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Cited by 10Telemedicine and Telehealth ImplementationDermatological and COVID-19 studiesDental Research and COVID-19

A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review

Open access
Long, Valencia, Chandran, Nisha Suyien·2022·JMIR Dermatology
DOI 10.2196/34228PMC PMC9118542

Published version of a preprint

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Abstract

Background: The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology. Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community. Objective: This narrative review summarizes the evolution of pediatric teledermatology from pre–COVID-19 pandemic times to the post–COVID-19 period. Methods: A search of MEDLINE, PubMed, and Embase was performed for original articles written in English and published from December 1, 2019, to April 1, 2022. Results: A total of 22 publications were included. Conclusions: Teledermatology will continue to play an increasing role in the management of skin diseases. A mindset shift in the types of conditions deemed suitable for pediatric teledermatology is needed.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes how pediatric teledermatology evolved from before to after the COVID-19 pandemic, covering delivery modes, conditions managed, reimbursement, medicolegal issues, and disparities. It concludes that teledermatology will play an increasing role but requires a mindset shift about which pediatric skin conditions are suitable for virtual care.

Key findings

  • The review included 22 publications. A 2015 US survey reported up to 89% of pediatric dermatologists had experience with teledermatology, using store-and-forward, synchronous live, and hybrid platforms.
  • A post–COVID-19 study found pediatric emergency virtual urgent care managed COVID-19–related concerns (36%), dermatologic concerns (15%), and trauma-related concerns (10%), with a 4-fold increase in volume compared to the same pre–COVID-19 period.
  • Pre–COVID-19, a Brazilian cross-sectional study reported that 63% of lesions in primary care could be managed via store-and-forward teledermatology without an in-person visit, and only 1% required biopsy.
  • Barriers included reimbursement concerns (69.8% of reported barriers in a 2021 AAD survey of 5000 participants) and malpractice/liability concerns (27%); disparities were reported for Spanish-speaking patients, Black/African American patients, patients with non-English preferred language, and patients on public insurance.

Methods

  • Narrative review based on a search of MEDLINE, PubMed, and Embase for original articles written in English and published from December 1, 2019, to April 1, 2022.
  • Search terms included “paediatric teledermatology,” “telemedicine,” “telehealth,” “virtual,” “videoconferencing,” and “teleconferencing.”
  • Articles were screened by title and abstract for relevance to pediatric teledermatology pre- or post–COVID-19; 22 publications were included.

Limitations

  • The paper does not state limitations in a dedicated section.
  • Evident from the text: it is a narrative review, not a systematic review, and no formal quality appraisal or meta-analysis is described.
  • Evident from the text: the search was limited to English-language original articles published from December 1, 2019, to April 1, 2022, so pre-pandemic evidence is discussed through included articles and references rather than a broad pre-2019 search.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/34228

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 38 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Pediatric teledermatology can be delivered via synchronous, asynchronous, and hybrid means.

    “Pediatric teledermatology can be delivered via synchronous, asynchronous, and hybrid means [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Interpretationreasoning

    Teledermatology will continue to play an increasing role in the management of skin diseases.

    “Teledermatology will continue to play an increasing role in the management of skin diseases.”
    • Also stated in: § Conclusion · plain
      “Teledermatology will continue to play an increasing role in the management of skin diseases.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    A 2015 survey of US dermatologists reported up to 89% of pediatric dermatologists having experience with teledermatology, using store-and-forward platforms, synchronous live consults, and hybrid platforms.

    “A 2015 survey of US dermatologists reported up to 89% of pediatric dermatologists having experience with teledermatology, using store-and-forward platforms, synchronous live consults, and hybrid platforms [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Premisecitation

    Privacy concerns can be ameliorated using photographs curated by the caregiver in lieu of real-time/live visual examination of sensitive body sites.

    “Privacy concerns can be ameliorated using photographs curated by the caregiver in lieu of real-time/live visual examination of sensitive body sites [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • Premisecitation

    Kim and Sivesind revealed that patients of Latin and African American descent had expressed less trust in the utility of medical photography to improve patient care, compared to patients who were Asian and White.

    “Kim and Sivesind [7], in a scoping review, revealed that patients of Latin and African American descent had expressed less trust in the utility of medical photography to improve patient care, compared to patients who were Asian and White.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] source

      Not checked in the free run.

    • Rests on an assumption: Differential digital literacy and connectedness among cultural and socioeconomic groups can create inequity in pediatric teledermatology uptake and care delivery.
  • Classified as probably not a substantial claim. 8
  • May combine two claims. 13

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    A total of 22 publications were included in the review.

    “A total of 22 publications were included.”
    • Also stated in: § Results · plain
      “A total of 22 publications were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology.

    “The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology.”
    • Also stated in: § Introduction · plain
      “The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community.

    “Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community.”
    • Also stated in: § Introduction · plain
      “Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pre-COVID-19, a 2017 randomized controlled trial of 40 patient-parent dyads at a US pediatric dermatology clinic found high concordance between photograph-based and in-person diagnosis but lower concordance rates for alopecia and neoplasms.

