Telemedicine is the practice of medicine using the electronic transfer of information about patients. Telecommunication in medicine shows great promise for improving dermatological care particularly for people living in remote communities (Teledermatology).

Teledermatology has already been shown to be a useful way to provide dermatological specialist support to remote communities. Dermatology is also the branch of medicine most likely to be used by general practitioners in isolated regions for help in the care of their patients.

Telemedicine was largely born during the 'space race' between the USA and the former USSR. The National Aeronautics and Space Administration (NASA), the USA military and USA Government funded many telemedicine projects. NASA was keen to develop a remote monitoring system to manage the health of American astronauts in space.

A recent Australian study (Tait and Clay, Australasian Journal of Dermatology) has confirmed Teledermatology can be a reliable way to diagnose many dermatological problems. In this study a general practitioner entered information about a patient along with digital photographs of their skin problem or skin lesion. The dermatologist then looked at the electronic patient details and photographs and recorded their preferred diagnosis along with other possible diagnoses or causes of the skin problem. The dermatologist then saw the actual patient face to face to evaluate their skin problem. In 25 out of 30 consultations, identical diagnoses were reached. In the remaining five cases, the preferred diagnosis and their second favored diagnosis were reversed.

Further studies are required to help determine the role teledermatology will play in the Australian medical system to provide improved access to specialist dermatological care, particularly for people living in remote areas. Such studies need to determine the limitations of the system along with its strengths. The gold standard remains face-to-face consultation between the patient and doctor. There may, however be many occasions when teledermatology will provide a useful, convenient, time saving support service for local doctors in communities without a resident or visiting dermatologist. Some problems may be easily solved with the help of an internet consultation, others patients may still need to then see a skin specialist in person to best diagnose and treat their skin problem.

Telemedicine is an emerging technology within Australia. The Government and many medical organizations, including the Australasian College of Dermatologists are showing interest in improving and establishing infrastructure within this country to make it possible to perform specialist medical consultations via the internet. Such consultations could occur in real time, or consist of information being sent for review by a specialist at a later time.

The diagnosis and treatment of skin problems will probably be one of the major applications for this technology in Australia. Dermatology is a very visual specialty that readily benefits from continued improvements in the quality of digital images. Skin rashes, lumps and bumps are easily photographed or filmed. Dermatologists outperform everyone else (physicians and GPs included) in the accuracy of diagnosis of skin complaints. Teledermatology will allow them to share their expertise with remote GPs to support them in the care of their patient's skin, hair and nail disorders.

Acknowledgement
This information is based on publications on Teledermatology in The Australasian Journal of Dermatology.
Last Modified 6 March, 2001 by Dr John R Sullivan / © 2001 Australasian College of Dermatologists