How to come into your next dermatology appointment prepared: follow these five healthcare homework tips from expert dermatologist Dr. JiaDe "Jeff" Yu.
Published On: Oct 5, 2020
Last Updated On: Jun 7, 2021
Melissa Thomson’s 10-year-old son Jonte gets care for his severe atopic dermatitis (AD) from more than 10,000 miles and 10 time zones away. Jonte is in the Hunter Valley area of New South Wales, Australia. His dermatologist, Dr. Richard Aron, is in Cape Town, South Africa.
In 2016, Thomson was worried about her son’s quality of life. Jonte had been hospitalized several times and needed wet wraps every night. Her search for a better solution led her to Aron’s Facebook treatment discussion group.
It outlined his specialized regimen, compounded antibacterial, steroid and moisturizer (CASM), which involves tailored doses of steroids and antibiotics diluted with moisturizers and compounded into a cream by the patients’ local pharmacists.
Thomson initially felt hesitant to get care from a dermatologist who couldn’t physically examine her son. But she felt an urgency to try something different from the potent medication that her local dermatologist said was the next step for Jonte.
“When a patient seeks help from a foreign dermatologist, they are usually in a desperate situation. It takes a leap of faith,” Aron said. In his 12 years of doing telemedicine for eczema and other skin conditions, known as teledermatology, he’s treated patients around the globe.
“Our son saw improvement overnight, and this continued,” said Thomson, adding that Aron has since treated Jonte for serious flares. Care has been fast, convenient and effective for this eczema family. “The whole process has been a blessing for us, and we are grateful to have the option to seek medical assistance from the other side of the world.”
Most teledermatology appointments don’t take place across such vast distances. And, in the time of COVID-19, virtual skincare is more available than ever to people with eczema.
Here’s what you need to know about teledermatology, along with tips for getting the best care.
Dermatologists provide virtual skincare in a couple different ways. Some, like Aron, use what’s called “store-and-forward” technology. With this method, patients send their dermatologist digital pictures of their skin, along with information about their medical history and symptoms.
The dermatologist reviews the images and info, emails the patient treatment recommendations and sends prescriptions to their pharmacy. Patients can email questions and concerns at any time. Everything takes place through secure, private patient portals that protect personal health information.
Other dermatologists use live video chats that mimic many aspects of in-person appointments. Patients get an email with a link to the video appointment and log on from their computer or smart device at the scheduled time. They discuss their symptoms with their dermatologist, who examines their skin over the video feed.
Video chats are also done through private, secure web-based platforms. Some platforms may ask you to download an app for the video, while others allow you to click a link and enter a secure video chat with your doctor.
Some dermatologists offer both video- and image-based care. Call your dermatologist’s office or visit their website to see if they offer virtual care and how their system works.
“In most cases, dermatologists can manage patients with eczema effectively with teledermatology,” said April Armstrong, MD, professor of dermatology and associate dean for clinical research at the University of Southern California Keck School of Medicine in Los Angeles.
Her research, published in 2017 in the journal Telemedicine and eHealth, shows people with atopic dermatitis who got virtual skincare were as happy with their quality of life, including eczema symptoms, as those who had in-person visits. Similarly, evidence published in 2020 in the Archives of Dermatological Research shows dermatology patients are generally very satisfied with virtual care.
That’s good news because more and more patients are getting telemedical care these days as a result of COVID-19. Before the pandemic began, only 14,000 Medicare patients per week used some form of telemedicine. However, between mid-March and early June, more than 10 million got virtual healthcare, according to the U.S. Department of Health and Human Services.
“The pandemic has created a rapid rise in teledermatology,” Armstrong said. “It’s a very good option for patients who want to stay at home but still make sure that their eczema is well monitored and managed.”
People with eczema who have to drive long distances to see their dermatologists also benefit from virtual care, said Kari Martin, MD, associate professor of dermatology and child health at the University of Missouri in Columbia, Missouri.
“Having the appointment in their own homes saves patients time as well as money in gas, lost work and childcare,” she said. “Since COVID-19 began, insurers have expanded coverage for telemedical care, and dermatology practices are offering many more timeslots for live appointments.”
Live video appointments are popular with both patients and providers, Martin added.
“Doctor and patient get to talk, and patients get immediate feedback on their questions. This back-and-forth discussion can be critical, and the video-based experience is much like an in-person visit,” she said.
