Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
Department of Dermatology, Health Partners Institute Dermatology, St. Louis Park, Minnesota, USA.
Contact Dermatitis. 2021 Sep;85(3):274-284. doi: 10.1111/cod.13856. Epub 2021 May 6.
Data regarding teledermatology for patch testing are limited.
Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs).
Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading.
Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement.
For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
有关远程皮肤病学进行斑贴试验的相关数据有限。
比较两位现场皮肤科医生（IPD）与八位远程皮肤科医生（TD）的斑贴试验读数和最终解释。
对接受斑贴试验的患者在 48 小时和第二次读数时拍摄 70 个筛查系列过敏原的照片。八名 TD 分别在 48 小时和第二次读数时查看照片并对反应进行分级（阴性、刺激性、可疑、+、++、+++）；此外，他们对每个反应分别编码最终解释（过敏、不确定、刺激性、阴性）。TD 分别对每位患者和斑贴试验反应的整体图像质量和置信度进行评分。根据临床意义（成功、不确定和失败）计算 TD-IPD 一致性的百分比。主要结果是第二次读数的一致性。
在 48 小时、第二次读数和最终解释时，分别有 99、101 和 66 名参与者的数据可用。第二次读数时的总体失败率（+/++/+++与阴性）为 13.6%（范围 7.9%-20.4%）。在 48 小时和最终解释时的总体失败率分别为 5.4%（范围 2.9%-6.8%）和 24.6%（范围 10.2%-36.8%）。读数的置信度与图像质量和分歧呈统计学相关。
对于斑贴试验，远程皮肤病学存在明显的局限性，包括第二次读数的临床显著总体失败率为 13.6%，最终解释的总体失败率为 24.6%。