    “Pre–COVID-19, a 2017 randomized controlled trial of 40 patient-parent dyads at a US pediatric dermatology clinic found high concordance between photograph-based and in-person diagnosis but had also highlighted that alopecia and neoplasms tended to have lower concordance rates between photographs and in-person diagnoses [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prior to COVID-19, a cross-sectional Brazilian study commented that 63% of lesions in primary care settings could be managed via store-and-forward teledermatology without in-person visit, and only 1% of cases required biopsy.

    “Prior to the COVID-19 pandemic, a cross-sectional Brazilian study [11] had commented that 63% of lesions in the primary care settings could be managed via store-and-forward teledermatology without the need for an in-person visit, as only 1% of cases required biopsy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Since COVID-19, the AAD has advised that Medicare could allow reimbursement of telehealth services rendered via telephone with payment for telephone-only encounters being reimbursed at the same rate as in-person office visits, based on the national Medicare Physician Fee Schedule.

    “Since the COVID-19 pandemic, the AAD has advised that Medicare could allow reimbursement of telehealth services rendered via telephone with payment for telephone-only encounters being reimbursed at the same rate as in-person (new/established) office visits. Rates are based on the national Medicare Physician Fee Schedule [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Coding and reimbursement for teledermatologyAmerican Academy of Dermatology20222022-04-15https://www.aad.org/member/practice/telederm/reimbursement

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Medicolegal implications associated with teledermatology may pose significant challenges to uptake, with the AAD survey highlighting 27% of participants having concerns with malpractice/liability.

    “Medicolegal implications associated with teledermatology may pose significant challenges to uptake, with the AAD survey highlighting 27% of participants having concerns with malpractice/liability [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

    • Rests on an assumption: To date, the extent of legal responsibility in cases of incorrect or delayed diagnosis remains ambiguous, and malpractice risk is not generally well characterized.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Premisenone given

    The COVID-19 pandemic has given new impetus for pediatric teledermatology to be embraced as infection control, physical distancing measures, and reduction in hospital attendances post-COVID-19 necessitate more remote yet viable options for pediatric care.

    “The COVID-19 pandemic has given new impetus for pediatric teledermatology to be embraced as infection control, physical distancing measures, and reduction in hospital attendances post–COVID-19 necessitate more remote yet viable options for pediatric care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Direct-to-consumer pediatric virtual urgent care can be beneficial for viewing the child in the setting of their own home, enabling more reliable observation and assessment of the child's behaviors and condition.

    “Direct-to-consumer pediatric virtual urgent care can be beneficial for viewing the child in the setting of their own home, enabling more reliable observation and assessment of the child’s behaviors and condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A post-COVID-19 study in a large academic medical center reported that pediatric emergency virtual urgent care could be conducted via telephone calls, allowing practitioners to manage pediatric concerns that were COVID-19-related (36%), dermatologic (15%), and trauma-related (10%).

    “A post–COVID-19 study in a large academic medical center reported that pediatric emergency virtual urgent care could be conducted via telephone calls, allowing practitioners to manage pediatric concerns that were COVID-19–related (36%), dermatologic (15%), and trauma-related (10%) [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pre-COVID-19, there was a scarcity of expert pediatric dermatologists for genodermatoses, with multidisciplinary clinics typically restricted to large cities.

    “Pediatric teledermatology should be expanded to slowly include the review of genodermatoses, which had already in pre–COVID-19 times seen a scarcity of expert pediatric dermatologists, with multidisciplinary clinics being typically restricted to large cities [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pediatric patients, compared to adults, are protected by additional laws governing health care delivery, so ethical and legislative-related concerns may escalate when dealing with a pediatric patient.

    “Pediatric patients, compared to their adult counterparts, are also protected by additional laws governing health care delivery—hence, ethical and legislative-related concerns may escalate when dealing with a pediatric patient [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The personal data of patients could be protected by pseudo anonymization, entity authentication, and data encryption.

    “The personal data of patients could be protected by pseudo anonymization (limiting access to authorized personnel), entity authentication, and data encryption [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The challenges physicians face with teledermatology consults pre- and post-COVID-19 are likely to remain similar, with the potential inability of physicians to make the correct dermatological diagnosis as a result of information inadequacy.

    “The challenges physicians face with teledermatology consults pre- and post–COVID-19 are likely to remain similar, with the potential inability of physicians to make the correct dermatological diagnosis as a result of information inadequacy (insufficient history obtained over virtual consult, limited ability to examine the patient thoroughly, poor quality clinical images, limited ability to use bed”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Heavy reliance on caregivers as sources of information in relation to the child may inadvertently lead to inaccuracy and bias.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Hybrid models may further help ameliorate physician-patient diagnostic and logistical difficulties.

    “Given that previous studies have shown that both store-and-forward and live interactive teledermatology could be diagnostically comparable, hybrid models may further help ameliorate physician-patient diagnostic and logistical difficulties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Havele et al retrospectively reviewed 1110 patient-provider live video consults and 89 store-and-forward, provider-to-provider pediatric teledermatology consults during COVID-19 and described that dermatologists faced different issues in terms of connectivity, video quality, and photograph quality when managing myriad conditions.

