Need a dermatologist? There's an app for that
Interested in clearing up your teen's acne without a visit to the dermatologist's office? There are mobile apps - and websites - for that.
Interested in clearing up your teen's acne without a visit to the dermatologist's office?
There are mobile apps - and websites - for that.
Teledermatology is a hot trend, especially for conditions like acne in which appointment scheduling presents more of a challenge than diagnosis.
In the Philadelphia area, there are at least three services available online: the smartphone app Spruce and the Web-based DermatologistOnCall.com and AcneCareMD.com. Though AcneCareMD.com limits itself to acne treatment, the other two provide experts to diagnose and treat a variety of skin conditions, ranging from eczema to lice to tick bites.
According to the U.S. Food and Drug Administration, an estimated 500 million smartphone users worldwide are using a health-care application. By 2018, 50 percent of the more than 3.4 billion smartphone and tablet users will have downloaded mobile health applications.
"Telemedicine is exploding," said Jamie Altman, a dermatologist who is owner and president of Aesthetic Dermatology Associates in Media and Paoli and proprietor of AcneCareMD.com. "Dermatology lends itself perfectly to telemedicine, because we're a very visual field. Acne can be readily diagnosed with photos and a patient history."
Compliance with treatment has often been a problem with acne patients, said Altman, who noted that rather than taking off from work or having a child miss a sporting event or activity, "patients can see us in their pajamas at 9 a.m. in their living rooms."
A single dermatology visit, without pharmaceuticals, costs $40 at Spruce, $47 at AcneCareMD.com, and $59 at DermatologistOnCall.com. Payments are mainly out of pocket, although on Jan. 1, Highmark began to pay for visits to DermatologistOnCall.com.
"Coverage for telemedicine is very spotty among insurance companies," Altman said. "It's something they are likely to cover in the future, but right now only a few companies do."
In all three services, patients first give a medical history of their skin treatment and overall health, and then securely transmit photos of their skin conditions.
Based on the history and pictures, doctors arrive at a diagnosis, formulate a treatment plan, and send prescriptions to patients' homes or pharmacies within one to three days.
Additional questions can be posed via messaging, or, depending on the service, phone.
Because medical services are limited to providers who are licensed in a specific state, and patients must be physically located in that state, patients are also asked for photo identification. At AcneCareMD.com, underage patients must have forms completed by a parent or guardian; Spruce does not accept patients younger than 18.
There are a number of reasons telemedicine might be attractive, particularly to acne patients, said Matthew Keller, associate professor of dermatology at Thomas Jefferson University Hospital.
"In dermatology, there are some simple conditions, like acne, that have very standard therapies," Keller said. "And in some cases, you may have to wait four to six months for a dermatology appointment, which can be a problem when prom season is on its way."
There are also teenagers' tight schedules to consider. When Kristen Monastero, 14, of Berlin, developed acne on her face, she tried a variety of unsuccessful over-the-counter treatments before her mother found an ad for AcneCareMD.com online. With sports and high school leaving her daughter little free time, Jill, 46, who is in retail sales, contacted the site.
"I knew it wasn't life-threatening; it was a typical teenage acne problem, and we didn't have time to get to the doctor. It was all about saving time," she said. "In a month, her face was all cleared up."
When it comes to treating conditions other than acne by telemedicine, Keller expressed some concern.
"People can usually say, 'I do or do not have acne,' " Keller said. "But with other skin conditions, like psoriasis or eczema, not everyone who thinks they have that disease is right. A doctor needs to see them face to face and think hard about their condition before deciding on a diagnosis."
He also worries about missing certain skin conditions by consulting only a photograph.
"What if someone takes a photo of a benign lesion on the back, and down below and to the side there was a melanoma that's not in the picture? You have to be careful," he said, noting that when patients visit a doctor's office, they are often checked for conditions - high blood pressure, moles - they didn't come in for.
As teledermatology expands, the American Academy of Dermatology wants to make sure these sites are connecting patients with board-certified dermatologists, said Anthony Rossi of the Memorial Sloan Kettering Cancer Center.
"We want to make sure that acne is being treated appropriately and effectively," Rossi said. "Acne that is not treated appropriately can lead to scarring or persistence, and dermatologists seek to treat acne effectively and individually for each person, not just a one-plan-for-all."
Rossi sees a future for telemedicine that will "include live, real-time assessments and the ability for better resolution to store and forward images."
As for Altman, he doesn't see his service as replacing all dermatologic office visits, although he thinks acne is not the only condition that lends itself to telemedicine.
"So far, the most important factor in telemedicine is the ease of access to a physician," he said. "And patients seem to like it."
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