Patient-assisted teledermatology practice: What is it: When, where, and how it is applied.

Recent teledermatology practice has been focused on different models made possible by robust advances in information technology leading to consistent interaction between the patient and health care professionals. Patient-assisted teledermatology practice also called patient-enabled teledermatology or home based teledermatology is one such novel model. There is a lack of scientifi c literature and substantive reviews on patient-assisted teledermatology practice. The present article reviews several studies and surveys on patientassisted teledermatology practice and outlines its advantages and barriers to clinical utility and analyses the potentiality of this concept. Incorporating patient-assisted teledermatology practice as a novel model in the revised classifi cation of teledermatology practice is proposed. In patient-assisted teledermatology, the patient can upload his/her clinical images as a fi rst contact with the dermatologist or an initial face-to-face examination can be followed by teledermatology consultations. The latter method is well suited to chronic diseases such as psoriasis, vitiligo, and leg ulcers, which may need frequent follow-up entailing signifi cant costs and time, particularly in the elderly. Teledermatology may also be used by the treating dermatologist to seek expert opinion for diffi cult cases. Studies have demonstrated the importance and usability of the concept of patient-assisted teledermatology practice. Various teledermatology care models are available and the appropriate model should be chosen depending on whether the clinical situation is that of easily diagnosed cases (“spotters”), chronic cases or doubtful cases and difficult-to-manage cases.

Newer insights in teledermatology practice.

The study and practice of dermatology care using interactive audio, visual, and data communications from a distance is called teledermatology. A teledermatology practice (TP) provides teleconsultation as well tele-education. Initially, dermatologists used videoconference. Convenience, cost-effectiveness and easy application of the practice made "store and forward" to emerge as a basic teledermatology tool. The advent of newer technologies like third generation (3G) and fourth generation (4G) mobile teledermatology (MT) and dermatologists' interest to adopt tertiary TP to pool expert (second) opinion to address difficult-to-manage cases (DMCs) has resulted in a rapid change in TP. Online discussion groups (ODGs), author-based second opinion teledermatology (AST), or a combination of both are the types of tertiary TP. This article analyzes the feasibility studies and provides latest insight into TP with a revised classification to plan and allocate budget and apply appropriate technology. Using the acronym CAP-HAT, which represents five important factors like case, approach, purpose, health care professionals, and technology, one can frame a TP. Store-and-forward teledermatology (SAFT) is used to address routine cases (spotters). Chronic cases need frequent follow-up care. Leg ulcer and localized vitiligo need MT while psoriasis and leprosy require SAFT. Pigmented skin lesions require MT for triage and combination of teledermoscopy, telepathology, and teledermatology for diagnosis. A self-practising dermatologist and national health care system dermatologist use SAFT for routine cases and a combination of ASTwith an ODG to address a DMC. A TP alone or in combination with face-to-face consultation delivers quality care.