    “Havele et al [13] retrospectively reviewed 1110 patient-provider live video consults and 89 store-and-forward, provider-to-provider pediatric teledermatology consults during the COVID-19 pandemic and described that dermatologists faced different issues in terms of connectivity, video quality, and photograph quality when managing myriad conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Adoption of VR technology for parents/families may be challenging, costly, and physically difficult for the roving active child.

    “Adoption of VR technology for parents/families may, on the other hand, be challenging. It may be costly to ensure adequate access with provision of VR technology to families. Parents may also face physical difficulties with using VR for the roving active child.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    With store-and-forward platforms, good photography forms the basis of the consult, informing on the evolution of a skin disease and assisting in more objective assessments when different doctors are involved in patient care.

    “With store-and-forward platforms, good photography forms the basis of the consult—where clinical photos inform on the evolution of a skin disease and assist in more objective assessments of a patient when different doctors are involved in patient care such as in larger public hospitals [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Sidoroff, A, 2016, Imaging in Dermatology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Virtual reality technology removes logistical barriers for teleproviders.

    “Virtual reality (VR) technology, where a headset can be worn by the teleprovider in various settings and even on-the-go, removes logistical barriers for teleproviders.”
    Quote in the paperNot a substantial claim
19 of 19

  • The paper relies on this without support.

    Heavy reliance on caregivers as sources of information in relation to the child may inadvertently lead to inaccuracy and bias.

    “Heavy reliance on caregivers as sources of information in relation to the child may inadvertently lead to inaccuracy and bias.”

  • The paper relies on this without support.

    There is a relative paucity of teledermatology practice guidelines for pediatric conditions other than infantile hemangiomas.

    “Apart from the consensus statement released by the Society of Pediatric Dermatology on the management of IH, suggesting that follow-up visits for IH could be safely performed via synchronous or asynchronous means, there is relative paucity of teledermatology practice guidelines for the other pediatric conditions.”

  • The paper relies on this without support.

    Prior to COVID-19 in the United States, private insurers offered reimbursement for teledermatology as an alternative to self-pay and federal health insurance programs such as Medicare and Medicaid, but policies varied between states and payer status.

    “Prior to the COVID-19 pandemic in the United States, private insurers offered reimbursement for teledermatology as an alternative to self-pay and federal health insurance programs such as Medicare and Medicaid. However, such policies varied between states and payer status.”

  • The paper relies on this without support.

    To date, the extent of legal responsibility in cases of incorrect or delayed diagnosis remains ambiguous, and malpractice risk is not generally well characterized.

    “To date, the extent of legal responsibility in cases of incorrect/delayed diagnosis remains ambiguous, and malpractice risk is not generally well characterized.”

  • The paper relies on this without support.

    In the United States, HIPAA governs compliance of clinical images to follow appropriate security precautions, with providers who fail to do so being subjected to legal penalties.

    “In the United States, the Health Insurance Portability and Accountability Act (HIPAA) governs the compliance of clinical images to follow appropriate security precautions, with providers who fail to do so being subjected to legal penalties.”

  • The paper relies on this without support.

    Low-income households may experience gaps in access to technology and internet connectivity that are requisites for teledermatology visits.

    “Low-income households may experience gaps in access to technology and internet connectivity that are requisites for teledermatology visits.”

  • The paper relies on this without support.

    Differential digital literacy and connectedness among cultural and socioeconomic groups can create inequity in pediatric teledermatology uptake and care delivery.

    “Differential digital literacy and connectedness among cultural and socioeconomic groups can create inequity in pediatric teledermatology uptake and care delivery.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Hybrid teledermatology visits using both synchronous and asynchronous communication may become more prevalent in practice.

    “Therefore, hybrid teledermatology visits using both synchronous and asynchronous communication may become more prevalent in practice [49].”

    From Store-and-Forward Images in Teledermatology: Narrative Literature Review (2022) · cites this paper as [49]

    The Discussion (Conditions Managed by Teledermatology; page unavailable) recommends hybrid platforms combining synchronous and asynchronous communication. The Conclusion says teledermatology will play an increasing role, but it does not specifically predict that hybrid visits will become more prevalent in practice. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Rosen, AR, 2016, Cutis, 97, 302

Cited by

Sorted by citations

Related

Authors
Long, V., & Chandran, N. S.
Affiliations
  • National University Hospital (SG)
  • National University of Singapore (SG)
Corresponding author
Long, Valencia
ORCID
Venue
JMIR Dermatology
Publisher
JMIR Publications Inc.
Published
2022-05-17
Volume
5
Issue
2
Pages
e34228
ISSN
2562-0959 (ISSN-L)
DOI
10.2196/34228
PMC
PMC9118542
OpenAlex
W4282918299
Semantic Scholar
c86ecaf711ff0be66db85b170d673f21c5e48f91
Cited by
10
References
21
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 1
FWCI
0.45
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Dermatology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Dermatology › Dermatological and COVID-19 studies
  • Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
Keywords
COVID-19 pandemic, telemedicine, pediatric dermatology, skin diseases, telehealth adoption, pre- and post-pandemic comparison

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