Skin is our largest organ, but many of us have never visited a dermatologist. New smartphone apps and websites are hoping to rectify this with dermatologic diagnoses at the click of a button. For a fee, teledermatology sites such as Spruce, Doctor Derm and Pocket Derm have board-certified dermatologists assess skin selfies submitted by the user. Though the innovation offers modern-age convenience, it begs the question: Are these online diagnoses accurate?
Recent research shows that teledermatology apps are reliable, but according to New York City dermatologist and LivingHealthy expert David Colbert, MD, remote diagnoses can be risky. He regularly sees patients with a false sense of security who have been tracking their moles with the help of the Internet. One million Americans are diagnosed with skin cancer every year and the dermatologist saw firsthand the devastating effects of a virtual misdiagnosis when a 27-year-old patient came in for Botox. Unfortunately, she also had a brown spot her app said was nothing, when in fact, the mole was stage 4 melanoma and, says Colbert, “She died, and I’m not joking.”
But before we scare you away, Colbert still believes that teledermatology—or the practice of using technology to remotely deliver dermatologic diagnoses—“is the way of the future.” He set up a teledermatology clinic in Cambodia via Angelina Jolie’s foundation and acknowledges the benefits of a virtual diagnosis via photos: “A good part of dermatology is done with imaging. Not a day goes by that I don’t get a photograph or video from a client—somewhere on the planet, making a movie or hiking Mount Everest—asking me what’s up with their skin,” says the dermatologist who’s also worked with Naomi Watts and Rachel Weisz. “You can make a very accurate diagnosis with a clear picture,” Colbert adds. “The important thing to know is to ask the right questions. A rash could be fatal if you don’t ask the right question, like ‘Do you have a fever?’ There are great limitations to it with people who don’t know what they’re doing—I call it the ‘Dr. Google’ phenomenon.”
Of the apps, “I’d be concerned about efficacy first, quality of care, security, safety and privacy,” says California-based Patricia Bergmann, MPH, who has deployed about 150 teledermatology models in rural areas. These models differ from self-serve websites and apps because medical staff takes the pictures and background info sent to the remote doctor. For patients who are physically too far from a dermatologist, Bergmann arranges for them to visit the office of a general practitioner, clinic or hospital where she’s trained staff to access a secure HIPPA-compliant specialty care website and input medical information in a safe, secure setting. “The sustainable teledermatology models I have deployed have the [remote dermatologists’] diagnosis and treatment plan for the skin problem within two days, often covered through insurance,” says Bergmann, who says follow-up appointments are frequently scheduled. In this way, like at Colbert’s Cambodian clinic, patients can safely access specialists without being left to their own devices.
While a 2014 University of Pennsylvania’s Perelman School of Medicine study reported a very high percentage of agreement between apps and face-to-face dermatologist consults in diagnosis and recommended treatment, Colbert remains wary because his rigorous training included weekly teledermatology rounds in which “some of the smartest people got everything wrong,” including determining whether a photo showed an actual melanoma or not. He also points out that taken at face value, virtual services could still lead to trouble.
For one, the idea of taking pictures of your body (especially photos of sensitive places) and uploading them to the Internet, is alarming. Additionally, there’s room for error when self-reporting symptoms, as opposed to being in an office with a professional who has been trained in the process (like with safe and regulated rural telemedicine models). “You could forget to mention you’re pregnant and somebody diagnoses a particular skin ailment and writes a prescription that could give you horrible side effects,” explains Bergmann.
Colbert also adds that legal liability becomes complicated—with an app, whom do you sue? “The patient has to take responsibility,” Colbert says. “The smartphone is not a doctor. It can help a doctor, but it can’t collect all the information and come up with an answer. Maybe one day we’ll have our own smartphone doctors that tell you what kind of bacteria you have or what injection you need, but for now we’re not there.”
Bottom line? “The safe way to use an app is to use it as a sign,” Colbert says. “If you feel really sick or are worried or anxious, just go see the doctor.”