transparent,3Resneck Jr., J.S. Abrouk M. Steuer et al.Choice, transparency, coordination, quality among direct-to-consumer telemedicine websites apps treating disease.JAMA 2016; 152: 768-775https://doi.org/10.1001/jamadermatol.2016.1774Crossref (79) Insurance Portabilabity Accountability Act-compliant UPMC Teledermatology website (edermatology.upmc.com) following recommendations.3Resneck The dermatology team, consisting board-certified dermatologists advanced practice providers under supervision, was notified about consults sent back their diagnosis, treatment, follow-up recommendations, allowing rapid patient-provider communication My patient portal. Patient descriptive factors are displayed Table I. Chi-square tests 0.05 level significance were used generate P values. via both majority female (88.6% vs 88.8%; = .931), Caucasian (92.4% 95.6%; .104), insured (P 87.8% 87.2%; .817). younger (29.95 45.47 years; < .0001), presented new-onset (79.2% 60.8%; .001), more commonly birth control pills (14.7% 7.3%; .001).Table IPatient cohortsTD∗TD abbreviation teledermatology.(n 394)In-person visit (n 250)P value†Significant values .05) bolded.Sex Female (%)349, 88.6%222, 88.8% Male (%)45, 11.4%28, 11.2%.931Age at Mean (standard error [SE])29.95 ± 0.6545.47 0.96<.001Race Caucasian364, 92.4%239, 95.6%.104 African American7, 1.8%3, 1.2%.748‡Fisher's exact test had least one cell count expected value less than 5; marked double dagger. Asian2, 0.5%4, 1.6%.214‡Fisher's Multiracial1, 0.3%0, 0%1.000‡Fisher's Other2, 0.5%0, 0%.524‡Fisher's Unknown or N/A18, 4.6%4, 1.6%.043New New condition312, 79.2%152, 60.8% Follow-up82, 20.8%98, 39.2%<.001Onset Median6 mo4.4 mo—Patient time assessment (d)3 d21 d—Insurance status Insured346, 87.8%218, 87.2%.817 Uninsured46, 11.7%31, 12.4%.782 Other not applicable2, 0.5%1, 0.4%1.000Other Mood disorder comorbidity125, 15.1%101, 15.3%.877 dermatologic condition94, 11.3%94, 14.3%.088 Any atopic dermatitis53, 6.4%31, 4.7%.165 Uses alcohol218, 26.3%164, 24.9%.556 pill122, 14.7%48, 7.3%<.001 Sexually active105, 12.7%101, 15.3%.134 Overweight/obese/metabolic disorder113, 13.6%119, 18.1%.018∗ teledermatology.† Significant bolded.‡ Fisher's Open table new tab team (advanced supervising dermatologists) managing significantly changed/modified treatment (99.0% 95.2%; .003) as II. 44.9% 61.6% recommended topical-only treatments including sulfacetamide sodium-sulfur, metronidazole, clindamycin, moisturizer/emollients. 51.0% 35.6% .0001) (doxycycline) topical combination treatment. A (57.4%) (53.6%) .349) advised discontinue steroids.Table IITreatment, follow-up, diagnostic concordance bolded.Systemic/topical therapy change390, 99.0%238, 95.2%.003 Discontinuing steroids first line treatment226, 57.4%134, 53.6%.349 Topical only177, 44.9%154, 61.6%<.001 Oral only16, 4.1%5, 2.0%.151 Both topical/oral treatment201, 51.0%89, 35.6%<.001 None0, 0%2, 0.8%.150Did follow-up? Yes, timeline requested51, 12.9%75, 30.0%<.001 but requested57, 14.5%40, 16.0%.596 No286, 72.6%135, 54.0%<.001Median days those returning requested [SE])40.63 3.277.25 8.5<.001Mode up In-person20, 39.2%71, 94.7%<.001 TD22, 43.1%2, 2.7%<.001 Telemedicine‡Telemedicine refers synchronous video dermatologist provider supervision.9, 17.6%2, 2.7%.007§Fisher's section sign.Mode In-person12, 21.1%34, 85.0%<.001 TD42, 73.7%3, 7.5%<.001 Telemedicine3, 5.3%3, 7.5%.688Follow-up analysisTD 19)‖The total number cohort 19 instead 20 specified heading "Mode team" because internal medicine physician, dermatology, therefore excluded analysis.In-person 71)P valueDiagnostic between Yes16, 84.2%66, 93.0%.358 No3, 15.8%3, 4.2%.106§Fisher's sign. Diagnosis addressed0, 2.8%1.000§Fisher's sign.Kappa statistic (κ)¶Our kappa suggested no agreement due inadequate sample size adequate power.0.000——∗ Telemedicine supervision.§ sign.‖ analysis.¶ Our power. All 4-12 weeks if improvement. versus likely (12.9% 30.0%; .001) preferred (43.1% 2.7%; Importantly, member, similar (84.2% 93.0%; .358). shows comparable accuracy consultations, suggesting utility patients. Study limitations include analysis, sample, decreased adherence As studies found rates patients,4Khosravi H. Zhang Siripong N. Moorhead A. Iii Comparing acne follow-up: visits.Dermatol Online 2020; 26 (13030/qt1424r02m)Crossref future prospective should focus improving education encourage continued care. None disclosed.