Diagnosing and treating patients from hundreds of miles away using online platforms is the basis of telemedicine, a new and fastgrowing trend. In dermatology, there are already numerous studies highlighting the value of teledermatology in delivering quality care to communities where dermatologists are scarce.

Herbert Goodheart, MD, oversaw the first teledermatology initiative at Elmhurst Hospital Center, a Mount Sinai Health System affiliate. This year, the Kimberly and Eric J. Waldman Department of Dermatology launched a formal teledermatology program directed by George Han, MD, PhD, at Mount Sinai Beth Israel. Under the supervision of Dr. Han, residents see patients remotely in real time at Bassett Medical Center in Cooperstown, New York.

Our doctors conduct online interviews and examinations, order tests, and prescribe medications, all from over a hundred miles away.

“Teledermatology allows us to help people in a way that other patients experience in Manhattan, where dermatologists are abundant,” says Shira Wieder, MD, a dermatology resident at Mount Sinai. “We have had the opportunity to help patients suffering from untreated psoriasis or atopic dermatitis their entire lives and have never been able to see a dermatologist. Patients are so appreciative of our help and seem to love the service, despite only getting to meet us over the computer.” Dr. Wieder said that some clinic nurses were initially skeptical about the teledermatology concept but now think it is a wonderful addition to their clinic. Ellen de Moll, MD, a dermatology resident, said she has also enjoyed her time on the rotation. “It has allowed me to help many patients with limited access and provide truly life-changing treatments for everything from acne to severe psoriasis to rare diseases, she says.” Dr. de Moll also noted some of the challenges of teledermatology, including the difficulty of obtaining clear images and the inability to touch and apply pressure to skin lesions.

Patient feedback has been very positive, with testimonials such as, “Less wait time to be seen by specialists” and “Getting care from physicians at a premier hospital.” Patients also appreciate the chance to see changes in their clinical photos and receive opinions from several physicians over the course of their care. Prior to teledermatology, the average wait time for a dermatology appointment for these patients in upstate New York was close to a year. Now they can consult with a Mount Sinai dermatologist within a couple of weeks, and sooner for urgent problems.

“Dermatology lends itself to telemedicine, given the uneven distribution of dermatologists in the U.S. and the visual nature of our field,” says Dr. de Moll.

Pregnancy can be associated with skin conditions that require medical evaluation because of possible health risks to the mother or her baby. The first manifestation may be itching, which affects up to 20 percent of pregnant women. Itching can be mild but in some instances is severe enough to affect sleep and quality of life. Most often, itching is caused by flare-ups of pre-existing skin conditions like eczema or atopic dermatitis. In such cases, the response to topical corticosteroids and good skin care is usually excellent, and there are no significant effects on fetal or maternal health.

One of the most common rashes specific to pregnancy is called polymorphic eruption of pregnancy (PEP), also known as pruritic  urticarial papules and plaques of pregnancy (PUPPP). PEP is linked to rapid weight gain and multiple pregnancies. It usually begins with itchy, hive-like lesions on the abdomen, especially within stretch marks, and may spread to involve the buttocks or thighs. It generally appears during late pregnancy and resolves within four to six weeks after delivery. A diagnosis of PEP is based on the classic appearance. PEP is not associated with increased maternal or fetal risks, and it usually does not recur during subsequent pregnancies.

A more serious condition is pemphigoid gestationis (PG), a rare autoimmune disorder that usually occurs during late pregnancy with an abrupt onset of itchy blisters. These are typically on the abdomen in the umbilical area and can spread to the whole body. An office-based procedure called a skin biopsy, in which a small piece of skin is removed and sent in a special medium to detect immunofluorescence, can clinch the diagnosis. Severe cases usually require oral corticosteroid treatment. PG is associated with an increased risk of prematurity, and the newborn may be small for its age. After delivery, the rash usually resolves within weeks to a few months. Skin manifestations may appear in the infant due to transfer of antibodies across the placenta. It is possible for PG to recur in the mother during subsequent pregnancies.

There are numerous other causes of itching and skin eruptions during pregnancy. The timing of onset, appearance, and distribution of the rash are important diagnostic signs. The dermatologist plays a key role in diagnosis and prompt treatment, which are crucial to protect the mother and her baby.