While we eagerly await for a return to “normal,” aesthetic doctors agree that telemedicine is one result of stay-at-home orders that may stand the test of time.
“Telemedicine has been very useful during the pandemic, and we’ve actually been able to navigate many situations where it will likely be used in the future,” says Denver dermatologist Joel Cohen, MD.
Here, what can be addressed via a telemedicine consult and what’s better left to an in-office visit.
What Can Be Addressed Via Telemedicine
Initial Consults and Assessments
Getting to know your provider in-person and fielding initial questions and concerns can now be done from home. “Telemedicine is a simple way for the patient to ask all of their initial questions, voice their concerns, fill out paperwork and showcase their condition in advance by photo and live by video,” says Beverly Hills, CA dermatologist Ava Shamban, MD.
New York plastic surgeon B. Aviva Preminger, MD agrees. “It’s important to be able to have that initial conversation with people who are home and interested, but not able to come in and explore their options.”
Because information is gathered before your virtual visit, Dr. Shamban notes physicians have an idea of what will be covered in the consult and have an opportunity to assess or discuss amongst the staff beforehand. “We have been encouraging this at our practice servicing nearly 500 telederm visits since this pandemic,” she adds.
Acne and Prescription Refills
“We can assess acne over a web call and talk to patients about next steps and topicals, as well as prescribe oral medications and off-label treatments such as spironalactone for women,” says Dr. Cohen.
However, while it has been made possible, virtual Accutane follow-ups have understandably come with their own set of challenges, as Dr. Cohen notes that the heavily regulated system is best navigated in-person.
Diagnosing Many Skin Conditions
“Compared with other specialties, dermatology is highly visual and a significant amount of work and training is already accomplished by photo and video,” explains Dr. Shamban, making diagnosing certain skin conditions pretty straightforward for qualified physicians.
“Naturally, there is a range of circumstances that would require an in-office visit or medical confirmation in person, but for the majority of skin conditions such as acne vulgaris, psoriasis, eczema, seborrhoeic dermatitis, warts, various rashes and others, we can diagnose, advise and provide topical treatment remotely,” says Dr. Shamban.
Certain Post-Procedure Wound Checks
While Dr. Cohen notes that post-procedure follow-ups are best done in person to rule out any type of infection, he says virtual calls do allow for certain diagnosis to be made when patients can’t come into the office. “If it doesn’t look like an infection, and instead looks angry and red like contact dermatitis, for example, I don’t have to have them come in and culture it, we can just change gears.”
In-Office Treatment Follow-Ups
Instead of making a trip back into your physician’s office after a laser or peel—Dr. Cohen notes he asks patients to come in every couple of days after certain treatments—taking a pulse on healing after a heavy skin-resurfacing treatment, for example, can now be done virtually in a pretty seamless fashion.
Dr. Preminger notes that “there is definitely value in telemedicine for longer-term follow-ups,” adding that virtual post-procedure check-ins have been especially helpful with clients who choose to travel immediately after a procedure.
For Greenwich, CT dermatologist Mitchell J. Ross, MD, virtual skin-care consultations have been especially popular. “Our patients have been loving it; it’s a very comfortable environment for them,” says Amanda Pucci, head of Greenwich Medical Spa’s clinical department. “They’re in their own homes and we can sit in their bathrooms with them as they show us their product lines and ask us questions.”
Dr. Cohen says he is seeing a similar trend in his practice. “Patients are asking more sophisticated questions about skin care,” he adds. “They are thinking about what they can do at home long-term that can really help them.”
What’s Better Left to an In-Office Visit
Proper Skin Cancer Screenings
“Serious and timely conditions that require biopsy must always be conducted in office,” notes Dr. Shamban.
Dr. Cohen agrees, noting there are definite limitations when it comes to the evaluation of a lesion for skin cancer, “especially a melanoma when you need a dermatoscope, and there are limitations when you’re trying to look at something and see if it’s infected or not, where you really need to see it live and then potentially culture it.”
As Dr. Preminger notes, proper evaluation of a wound or incision site requires more than a virtual view. “As a surgeon, there’s a lot that you need to touch and examine that gets lost in a two-dimensional screen. I think that all of medicine is realizing that there is a lot that can be done now remotely via telemedicine, but for post-operative care in particular, a lot of that is better off done in person.”
“Typically, if I had a patient with questions about a wound after surgery, that’s something I would bring them into the office for because it’s important,” adds Dr. Cohen, explaining area must be felt for any warmth, pockets of fluid or any embedded infections in the sutures.
Re-Evaluating Treatment Plans
Regardless of how qualified your dermatologist is, there’s always a chance that the prescribed skin treatment may react adversely at home. When this is the case, your doctor may ask to see you in person to rectify the problem, depending on its severity.
“If topical treatment recommendations for atopic conditions are not working or conditions worsen, an in person follow up may be recommended, if not required,” adds Dr. Shamban.