You Can Still See A Dermatologist While Social Distancing With Teledermatology
Maybe it's stress, maybe it's panic-munching snacks–however you're being affected in these trying times, your skin might be freaking out too (hello, new zits!) But, with all non-essential doctor's visits at a standstill right now, you can't get to the dermatologist's office like you would normally. That's where teledermatology comes in. Yup, you can basically FaceTime with your derm and have them quell any concerns you have about your skin while still practicing social distancing.
"While the treatment of COVID-19 infected patients is the most pressing health issue we are facing right now in this country, it is important not to neglect the routine medical care needed by patients," says Joshua Zeichner MD, Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in NYC. "Video visits are definitely filling the void that has developed over the past few weeks as patients have been remaining at home and doctor's offices have closed their doors to all non-essential or non-life threatening health issues."
Virtual visits have been around as an option before, but they're definitely seeing a spike and coming in handy now. Here's everything you need to know.
There are different methods of telederm visits.
You can have a "live" virtual visit, where you are speaking to your derm in real time over video (every dermatologist has different preferences), or a "store and forward" visit, which involves taking photos for your provider to evaluate and talking through text to communicate with a dermatologist.
As for platforms, you might have to download a HIPAA-compliant service like RingCentral or MyChart. Other derms we spoke to said they were fine with even using FaceTime or Skype if that was easiest for their patient. Even if you do opt for video, however, it's good practice to take pics in case anything changes in your skin by the time you meet.
"Many dermatological conditions can be diagnosed visually, meaning without the use of additional labs or skin samples," says Aimee Paik, MD, a dermatologist with Apostrophe. It's a store and forward platform that has you take a quiz (it takes five minutes), submit photos, get evaluated within 24 hours, and prescriptions (both oral and topical) sent straight to your doorstep. "This makes the process more efficient for everyone and results in lower costs to patients," she says. Apostrophe doesn't take health insurance, but a visit can be $20 (and goes towards the total cost of your Rx regimen).
Not every skin condition can be evaluated digitally.
"In general, teledermatology is best for acne, rosacea, melasma, rashes, skincare curation, and cosmetic consultation," says dermatologist Melissa Kanchanapoomi Levin, MD, founder of Entiere Dermatology. That being said, concerns that require in-person treatment–like draining a boil, applying liquid nitrogen to a wart, or getting a cortisone shot in a cystic pimple–obviously can't be addressed. "TeleVisits won't cure any concern where a procedure is needed, but at least patients can get piece of mind," says Roy Seidenberg, MD, dermatologist at the Laser & Skin Surgery Center of New York.
Some patients that have to be monitored with monthly visits, like those on Isotretinoin (more commonly known as the discontinued brand Accutane) or psoriasis patients on biologic medications will definitely find video visits helpful for not interrupting treatment.
Body checks, like skin cancer screenings, are best left for when you can get in front of a derm IRL.
Telederm communication requires some preparation.
However you're communicating with a derm, you'll need to give a clear picture of your skin's condition. "You should prepare for a video visit the same way you would an in office visit. Take off any makeup. Make sure you are wearing an outfit that can easily be moved to show the doctor your rash," says Dr. Zeichner.
Lighting is important! Natural lighting is best, so turn off flash, stand in front of a window and try to have a plain, non-distracting background. You can also try the bathroom, which tends to be the most well-lit room in the home.
"I always recommend patients have a list of questions ready, so they don't forget anything," says Dr. Seidenberg. "Also have a pen and paper to take notes and the name and number of your local pharmacy. Collect your present medications, as we may review your treatment regimen."
Dr. Paik advises avoiding using any scrubs or exfoliants before you capture your skin. She also has wise advise for getting a clear photo, "You want to take the photo from straight in front of you so that your face takes up almost the entire frame. Using your phone’s camera tends to produce the best images, much better than those taken by your computer’s camera."
Dr. Levin has her patients take three photos of the area of concern with this useful guide: Further away (ask yourself, "Who is this?"), mid-distance (ask yourself, "Where is this?"), and close-up (ask yourself, "What is this?").
A virtual visit could cost different from your usual visit.
The dermatologist we spoke to noted that, amidst the COVID-19 pandemic, most commercial insurances are covering video visits like they would cover in-person visits. You're likely paying the same amount you would normally, however, some insurances are waiving fees or allowing you to pay less during this difficult time. Some offices also offer a self-pay option, but it's best to check with your insurance and your derm's office to workout how much out of pocket your vid chat will require.
Your evaluation will likely be quicker.
You'll save a lot of time with submitting all your info and comments beforehand and not having to commute to your doctor's office or wait in the waiting room. "My video visits tend to last no more than 15 minutes," says Dr. Zeichner. "Most of the issues being treated by video tend to be very directed and specific. While your dermatologist can look at a new or changing spot, a video visit cannot take the place of an in person full body exam." All the other derms we spoke to echoed the same 15-minutes to half an hour, max, time frame.
Is teledermatology what the future looks like?
"I think many people will realize how convenient telemedicine is and how it can easily be incorporated into one’s life," says Dr. Paik. "Rather than taking off work and wasting precious time waiting in a doctor’s office and/or pharmacy, telemedicine makes medical care extremely efficient and flexible." That being said, there's something to be said about in-person communication with your provider. "The exam is more thorough: The lighting is better, I can palpate the skin lesion, I can use my dermatoscope, patients usually change into a gown," says Dr. Seidenberg.
It's best if you can continue with your regular dermatologist since getting on a call with a brand new doctor can be more challenging without an established relationship. While there's no other option other than a virtual visit right now, you've got all the 411 to make the best choice for yourself moving forward.
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