Teledermatology Effective in Periorificial Dermatitis Management

Findings are in agreement with research supporting the use of teledermatology for managing periorificial dermatitis.

Outpatient teledermatology may be effective for patients with periorificial dermatitis after an initial primary care consultation, researchers reported in a letter to the editor published in the Journal of the American Academy of Dermatology.

The retrospective study evaluated the effects of outpatient teledermatology on access to care, diagnosis, work-up, and treatment between rural referring primary care providers (PCP) and outpatient teledermatology teams at an academic medical center.

A total of 46 patients (mean age, 42.2±19.9 years; 80.4% women; 95.6% White) with periorificial dermatitis were assessed from outpatient teledermatology encounters recorded in electronic medical records (EMR).

The PCPs submitted asynchronous or store-and-forward teledermatology eConsults from outpatient locations and included facial eruption digital images and relevant historical data. The teledermatologists were informed of the eConsults from shared EMR, and their recommendations were returned to the PCP in a similar manner.

As previous studies have shown that teledermatology decreases consultation to outpatient dermatology clinics by 65%, teledermatology can be utilized for this disease.

Most (n=43, 93.5%) referrals used nonspecific language such as “rash,” “facial rash,” or “lesion,” and 6.5% (n=3) of referrals included specific diagnoses (eg, perioral dermatitis). The percentage of agreement demonstrated a discordance of 95.7% (n= 44) between teledermatology and the initial PCP diagnoses, and 100% of cases had a modification in management.

All participants were instructed to follow up in 8 to 12 weeks if no improvement occurred, researchers explained. Among the cohort, 4.3% (2/46) of patients required in-person follow-up owing to a lack of improvement. Concordance between the initial teledermatology encounter and live dermatology clinic follow-up visit was 100% (n=2).

Most (95.7%; n=44) patients were advised to use topical treatments such as clindamycin, metronidazole, sulfacetamide sodium-sulfur, and moisturizers/emollients. Oral treatments, primarily doxycycline, were recommended to 60.9% (n=28) of patients. All participants were advised to use a topical, oral, or combination treatment based on severity, and 45.7% (n=21) of patients were advised to discontinue current topical steroids.

In all, 59% of the consults were submitted from a location about 103 miles away, suggesting high use of consults for locations farther away from where the teledermatologists’ clinics were primarily based. The average consult submission to response time for same-day consults during clinic hours was 1 hour and 34 minutes.

Study limitations include the retrospective design and restriction of cases to those for which teledermatology was requested.

“Overall, this study suggests that periorificial dermatitis access to care, diagnosis, work-up, and management are impacted by outpatient teledermatology and uphold a previously established standard of care for periorificial dermatitis,” stated the researchers. “As previous studies have shown that teledermatology decreases consultation to outpatient dermatology clinics by 65%, teledermatology can be utilized for this disease.”

References:

Shah VK, English III JC. Store-and-forward outpatient teledermatology improves care for patients with periorificial dermatitis after an initial primary care consultation: a retrospective study. J Am Acad Dermatol. Published online October 21, 2022. doi: 10.1016/j.jaad.2022.10.036