title: The Empirical Foundations of Teledermatology: A Review of the Research Evidence.
abstract: BACKGROUND
  This article presents the scientific evidence for the merit of telemedicine interventions in the diagnosis and management of skin disorders (teledermatology) in the published literature. The impetus for this work derives from the high prevalence of skin disorders, the high cost, the limited availability of dermatologists in certain areas, and the promise of teledermatology to address unmet needs in this area.
  
  
  METHODS
  The findings are based on a targeted review of scientific studies published from January 2005 through April 2015. The initial search yielded some 5,020 articles in Google Scholar and 428 in PubMed. A review of the abstracts yielded 71 publications that met the inclusion criteria for this analysis. Evidence is organized according to the following: feasibility and acceptance; intermediate outcomes (use of service, compliance, and diagnostic and treatment concordance and accuracy); outcomes (health improvement and problem resolution); and cost savings. A special section is devoted to studies conducted at the Veterans Health Administration.
  
  
  RESULTS
  Definitions of teledermatology varied across a wide spectrum of skin disorders, technologies, diagnostic tools, provider types, settings, and patient populations. Outcome measures included diagnostic concordance, treatment plans, and health.
  
  
  CONCLUSIONS
  Despite these complexities, sufficient evidence was observed consistently supporting the effectiveness of teledermatology in improving accessibility to specialty care, diagnostic and treatment concordance, and skin care provided by primary care physicians, while also reducing cost. One study reported suboptimal clinical results from teledermatology for patients with pigmented skin lesions. On the other hand, confocal microscopy and advanced dermoscopy improved diagnostic accuracy, especially when rendered by experienced teledermatologists.
authors.affiliation: 1 eHealth Center, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Rashid L
authors.initials: RL
authors.lastname: Bashshur
authors.affiliation: 2 Department of Geography, University of Kentucky , Lexington, Kentucky.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Shannon
authors.affiliation: 3 Department of Dermatology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Trilokraj
authors.initials: T
authors.lastname: Tejasvi
authors.affiliation: 4 Center for Connected Health , Partners HealthCare, Boston, Massachusetts.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kvedar
authors.affiliation: 1 eHealth Center, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Gates
mesh_terms: D003880:Dermatology; D036262:Empirical Research; D019317:Evidence-Based Medicine; D006801:Humans; D012871:Skin Diseases; D017216:Telemedicine; D014481:United States
keywords: evidence; skin disorders; teledermatology; telehealth; telemedicine