RESUMEN
Importance: Amidst widespread social distancing measures enacted during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services expanded telehealth service coverage for beneficiaries. U.S. dermatologists and their patients have since transitioned toward billable video-based visits. Teledermatology continues to rapidly evolve, and dermatology providers should be aware and informed of systems, benefits, and barriers to effectively incorporate teledermatology into patient care. Objective: The aim of this study was to review the history of teledermatology, its progression to the current state, and its use and expansion during the COVID-19 pandemic. Results: Our findings suggest that teledermatology is a useful tool to address the dermatologic needs of those with limited mobility, critically ill patients, and remote communities. Teledermatology could decrease the burden of skin disease and improve the quality of life for many people, as well as empower patients to be more active in their own care. Certain conditions are more amenable to diagnosis and long-term management with teledermatology, such as acne, psoriasis, rosacea, and atopic dermatitis. Dermatologists should prioritize seeing patients with pigmented lesions in person, as melanoma may be more difficult to detect via telemedicine. Unified legislation for teledermatology is necessary as medicolegal protection, safety and privacy quality analysis, and The Health Insurance Portability and Accountability Act of 1996 (HIPAA)-approved security compliance have yet to be fully addressed.
RESUMEN
Dupilumab has recently been approved by the Food and Drug Administration for use for treatment of moderate to severe atopic dermatitis in children aged 6 to 11 years. It presents a novel treatment option with a favorable safety profile for patients who are currently reliant on immunosuppressants, including cyclosporine A, methotrexate, and mycophenolate mofetil. Particularly during the current COVID-19 pandemic, immunosuppression should be avoided to retain intrinsic antiviral immunity. Transitioning to dupilumab should be executed strategically-tapering immunosuppressants and minimizing risk of flare by overlapping with the biologic. Herein, we use results of outcome measurements from LIBERTY AD ADOL and LIBERTY AD PEDS trials of dupilumab in adolescents aged 12 to 18 years and children aged 6 to 11 years, respectively, to propose a schematic for an 8-week transition between medications.