What Happens During an Online Dermatology Visit?

“Telemedicine can be used to evaluate new symptoms, manage previously diagnosed conditions, follow up on treatment plants, order lab tests and to prescribe medications,” says Tsippora Shainhouse, MD, FAAD, a board-certified dermatologist in Beverly Hills, Calif., in private practice at SkinSafe Dermatology and Skin Care. “An online dermatology visit can also be used to determine if a condition can be managed from home or if they should come into the office for in-person evaluation, workup and treatment.”

Dr. Shainhouse adds, “A telemedicine appointment is considered a true medical appointment.”

And amid the COVID-19 pandemic, the demand for online dermatologist visits has spiked, and providers are responding with secure video and messaging platforms that allow patients to access care from home. Remarking on the growth of online dermatology, Jennifer Haley, MD FAAD, a board-certified dermatologist and host of the Radiance Revealed podcast, says in 2013 she was seeing about 30 patients per month through online dermatology visits. “Now, I see up to 250 per month and I’m licensed in 20 states,” she says. “I primarily do online dermatology now.”

So, what happens during an online dermatology visit? When can you use online dermatology, and what can you expect as it relates to sharing photos and information, getting a diagnosis and managing a skin issue after the fact? Read on to learn more.

Online dermatology is best for visible skin, hair and nail conditions, according to AAD. Some of those issues include:

• Rashes
• Acne
• Eczema
• Psoriasis
• Suspicious spots

Dr. Haley adds fungal conditions to the list, some hair loss issues, shingles, cold sores and rosacea to the list. “Telemedicine is not good for an overall skin check,” she says. “I have patients try to send me pictures of 30 moles and that will not do because the 30 moles they are worried about will end up looking fine and I’ll find spot number 31 that is concerning. Routine full-skin examinations should be done in the office once a year, and twice a year for high-risk patients.”

Online dermatology is a way to follow up on those skin conditions, and refill necessary prescriptions. “I can send prescriptions electronically and I typically will recommend supplements and topical skin care with links to information,” Dr. Haley says.

Not only that, she can provide at-home units for therapies for conditions such as psoriasis and eczema.

As for suspicious spots, a dermatologist can gather photos to review digitally to determine if a spot needs to be looked at in the office—and, perhaps provide peace of mind if the spot is truly nothing to be worried about. Dr. Haley does not perform total skin checks virtually, but a patient can send a high-quality image of a spot.

Keep in mind, an online dermatology appointment might start remotely and end up as a triage appointment during which a board-certified dermatologist will recommend an in-office follow-up.

“About 30% of the time, I can give them  reassurance, and 70% of the time, I’ll say, ‘Go to aad.org and find a dermatologist near you and let them know you consulted with a board-certified dermatologist and see if you can get an ASAP appointment for one spot only,” she says. “While it might be a three-month wait for a routine skin check appointment, if you have an urgent spot that has been pre-screened through an online visit, you can usually get an appointment within a week or two.”

To sign up for an online dermatology appointment, first be sure the provider is board-certified. One place to start is to search AAD.org. AAD also recommends finding a dermatologist who offers telemedicine appointments by doing an advanced search for teledermatology as the practice focus.

Dr. Shainhouse asks patients to schedule online appointments just as they would an in-person visit. She uses a compliant, encrypted email system and patients can send her a message to her to request a time. She will request that patients email photos through the secure account, and during a real-time video call, she will review the images with the patient and make recommendations, if possible. She handles uploading images into the patient portal chart/records.

Another way to sign up for online dermatology is to use a platform like Dermatologist On Call or MDlive, which are two venues by which Dr. Haley sees patients. These are asynchronous appointments that are “store and forward,” meaning you request an appointment, provide images and information, and a board-certified dermatologist will review and provide insight usually within 48 hours.

Specifically, to sign up for an online visit with Dermatologist On Call, you create a patient profile by providing your name and email, followed by creating a username and password. From there, you describe your dermatology concern and upload photos. From there, a board-certified dermatologist will review the information and either provide a diagnosis and treatment plan, or recommend an in-person visit at a board-certified dermatologist near you. This platform tries to match you with an online dermatologist that has offices in your region so if an in-person follow-up is necessary, you don’t have to travel far.

MDlive’s online appointment process is similar. Though, as opposed to the store-and-forward option, you can have a doctor visit right away or schedule an appointment by using your phone, computer or the MDlive app. Dermatologist visits can cost $0 to $75 depending on your insurance.

You’ll get more out of your online dermatology appointment if you prepare for the experience. AAD recommends preparing for telemedicine dermatology by first contacting your insurance provider to see if your plan covers telemedicine. Because of the COVID-19 pandemic, your insurance might have updated its policies and your online visit could be covered just as if you were seeing a board-certified dermatologist in person.

Also, gather information to prepare for your online dermatology appointment, particularly if you are seeing a new provider that does not have information about your medical history and medications. A dermatologist might request that you fill out forms, and an online dermatology platform may include a questionnaire for you to complete prior to booking a virtual visit. AAD says you can expect to provide the following information:

• Medications
• Medical history / family history
• Skin issues you’ve experienced in the past
• When you noticed your current skin symptoms and whether they have worsened
• Allergies

Be sure you have the technology to participate in an online dermatology appointment—and most patients do since platforms generally allow you to see a doctor by using your phone, computer or tablet. You might be asked to download an app, or a provider could text you a link that you open to start a video appointment. This is the case with tools like Doxy.me. Asynchronous appointments are conducted through secure messaging that allows you to upload photos.

