gms | German Medical Science

Background: Telemedicine increasingly established itself ashas become an important element of health care in many countries and profited from the technological progrcess that happened overof the last two decades. Due to the visual character of itsthe dermatological speciality, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation.

Objective: To detect identify the use of teledermatology across the world with regard to geographical distribution, treated indications, research questions, geographical distribution, its reliability in diagnosis and therapy compared to classic face-to-face consultations and to gain insight of potential developments in the future.

Methods: Systematic literature review search of the medical databases Pubmed Medline uand Embase for eligible publications in October 2015 and cross-validation search in March 2016. Search results were reviewed following predefined inclusion and exclusion criteria.

Results: Overall we found The search resulted in 652 publications on teledermatology of which 204 had eligiblemet the inclusion criteria for analysis. The majority of dermatological indications for telemedical consultations were not specified and included all various kinds of skin diseases (n=125), followed by skin cancer (n=51) and wounds (n=12). Few studies concentrated on Cchronic inflammatory diseases such as Psoriasis (n=7) and atopic dermatitis (n=4) represented only a small fraction. Research questions predominantly focused on concordance (n=156), effectiveness (n=30) and cost-effectiveness (n=24) in order to determine the value. Teledermatology proved to be a very reliable consultation tool in the majority of studies (n=139). Where results could be quantified, similar numbers of studies classified teledermatology and has been classified as equivalent (n=21), superior (n=30) or in some cases inferior (18) compared to classic face-to-face consultations. If specified, telemedicine It was used to consult patients in peripheral locations (n=31) with poor health care, in daily dermatological routine for patient management purposes (n=59), to consult patients in peripheral locations (n=31) with poor health care, for medical support in nursing homes or home care settings (n=19), and in rare cases for emergency diagnosis (n=2).

The application majority of published studies on teledermatology was largely limited toperformed in the USA (n=53), followed by Europe with the United Kingdom (n=26), Spain (n=14), the Netherlands (n=12), Italy (n=11) and Austria (n=11) as their biggest representatives. Eligible teledermatological studies form Germany were n=6. Very littleFew publications were found from other European, Latin American, Asian, Australia and African countries.

Discussion: The value and application of teledermatology worldwide increased over the years and is illustrated by the number of countries in whichwhere digital patient communication is used. A variety of studies demonstrated the reliability of the technique with high degrees of concordance and a significant reduction in cost and time for both physician and patient, although single study results are not always in agreement with others. Unfortunately, especially large countries and continents with a poor geographical distribution of physicians seem to be underrepresented in teledermatological use, as concluded from publication output. This inequality might be based ondue to individual national health care systems with financial issues such as equal reimbursement or legal problems leading tocausing delay of a restriction in progress. The increasing demand of medical consultation due to the growing undersupply in rural areas and long waiting periods for physician appointments will lead to a further development of teledermatology.

Practical implications: The increasing demand of medical consultation due to the growing undersupply in rural areas and long waiting periods for physician appointments will lead to stands to benefit from customized applications of a further development of teledermatology.