Teledermatology research review


  • John D. Whited MD, MHS

    Corresponding author
    1. From the Institute for Clinical and Epidemiologic Research, Department of Veterans Affairs Medical Center, Durham, NC and the Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
      John D. Whited, md, mhs VA Medical Center 152 Building 6, 508 Fulton Street Durham, NC 27705 USA E-mail:
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      Dr Whited is supported by a Department of Veterans Affairs Health Services Research and Development Service Research Career Development Award (RCD 98–302). The views expressed in this article are those of the author and do not necessarily represent the views of the United States Department of Veterans Affairs.

John D. Whited, md, mhs VA Medical Center 152 Building 6, 508 Fulton Street Durham, NC 27705 USA E-mail:


Teledermatology consultations can be performed using either store-and-forward or real-time technology. The best-studied aspect of teledermatology is diagnostic reliability, also known as diagnostic agreement. A good level of diagnostic reliability is achieved by dermatologists using both store-and-forward and real-time modalities and is comparable to that found between clinic-based examiners. Less information is available regarding diagnostic accuracy. Current data suggest that teledermatologists reviewing store-and-forward consults achieve accuracy comparable to that of clinic-based dermatologists. When store-and-forward consult systems are used, approximately one in four in-person clinic appointments are averted. Real-time consult systems avoid the need to schedule approximately one in two clinic visits. Store-and-forward technology results in timelier interventions for patients when compared to a conventional referral process. To date, surveys of both store-and-forward and real-time teledermatology consult modalities suggest that patients, referring clinicians, and dermatologists are all highly satisfied with teledermatology consults. Very little has been published about the economic impact of store-and-forward teledermatology, whereas several studies have evaluated real-time modalities. Teledermatology has ranged from a cost-saving strategy to an intervention that incurs greater costs than conventional care, depending on the health care setting and economic perspective. Future research focusing on diagnostic accuracy, clinical outcomes using clinical course or disease status as outcome measures, development of reliable and valid teledermatology-specific survey instruments, and economic analyses that assess cost-effectiveness will help guide future teledermatology program assessments and policy.