When it comes to providing photos prior to or during an online dermatology visit, the quality and angle can make the difference between a successful virtual visit vs. needing an in-person follow-up appointment to better examine a skin issue. Most smartphones today are capable of capturing quality images that can be used during an online dermatology visit.

When reviewing suspicious spots via online dermatology, Dr. Shainhouse asks patients to send a “general photo” and a “more distinct photo.” “That way, I can see where the spot is located on the body part along with a close-up photo so I can examine details,” she says.

Here are some pointers for taking quality photos to upload for an online dermatology visit.

• Check the lighting. If natural light is not enough, use a flashlight to illuminate the skin issue. Avoid shadows and glare.
• Capture several angles. Take pictures of all sides of the skin area of concern.
• Take comparison pictures. Show the dermatologist what other healthy skin areas look like. For instance, when showing a spot on your arm, take a picture of the arm of concern and the other arm where there is not a skin issue.
• Avoid makeup. You want the online dermatologist to get the most realistic view of the skin issue.
• Ask for help. Taking a picture of a hard-to-reach area on your body could require asking someone else to assist. Another option is to use a mirror.

Online dermatology results can happen as quickly as immediately after you consult with a doctor, or the results can take 24 to 48 hours. Some platforms like SkyMD say they will provide a diagnosis within minutes of holding an online dermatology appointment.

That said, results can take longer if your online dermatology appointment evolves into an in-office visit that requires a biopsy or culture. It can take one to two weeks to receive results.

What happens after an online dermatology appointment? Depending on the nature and purpose of your online dermatology visit and diagnosis, you may be given a prescription for medication or received treatment advice to address the skin issue. It’s also likely you will have a follow-up appointment to check in on your progress to see whether the treatment plan is working.

Overall, online dermatology allows patients to continue receiving care for many skin conditions conveniently and safely from home. And, it can be an efficient method for pre-screening issues that may involve a follow-up in-person visit. Dr. Shainhouse says, “Patients are loving online visits—they are asking for it and want it to continue to be an option.”

Whether to address a rash, deal with acne or get medication to cure a cold sore, there are a range of online dermatology tools to address these and other issues. Here are some helpful resources so you can learn more about what to expect of an online dermatology visit.

American Academy of Dermatology (AAD)

The American Academy of Dermatology (AAD) allows you to search for a board-certified dermatologist in your area, and find a telemedicine dermatology provider who carries the AAD credentials. The resource offers informative articles about dermatological conditions, along with a robust Coronavirus Resource Center designed mainly for providers. However, patients can also learn how telemedicine is delivered by dermatologists through these tools. The association also helps patients understand how dermatologists are helping keep patients safe during the pandemic and beyond.

Dermatologist On Call

Dermatologist On Call is an e-visit platform that allows you to create a profile, upload images and receive a diagnosis and treatment protocol from a board-certified dermatologist. Dermatologist On Call says its online dermatologists treat more than 3,000 conditions of the skin, hair and nails. The website also offers helpful articles about dermatological issues geared toward patients who want to learn more about specific conditions or how to use telemedicine.

MDLive

MDLive has a partnership with Dermatologist On Call, which is the largest national network of American Board of Dermatology certified or American Osteopathic Association certified doctors. While Dermatologist On Call focuses only on dermatological issues, MDLive connects patients to providers who address 80 common conditions that fall into the categories of medical, behavioral and dermatological care. You might choose to open a profile on MDLive if you expect to use telemedicine for other issues including dermatology. Then, you can keep your online care in one place.

American Board of Dermatology

The American Board of Dermatology is a medical specialty board of the American Board of Medical Specialties (ABMS). Its goal is to protect the public by assessing and certifying doctors who meet educational, training and professional requirements. Dr. Haley explains that the board offers quarterly assessments to maintain certifications. “Be sure you see a board-certified dermatologist because they are the ones in the know about the newest technologies,” she says.

American Society for Dermatologic Surgery

The American Society for Dermatologic Surgery (ASDS) is the largest U.S.-based specialty association for dermatologic surgeons who are recognized as leaders in cosmetic and medically necessary skin surgery.

The American Society for Mohs Surgery

The American Society for Mohs Surgery addresses how telemedicine can be delivered. It is a professional medical society that supports skin cancer training and increasing the number of trained Mohs surgeons.

First Derm

First Derm allows you to consult with an online dermatologist by using its app to snap a picture of the skin issue. Information is sent to and reviewed by a First Derm dermatologist. Treatment is provided in 70% of cases, according to First Derm, which states: “If needed, our app directs you to your closest dermatologist, pediatrician or clinic.”

Teladoc

Teladoc allows you to use a Teladoc account to upload images of your skin condition. A board-certified dermatologist based in the United States will diagnose and provide a treatment plan within two days or less. The common issues Teladoc dermatologists can treat with an online appointment include: acne, psoriasis, eczema, rosacea, rash, poison ivy, skin infections and dermatitis.

Pearl Health

As an on-demand dermatology online resource, Pearl Health allows you to ask basic dermatology questions by using a pop-up chat box that appears when you visit the site. Based on the question you ask, the Pearl virtual assistant will connect you with a licensed dermatologist that specializes in your issue. You can chat one-on-one with the dermatologist.

OnlineDoctor.com interviewed these experts for article guidance:

Tsippora Shainhouse, MD, FAAD, a board-certified dermatologist in Beverly Hills, Calif., in private practice at SkinSafe Dermatology and Skin Care

Jennifer Haley, MD FAAD, a board-certified dermatologist and host of the Radiance Revealed podcast

• American Academy of Dermatology (AAD), preparing for telemedicine dermatology
• AAD, Coronavirus Resource Center
• American Board of Dermatology
• The American Society for Mohs Surgery