A dermatologist and clinical associate professor of dermatology discusses implementing telehealth in dermatology practices.
Julie Harper, MD
With U.S. state governments imposing shelter-in-place orders beginning in mid-March because of the COVID-19 pandemic, the practice of medicine has been upended. As is the case with many other specialists, dermatologists have had to change the way we see and treat patients. At my own practice in Birmingham, Alabama, we were able to transition some of our clinic visits to telemedicine visits in recognition of the fact that live appointments would not be responsible.
Switching to virtual visits has been especially amenable for patients who require frequent visits — notably, existing patients who need prescription refills and those with severe acne who are taking isotretinoin and must be seen every four weeks. In addition to patients with acne, we have been using telehealth successfully for patients with rosacea, psoriasis, and eczema. In our experience, virtual visits with these patients can be as efficient and effective as in-person visits, namely because the assessment of these skin conditions is very visual and the treatment is usually not procedural-based.With telemedicine, we do not have to interrupt patient care. Using videoconferencing technology through our electronic medical record (EMR) platform, we can continue to connect with patients on a regular basis, inquiring about their overall health, as well as their skin health. Surprisingly, we have found that virtual visits with a patient in their own home even has some advantages. This is especially true for patients with acne, many of whom are teens. They are very accepting of technology and love virtual visits as they find them to be convenient and flexible. One of the benefits of doing telehealth visits with acne patients is that we can see for ourselves which medicines they are using to self-treat their acne, which they’ll often show us if asked. As is the case with patient visits in the clinic, we can hear from them directly about their progress with a specific acne treatment.
Telehealth visits also give acne patients a pathway to continue treatment even with the barriers put in place by shelter-in-place orders, and to try new treatment options. For example, we have a new topical minocycline foam recently FDA-approved for acne. For patients with both facial and truncal acne, we now have the option of treating them with the first topical retinoid treatment specifically studied and proven safe and effective to treat acne on the face, chest, shoulders and/or back. AKLIEF (trifarotene) Cream, 0.005%, which is FDA-approved for the treatment of acne vulgaris, can be easily prescribed during a telehealth visit to appropriate patients.
For certain patients, a virtual appointment is not a viable option. Patients with melanoma and those in urgent need of a full body skin cancer screening cannot be examined appropriately during videoconferencing. To accommodate patients requiring an in-person visit, we did not shut down our practice entirely, but kept it open for urgent visits. Only one physician or nurse practitioner, two medical assistants and one person at the front desk handling scheduling were present each day. That approach allowed us to accommodate patients — (e.g., someone needing a skin infection treated or stitches for an injury) – who wanted to avoid visiting an urgent care or an emergency department, where they could be exposed to someone infected with SARS-CoV-2.
Now that the stay-at-home order has been lifted in our state, we have returned to full office hours and a full staff, but we have put in place the following procedures to ensure that face-to-face visits are as safe as possible for both our staff and patients:
The positive experience our practice has had with telehealth is similar to that of other local dermatology practices with which I have been in contact. None of us could have anticipated a global pandemic like COVID-19 in our lifetime, but we adapted to the best of our ability, so we could continue to ensure uninterrupted patient care. Telemedicine is not perfect but it does have many advantages that were highlighted during this pandemic. I expect that telemedicine will continue to be utilized in the near future and very likely into the distant future as well.
Julie Harper, MD, is a dermatologist at Dermatology & Skin Care Center of Birmingham and clinical associate professor of dermatology at the University of Alabama-Birmingham. This piece reflects her own views and not necessarily those of this publication. Harper has received honoraria related to speak, consulting, and/or research grants from Galderma.