Advancing Pediatric Teledermatology: Trends, Barriers, and Innovations in Access and Equity (2020-2024).

Pediatric teledermatology has rapidly expanded over the past four years, improving access to dermatologic care, particularly for under-resourced populations. This expansion has proven effective in reducing no-show rates, improving diagnostic accuracy, and enhancing treatment adherence. Store-and-forward and synchronous telehealth models have facilitated timely dermatologic care, particularly for conditions like acne and atopic dermatitis. However, disparities remain, with non-English speakers and publicly insured patients experiencing barriers to telemedicine access due to digital literacy gaps and limited access to technology. While teledermatology increases efficiency, limitations such as the inability to conduct tactile examinations and reliance on high-quality imaging continue to challenge its widespread adoption. Recent innovations, including artificial intelligence-driven diagnostics, teledermoscopy, and mobile-based platforms, have further optimized teledermatology's capabilities. Additionally, state policies and reimbursement structures significantly influence its accessibility and implementation. Ensuring equitable integration of teledermatology into routine care requires targeted interventions, including expanded bilingual technical support, digital literacy initiatives, and hybrid care models that balance remote consultations with in-person evaluations. Addressing these challenges will be essential for sustaining teledermatology's role in pediatric dermatology and optimizing its long-term impact on healthcare accessibility and equity. This review synthesizes evidence on the clinical performance, accessibility, and equity of pediatric teledermatology from 2020 to 2024, offering insight into implementation challenges and opportunities for future integration into routine pediatric practice.