Online dermatology visits for acne can be effective

by Chris Emery

Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor’s office, a new study found.

Patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits, Alice J. Watson, MBChB, MRCP, MPH, of the Center for Connected Health in Boston, and colleagues wrote in the report, published online April 19 in the Archives of Dermatology.

Using a 1-to-10 scale, there were no significant differences in dermatologists’ satisfaction with the overall care they provided for patients in the control versus intervention groups (9.39 versus 9.04, P=0.16) or with the patients’ acne improvement (8.92 versus 8.34, P=0.06).

Dermatologists were more likely to report wishing that they could have managed their office visit subjects via e-visits than the reverse (P<0.001), the researchers noted.

Furthermore, although the online visits took about the same amount of time for doctors as office visits (4 minutes 42 seconds versus 4 minutes 8 seconds, respectively; P=0.57) they saved time for patients. Patients attending an office visit spent an average of 22 minutes (range, 15 to 35 minutes) in the physician’s office, while 91% of those completing an e-visit were able to do so in less than 20 minutes. In addition, almost half of the control group patients (45%) spent between 30 and 60 minutes traveling to the physician’s office.

“These findings suggest that dermatologists obtain sufficient information from digital images and survey responses to make appropriate management decisions in the treatment of acne,” Watson and colleagues wrote. “In addition, this model of care delivery was popular with both physicians and patients, likely owing to the convenience and/or time savings associated with e-visits.”

Demand is growing for specialized medical care, such as internal medicine, psychiatry, and dermatology, but too few doctors are available in these fields, according to the report. As a result, doctors are struggling to keep up with demand for appointments and patients must often wait for long periods of time for treatment.

The field of dermatology faces a rise in skin cancer and a uneven distribution of dermatologists, leading to poor access for many patients, particularly in rural areas.

Watson and colleagues theorized that one way to address poor access to dermatology services was to have patients and doctors interact through a Web-based platform. “Familiarity with online banking, travel, and shopping sites may promote patient interest in receiving the same level of convenience and 24/7 access to services in the healthcare industry, a field traditionally slow to respond to consumer preferences,” they wrote.

The authors enrolled 151 patients with mild to moderate facial acne in a prospective, randomized controlled study at two teaching hospitals in Boston between September 2005 and May 2007. The mean age of subjects was 28 years, and most patients were female (78%), white (65%) and college educated (69%).

The patients attended an initial office visit with a dermatologist, during which the researchers took three baseline photographs of their faces. Subjects who were assigned to participate in the online system were provided with a digital camera and trained on how to take photographs of themselves that could be compared with the baseline photos later.

While control subjects received four in-office follow-up visits, those in the intervention group received four e-visits through the online system. For the e-visits, the patients took three photographs of themselves and uploaded them to a secure Web site, answered an online questionnaire about their acne, and provided copayment through the site.

Of the 54 patients who participated in the e-visits, 39 had to resubmit one or more e-visits due to poor photo quality or technical errors, such as failing to attach photos.

Dermatologists responded to the e-visit subjects within three business days and were able to modify treatments, clarify patient history, and prescribe medicine through the online system.

The authors cautioned that the study subjects were mostly white, educated women, so the results might not apply to the wider population of acne patients, who might be less comfortable taking such an active role in their own treatment or using technology.

They also noted that their study did not address comedones or cysts because neither are easily apparent through digital photography.

Of the 20% dropout rate in the study, two-thirds of the dropouts were from the group receiving online treatment. While the analysis suggested that the difference in dropout rates between the control and intervention groups did not invalidate the study, the authors suggested that patients may need help acclimating to new methods of treatment.

“Even motivated patients may require support and encouragement to adopt new methods of follow-up, and this should be anticipated in resource planning for introduction of such services into clinical practice,” they wrote.

Chris Emery is a MedPage Today contributing writer.

Originally published in MedPage Today. Visit for more dermatology news.