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Teledermatology and chronic skin diseases: Real life experience in a Southern Italian Dermatologic Centre

Dear Editor, Since the COVID-19-outbreak, different measures have been applied in hospitals in order to avoid or limit as much as possible coronavirus infection spread, including the reduction of face-to-face visits and the implementation of teledermatology. We read with great interest the article written by Brunasso et al, which reported the special measures applied in their dermatologic center during the COVID-19-era, in order to guarantee a continuity of care for patients. Particularly, they focused their attention on the use of teledermatology, and remote monitoring technologies to improve the quality of care, reduce barriers (as lock-down) and allow to follow-up patients during this emergency-period. Herein, we report the measures applied in our dermatologic clinic (University of Naples Federico II) to ensure a continuous follow-up especially for chronic skin diseases, such as psoriasis, acne and hidradenitis suppurativa. With the lock of the face-to-face visits, we implemented smart-working as well as teledermatology services. Particularly, we implemented different type of consultations for patients: (a) phone consultations; (b) video-consultations through teledermatology service; and (c) WhatsApp support group. Regarding phone consultations, this service was the most used, especially for patients with chronic skin diseases, requiring chronic immunomodulant treatments such as biologics. To date, about 470 patients have been phone-contacted, looking for suspicious symptoms of COVID19-infection (fever, cough, or dyspnoea), to ensure patients were following in the right way treatments and to check the efficacy of ongoing treatments. Teledermatology service has been available for both first and follow-up visits resulting a high-appreciated service, among both patients and physicians. Indeed, about 150 videoconsultations have been performed, with high positive patients' feedback, especially from young patients referring to acne centre. The last implemented service was the WhatsApp group tool. This was a service started before the COVID-19-pandemic reserved to the emergencies and, then improved during this pandemic, which showed the importance in supporting patients, prescribing an adequate therapy, and following them during treatment with phone messages in order to avoid treatment discontinuation. While data from literature indicate teledermatology as a popular service among both patients and clinicians, studies regarding the real effectiveness, costs, feasibility and accuracy of live teledermatology compared to standard care are still missing. However, several studies regarding the use of teledermatology in normal settings have been reported, demonstrating that live-interactive and standard care were comparable with regard to feasibility and accuracy. Our data about the use of teledermatology seems to indicate teledermatology as a great support for physicians in this emergency situation in order to avoid face-to-face visits, thus reducing the risk of infection. Hence, we believe that recent improvements and experiences achieved with these services, as well as the diffusion of health technologies, could be the beginning of a larger application of new technologies among both physicians and patients during the pandemic period as well as in normal settings. However, more data are needed in order to evaluate the real efficacy as well as the eventual economic and administrative impact related with a larger use of teledermatology.