Altieri Lisa, Hu Jenny, Nguyen Andrew, Cockburn Myles, Chiu Melvin, Cotliar Jonathan, Kim Jenny, Peng David, Crew Ashley
1 David Geffen School of Medicine at UCLA, USA.
2 Division of Dermatology, UCLA, USA.
J Telemed Telecare. 2017 Jan;23(1):68-73. doi: 10.1177/1357633X15621226. Epub 2016 Jul 9.
Introduction Demand for dermatologic services in safety net hospitals, which disproportionately serve patients with darker coloured skin, is growing. Teledermatology has the potential to increase access and improve outcomes, but studies have yet to demonstrate the reliability of teledermatology for all Fitzpatrick skin types. Methods We assessed the reliability of teledermatologists' diagnoses and management recommendations for store-and-forward teledermatology in patients with lightly pigmented (Fitzpatrick skin types I-III) versus darkly pigmented (Fitzpatrick skin types IV-VI) skin, when compared to in-person diagnosis and management decisions. This prospective study enrolled 232 adult patients, presenting with new, visible skin complaints in a Los Angeles county dermatology clinic. Forty-seven percent of patients were Fitzpatrick skin types I-III, and 53% were Fitzpatrick skin types IV-VI. Results Percent concordance for the identical primary diagnosis was 53.2% in lighter (Fitzpatrick I-III) skin types and 56.0% in darker (Fitzpatrick IV-VI) skin types. There was no statistically significant difference in concordance rates between lighter and darker skin types for primary diagnosis. Concordance rates for diagnostic testing, clinic-based therapy, and treatments were similar in both groups of Fitzpatrick skin types. Discussion These results suggest that teledermatology is reliable for the diagnosis and management of patients with all Fitzpatrick skin types.
安全网医院对皮肤科服务的需求不断增长，这些医院服务的患者中肤色较深的比例过高。远程皮肤病学有潜力增加医疗服务可及性并改善治疗效果，但研究尚未证明远程皮肤病学对所有菲茨帕特里克皮肤类型的可靠性。方法：我们评估了远程皮肤科医生对存储转发式远程皮肤病学中色素较浅（菲茨帕特里克皮肤类型I - III）与色素较深（菲茨帕特里克皮肤类型IV - VI）皮肤患者的诊断和管理建议的可靠性，并与现场诊断和管理决策进行比较。这项前瞻性研究招募了232名成年患者，他们在洛杉矶县皮肤科诊所出现新的、可见的皮肤问题。47%的患者为菲茨帕特里克皮肤类型I - III，53%为菲茨帕特里克皮肤类型IV - VI。结果：色素较浅（菲茨帕特里克I - III）皮肤类型中相同初步诊断的一致性百分比为53.2%，色素较深（菲茨帕特里克IV - VI）皮肤类型中为56.0%。在初步诊断中，色素较浅和较深皮肤类型之间的一致性率没有统计学上的显著差异。两组菲茨帕特里克皮肤类型在诊断测试、基于诊所的治疗和治疗的一致性率相似。讨论：这些结果表明，远程皮肤病学对所有菲茨帕特里克皮肤类型患者的诊断和管理是可靠的。
