Jaggi Rao

Psoriasis is a chronic, immune-mediated systemic condition characterized by inflammatory changes that may involve the skin and joints. It is relatively common, with a prevalence rate of 2–4% in North America, and a global prevalence rate of up to 11.4%. Years ago, affected patients may have ranged in age from 18–39 to 50–69 due to bimodal distribution. While initially thought to be a dermatologic disease, it is now a recognized multisystem condition with a genetic predisposition. The complex pathophysiology is thought to originate from dysregulation between the innate and adaptive immune systems. T-lymphocytes, dendritic cells, cytokines such as interleukin (IL) 23, IL-17, and tumor necrosis factor (TNF) have all been implicated in and contribute to the inflammatory sequelae. The chronicity and pathogenesis of disease may predispose patients to significant functional impairments, associated comorbidities such as metabolic syndrome and cardiovascular disease, and diminished quality of life. This has prompted novel approaches to management with the introduction of biologics and small molecule therapies that address the underlying immune dysregulation. There are multiple clinical manifestations including plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, and pustular psoriasis. Among the most common is plaque psoriasis which typically presents as symmetrically distributed, well demarcated, erythematous, scaly plaques or patches that may be pruritic. Common sites of involvement include the extensor surfaces of the elbows, knees, the trunk, gluteal cleft, and scalp. Guttate psoriasis is typically preceded by upper respiratory infections and represents approximately 2% of all cases of psoriasis. It involves several small (<1 cm) confetti-like papules and plaques. A severe, although uncommon form is erythrodermic psoriasis which results in widely distributed erythema, scales and exfoliation of a large surface area of the skin. Due to the widespread loss of the epidermal, dermal barrier and associated risk of fluid loss, electrolyte disturbances and infection, it is considered a dermatologic emergency. Pustular psoriasis is also an uncommon, potentially severe, clinical variant, with possible complications secondary to acute widespread erythema and development of multiple pustules.

Background: Teledermatology utilizes photoimaging and background information to allow dermatologists to remotely provide a diagnosis to practitioners. ConsultDerm is an asynchronous, web-based teledermatology software that allows practitioners to submit their electronic referrals for assessment by board-certified dermatologists. Objective: Our study aimed to retrospectively analyze teledermatology’s utilization in Canada by using the teledermatology platform ConsultDerm. Methods: After implementing inclusion criteria, 1000 patients were selected, and relevant demographic and clinical information were extracted for data analysis. In addition, an online survey with pre-formulated questions was distributed to 7 dermatologists currently using the ConsultDerm platform to determine their experience in utilizing teledermatology. Results: Of the 1000 patients, 66.5% had not received treatment prior to their teledermatology referral, and on average, patients experienced symptoms for 489.5 days prior to their referral. Diagnoses made were categorized by conditions, most common being dermatitis (37.1%), followed by acneiform conditions (10.6%), benign lesions/neoplasms (12.1%), infections (9.4%), and dyspigmentation (3.1%). Most consults originated from small population centers, and the referring practitioners were predominantly family physicians. Dermatologists utilizing the platform expressed ease of use, however, areas of improvement were identified such as increasing the quality of imaging and more detailed patient history. Conclusion: Through our analysis of 1000 cases, we identified how a teledermatology consultation could be used to assess a wide variety of cutaneous conditions, improving access for patients who may face barriers to seeing a dermatologist.