Mobile Device Digital Photography for Teledermatology Consultation: Real-Life Situations

Objective: The use of mobile phones for teledermatology consultations is increasing. In this study, we aimed to describe photographic problems in teledermatology performed via mobile phones and their effects on diagnostic decision-making. Materials and Methods: Three dermatologists independently reviewed the medical histories and photographs of patients taken by primary-care physicians for teledermatology between January 2018 and August 2020. The consensus of the dermatologists’ decision-making was categorized into “definite diagnoses given,” “probable diagnoses given,” and “unable to provide any diagnosis.” Relationships between photographic errors and dermatologist decision-making were investigated. Factors related to photographic problems were evaluated. Results: In all, 899 images from 220 patients were reviewed. The most common purpose of teledermatology was to make a diagnosis. The most frequent diagnoses were eczema, infection, and autoimmune diseases. Consultants gave definite diagnoses for 63.2% of patients and probable diagnoses for another 29.5%. However, diagnoses were not made in 7.3% of cases. Defocusing and non-eczematous lesions were significantly associated with the inability to give diagnoses (P = 0.002 and 0.037, respectively). Pictures from peripheral areas showed higher frequencies of distortion errors, improper framing, wasted space, and improper background, while truncal regions tended to have lighting problems. The outpatient department setting was associated with a lack of overview and defocusing. Conclusion: Focusing was the central factor for making diagnoses in teledermatology. Lighting should be more concerned in truncal regions. While using smartphone cameras, distortion should be aware. These factors should be considered to improve the effectiveness of teledermatology.