International Psoriasis Council

Advancing Knowledge. Improving Care.

Advancing Knowledge. Improving Care.

Opportunities and Limitations of Telemedicine in the Diagnosis and Treatment of Psoriasis

Experts provide a global consensus statement regarding telemedicine in psoriasis management, considering cultural and technological differences.

Psoriasis is a skin condition that presents unique challenges, such as the need for long-term management. With the popularization of “telemedicine” as a convenient mode of communication between doctors and patients post-pandemic, defining best practices for its use in psoriasis treatment is critical. The International Psoriasis Council recently installed a new working committee to establish a road map for developing and implementing telemedicine focused on psoriasis diagnosis and management.

The COVID-19 pandemic introduced unprecedented limitations on in-person medical examinations. As a result, remote delivery of medical services has become an increasingly important component of healthcare. “Telemedicine” (TM), a healthcare innovation that seeks to reduce the need for physical contact during medical diagnosis and treatment, is gaining popularity among physicians. However, several barriers to its implementation must be overcome. For instance, only a few countries currently have regulatory guidelines for TM, and most require a policy framework to determine reimbursements.

Teledermatology (TD), the treatment and diagnosis of skin diseases in TM, faces several additional barriers to implementation. Although skin diseases are often diagnosed through visual cues, photos or videos may be inadequate for diagnosing conditions like psoriasis. Moreover, since in-person interaction between the doctor and patient has traditionally been considered optimal for psoriasis care, the transition to remote care may be difficult.

Until now, TM has primarily been focused on “first contact visits.” To this end, The International Psoriasis Council (IPC) recently installed a working group of experts to review the state of TD and propose new ways in which they can integrate and facilitate the implementation of TM in psoriasis care. The group, chaired by Alexander Navarrini and co-chaired by Joel Gelfand, also included Peter van de Kerkhof, Mohamed H. M. El Komy, Andrea Chiricozzi, April Armstrong, Vahid Diamei, and Christophe Hsu. The team formulated statements on various aspects of TM according to the nominal group technique to reach a consensus on these statements and explore the variation of opinions. A total of 36 statements regarding TD and psoriasis were agreed upon and published in the JEADV Clinical Practice. According to Prof. van de Kerkhof, the corresponding author of the article, “These statements offer valuable insights into the current and future state of TD in psoriasis care.

The working group explored the utility and limitations of digital communication techniques like store and forward (SAF) and live video conferencing (LVC) in diagnosis and treatment. The members also explored the value of “hybrid TM, ” which incorporates in-person and remote communication. Following these discussions, the IPC will establish a professional forum to inform physicians on best practices in TM and collaborate with healthcare organizations to improve access to TD. Apart from the inherent value of communication techniques, the group investigated each technique’s legal aspects, cost-effectiveness, and reimbursement potential. After examining these aspects, the expert group has called for increased awareness about data security and reiterated the urgent need for a reimbursement system. As mentioned earlier, restrictions due to the COVID-19 pandemic have spurred a renewed interest in TM. Therefore, the group investigated the state of TM consultation during the pandemic and the lessons learned in its wake. To make these lessons accessible to physicians worldwide, information regarding new findings and innovations from the pandemic will be available on the IPC website. While virtual ways of working have advantages, especially in the early diagnosis of psoriasis, the expert group observed that it might also have significant limitations, necessitating in-person consultations during certain stages of the disease. While the group acknowledges that TD can be as effective as in-person consultations in some cases, they also recommend sharing experiences in discussion forums to optimize its use. The increased use of artificial intelligence to improve the accuracy of virtual diagnosis and ensure reproducibility in TD must also gain impetus. The experts agreed that TD is adequate for early and continued treatment of skin diseases, including psoriasis, using topical therapies and biologics. They also emphasized the potential of TD in extending treatment to underserved populations. “TD may help increase access to professional dermatological care for medically disadvantaged populations,” observes Dr. Navarrini. In conclusion, the expert statements strongly recommend exploring the utility of TM in treating skin diseases while being mindful of its limitations.

Reference

Telemedicine and Psoriasis: A Review Based on Statements of the Telemedicine Working Group of the International Psoriasis Council. El Komy M, Chiricozzi A, van de Kerkhof P, et al. JEADV Clin Prac. 2022 Dec. doi 10.1002/jvc2.93

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