Teledermatology – Skin Images and Patient Information

Last week, the basics of teledermatology was introduced – What Teledermatology is, its different forms and patient points when getting started on it. Today, we continue with the 2nd part of this 5-part series, focusing on a central part of the teledermatology process – Skin Images and Patient Information. Much of the guidelines are obtained from the British Association of Dermatologists’ Quality Standards for Teledermatology.

Information for Skin Patients

Before getting started on (and providing consent to) teledermatology, there are good practices on what Information You (as the skin patient) Ought To Be Provided With: 

1. What the tele dermatology process involves and why it is helpful in your case
2. Why there may be a difference in diagnostic accuracy from in-person consultation
3. Process in place to have an in-person consultation should the need arise
4. Who takes the images and what images are needed
5. What information will be sent with the images
6. How the images are transferred
7. Information about the specialist to whom the images are sent to and what the specialist will do with the information
8. What happens in response to the teledermtaology consultation
9. How you can access your own information
10. Where your skin images are stored, for how long and who have access
11. The fact that you do not have to consent for teledermatology

Information from Skin Patients

Once you have consented to teledermatology, a critical part of the process is compiling complete and accurate Information on You and Your Skin Condition. Information that are expected to be collected, stored and transmitted (Store-and-Forward) are:

Personal Information on Patient 

• Date of birth
• Gender
• Ethnic group
• Address, contact number

Information on Patient’s Skin Condition

• Date of onset and duration of skin lesions
• Whether single or multiple skin lesions
• Locations of the skin lesions
• Changes in size, shape and colour
• Any bleeding and/or ulceration
• Symptoms that accompany the skin lesions

Information on Patient’s Medical History 

• Any personal and/or family history of skin cancers
• Other risk factors, e.g. excessive sun exposure, fair skin, large number of birth marks, currently on immunosuppressant medication
• Other medical conditions
• Repeat and recent medications

In particular, for those with inflammatory skin condition, e.g eczema, information from you that is required are:

• Previous treatment for eczema and response to medication
• Personal and family history of skin disease and atopy
• Known allergies
• Active problem list
• Body map is recommended to show the site of lesions and the extent of inflammation at each site

A note on Skin Images

1. If the skin images are to be taken at the clinic of your referring physician, a few points that they ought to bear in mind are:
2. Protecting your modesty – You have the right to have a chaperone or bring a companion
3. Images should be a minimum of 2000×1500 pixels or 3 megapixels
4. Images should be taken at least at two different angles, to compensate for loss of details from reflection
5. Images should be mid-close up to identify where the lesion is and macro (close-up)
6. The focusing distance should be at least 20cm for macro close-up.
7. Image filenames should be clearly identified
8. Skin lesions can be identified using sticky labels, surgical tape or washable markers.

In Store and Forward Teledermatology, capturing quality images, recording accurate and complete information is a critical success factor. If the dermatologist is comfortable with the quality of imaging and information, it is less likely that you will be called in for an in-person consultation.

What is your experience? Were you provided with adequate information BEFORE you consent to teledermatology and did you feel that your referring physician recorded all the requisite information? Share in the comments so we can benefit from your experience!