Pinpointing when and how of teledermatology

We read with considerable interest the research conducted by Reinders et al.¹ This study aimed to address the underutilization of teledermatology in Germany for managing psoriasis, a chronic condition that requires ongoing follow-up care. The relevance of this work is highlighted by the necessity for continuous patient monitoring, the occurrence of acute flares that require prompt—though not necessarily urgent—specialist intervention and the longstanding relationships typically established between patients and their treating physicians. These factors are especially significant in a context where waiting times are increasingly extended. Regrettably, this issue is relevant to many countries, where a lack of specialists significantly limits access to standard care, making the implementation of teledermatology more of a necessity than an option.

We fully agree with the authors on the importance of aligning digital health services with the needs explicitly expressed by patients themselves. It emphasizes the importance of understanding the specific requirements associated with each medical condition and the individual needs of patients. In fact—and although it may appear contradictory to some critics—telemedicine is a tool that serves the individualization of medical care. It makes it possible to offer the type and intensity of care that each patient needs, at the right time and in the most convenient setting, which in many cases may be the patient's own home. However, it is important to recognize that acquiring telemedicine technology alone does not guarantee its successful implementation. Telemedicine is a transversal innovation that has repercussions on multiple dimensions of the healthcare organization: from the structure of agendas, allocation of human resources, training, clinical protocols, and face-to-face access circuits, as well as interoperability with other information systems (diagnostic imaging, prescription and dispensing of drugs, etc.). Therefore, the integration of teledermatology into services and consultations, particularly within specialized units such as a psoriasis clinic, necessitates a thorough redesign of both functional and structural aspects to effectively address patient needs. Most of the current perceptions of teledermatology among patients—clearly highlighted in this study—are largely attributable to the technology adoption process that occurred without the corresponding redesign of dermatology services and units implementing it.

In addition, the study indicates a low perceived privacy risk among patients, which could reassure authorities considering regulations that balance privacy with accessibility. Efforts might be better directed toward ensuring reimbursement for teledermatology services, aligning them with traditional face-to-face consultations.

Regarding technology acceptance and competency, factors such as age and gender play a significant role. Specifically, the findings suggest that full-time employees in Germany—who are predominantly male—and patients with lower incomes suffering from psoriasis may highlight underlying disparities in healthcare access.

The preference for a known physician over an unfamiliar dermatologist with access to patient data underscores the importance of viewing medicine as more than an individual transaction between a doctor and a patient. Instead, it is a complex, interconnected relationship where technology can and should be leveraged to benefit both parties.

Studies such as that of Reinders and colleagues provide, on the one hand, robust evidence supporting the need for a system-wide, integrated implementation of teledermatology and, on the other, an excellent roadmap for delivering a model of care that is agile, accessible, and individualized—in ways that conventional care has not yet been able to achieve. As the authors rightly point out, customizing teledermatology services to align with patient preferences can enhance its acceptance and effectiveness.

PP: Board member of Dermosight. LF: Founder and consultant of DermaQ Salud Digital and Dermapeople.