Teledermatology and other kinds of virtual healthcare aren’t without snags. Unsurprisingly, many issues that can frustrate patients and providers are technical. The right preparation, however, can prevent problems.
Here’s what dermatologists suggest for effective, glitch-free virtual care:
Check with your insurer to see if they cover teledermatology. Many insurers covered some level of telemedical care before COVID-19. During the pandemic, federal government expanded coverage and simplified rules for virtual care. At press time, legislation was in the works to make many of these changes permanent.
Ask your dermatologist’s office in advance how your appointment will work. To prepare well, you’ll need to know what kind of appointment you’re having (live or with digital pictures and email) and whether you’ll be provided with any necessary links, through email or text.
Make a list of issues and questions you want to cover. “When patients have an organized list, it helps me cover all the points they want to talk about,” said Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center.
Take high-resolution pictures of areas of eczema and send them to your dermatologist before the appointment. This is especially helpful for skin in hard-to-see areas or when the patient is a child. “Sometimes the video stream quality isn’t high enough to see the skin in great detail,” Lio said.
Take several pictures of affected skin from different angles. Make sure images are clear and unblurred. The most helpful pictures show skin in natural light without any background distractions.
Set up for video appointments in a well-lit, private area with a strong internet connection. A quiet, distraction-free environment is best. It should be a room where your video stream won’t stall, get choppy or cut out.
Not everyone with eczema has access to high-speed internet and the devices needed for successful video appointments. If you don’t and aren’t ready to make an in-person visit, ask your dermatologist if phone-based care is possible.
Test your camera and microphone. “Make sure they’re working before your appointment,” Armstrong said. “If you’re not comfortable with the technology, ask a friend or family member for help setting it up and testing it.
Also make sure the device you’re using is placed or can be moved to where you can easily show your doctor the areas of skin you’re concerned about.
Understand how your follow-up care will work before you end the appointment. Most dermatologists send follow-up emails and answer questions through their patient portal. Some may phone you. Know how they’ll get in touch with prescriptions and other information, and how to connect with them if you have questions.
“I email my treatment recommendations through our patient portal, along with links to over-the-counter products I’ve suggested so patients know exactly what to pick up,” said Lio. “I also include a link to the pharmacy where I’ve sent their prescriptions.”
Aron agrees that good communication and ongoing care are the key to giving people with eczema the best outcomes with teledermatology. “I take responsibility for my virtual patients’ care exactly as I would if they were in my office,” he said.
Like everyone else, people with eczema are living with uncertainty and near-daily life changes brought by COVID-19. An ongoing Census Bureau survey that began in April found that rates of depression and anxiety among U.S. adults are three times what they were in early 2019.
Stress and other mental health issues can make eczema worse and harder to cope with. As with medical care, there are more options than ever to virtually improve mental health and overall wellness.
The pandemic has bolstered the already booming world of online exercise and wellness classes. You can do yoga, indoor cycle or lift weights with an instructor who’s teaching live from the other side of the country or world.
There are also many options for getting some online calm if creating art, cooking or listening to music is how you destress. If museums are your relaxation jam, you can wander virtually through some of the world’s best galleries from your smartphone or computer.
Virtual mental health counseling, or telecounseling, is also readily available. Like other telehealth care, it’s often covered by insurance. It works like most virtual care, with video chats done through secure platforms.
As with teledermatology, you’ll need a strong internet connection and good lighting to get the best results from telecounseling, said licensed professional counselor Lisa Henderson.
“Counselors are trained to read micro-expressions, and we communicate with them too,” said Henderson, co-founder and COO of Synchronous Health in Nashville, Tennessee.
“Another important consideration for getting the most out of a session is feeling safe in your surroundings. If you’re worried about who might hear what you’re saying, the session won’t be as effective as if you feel like you can share and explore freely.”
It’s also important for your counselor to be comfortable with telecounseling technology.
“Most counselors are well-suited for telecounseling, but not all are,” Henderson said. “If the client feels uncomfortable, whether because of something specific about the counselor or simply because the counselor isn’t great with technology, it’s their right and responsibility to try a different counselor.”
Telecounseling, she noted, makes finding the right professional easier. “The options for counselors are as wide as your state, not limited to those who are conveniently located,” she said.