Telederm: friend or foe


Pearl Kwong, MD, PhD, a solo pediatric dermatologist in Jacksonville, Florida, captured the attention of her audience at this year’s Society for Pediatric Dermatology meeting with a hilarious introduction. Discussing how often primary care doctors would call him (constantly!) during the height of the pandemic, Dr Kwong said: “I could finally get them to stop calling me all the time when I answered, ‘hello, I’m in the bathroom: what do you want?'”

This light start turned into a brief overview of the different types of teledermatology available: synchronous (real-time live video visits); asynchronous (store and transfer videos); mixed (store and transmit and live); and teledermatology between primary care physicians and dermatologists.

“Telehealth is not a new concept,” Kwong said. “Historically, classic examples where telemedicine was (and still is) ideal are found in the fields of radiology, inmate health care, psychiatry, and home health care.” Before COVID-19, however, there was resistance to telemedicine on all fronts, including lack of confidence in diagnosis, lack of resources and platforms, insurance reimbursement was unreasonable, and too regulated (depending on the state in which you were practicing).

Then came COVID-19: usage increased, HIPAA restrictions were lifted, more efficient platforms emerged, and patients and healthcare providers were adapting.

For dermatologists looking for advice on providing the most effective televisit, Kwong pointed to organizations offering assistance, such as the telehealth pages on the AAD, AAP, and SPD websites.

However, challenges remain for practitioners, such as getting paid correctly (coding issues), the images patients upload (which may be blurry or otherwise unclear), and accounting for violations of HIPAA, even if HIPAA relaxes some of its restrictions.

“It can be exhausting talking to a patient who is walking around her house, showing me her messy rooms, walking outside, trying to get a good signal, or not pointing her phone or tablet properly,” Kwong joked. “The person ceiling is my most common view on a telehealth call.” Other weird places include a patient’s car (“do you actually drive on that TV tour??”), the grocery store, or a Disney World vacation. “I’m just waiting: any day now, someone is going to schedule a TV tour while they scream and throw their arms up on Magic Mountain.”

Plus, the lack of human interaction and rapport adds to the challenges of telemedicine, Kwong says, not to mention eye strain from being on a screen so much. Nonetheless, Kwong notes, telederma also means less time away from school for a patient, one can make last-minute appointments, less time off work for parents, and “no need to wear masks at both ends: you can see your patient’s whole face!” There is also, during waves of viruses, such as COVID-19, less risk of infection for the patient and the practitioner.

In summary, Kwong summed up: Teledermatology is here to stay with its benefits and challenges. Future research is still needed to optimize the technology, policies and regulations need to be reviewed and established, and more education is needed to train all practitioners in the rules and regulations of teledermatology.


Kwong P. Teledermatology: friend or foe. SPD 2022 47th Annual Meeting. July 8, 2022. Indianapolis, Indiana.

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