Dermatologists’ Perceptions of The Use of Teledermatology in Managing Hidradenitis Suppurativa (Preprint)
Authors: Long Valencia , Choi Ellie Ci-En , Chen Zhaojin , Kamil Moonyza Akmal Ahmad , Rajagopalan Murlidhar , McMeniman Erin , Chandran Nisha Suyien 
Published: November 2022

BACKGROUND

The COVID-19 pandemic has led to rapid adoption of teledermatology for the management of both acute and chronic skin disorders. Amongst conditions managed with teledermatology, Hidradenitis Suppurativa (HS) is a chronic inflammatory condition which due the nature of its skin lesions and the sites involved, is perceived to require recurrent clinical evaluation and may be subjected to privacy concerns amongst patients when managed over teledermatology.

OBJECTIVE

We sought to assess dermatologists’ perceptions of and experiences with teledermatology in managing HS.

METHODS

Participants were invited to completed a survey electronically, via a secure online platform. The survey was disseminated to members of the Asia Pacific Hidradenitis Suppurativa Foundation and through word of mouth, gathering responses over February to June 2022, from participants practicing in the Asia-Pacific region. Data pertaining to demographics and survey responses were collated. Associations between demographics and attitudes towards teledermatology for hidradenitis suppurativa was evaluated by multivariable ordered logistic regression. Attitudes towards teledermatology between hidradenitis suppurativa and atopic dermatitis were compared by random-effects ordered logistic regression, with adjustment for demographics.

RESULTS

100 responses were obtained comprising of 76 (81.7%) dermatologists and 17 dermatology trainees (18.3%). There was equal representation of male and female gender. There was ambivalence amongst physicians regarding comfort and willingness to employ teledermatology for HS patients. Older physicians had increased tendency to express sentiments that it was difficult to accurately assess disease severity for HS, and concerns that patients may not be familiar with using teledermatology for HS. There was an overall increased tendency for physicians to perceive difficulty in managing HS compared to AD (assessed as a control cohort) – in terms of photography of hard-to-reach/sensitive areas (adjusted OR 4.71 (95% confidence interval: 2.44-9.07); p value < 0.001), accurate assessment (adjusted OR 2.66 (95% confidence interval: 1.48-4.79); p value 0.001), privacy issues from examination of private body areas (adjusted OR 2.75 (95% confidence interval 1.36-5.56); p value 0.005).

CONCLUSIONS

This study, is the first, to our knowledge that assess physician attitudes towards the use of teledermatology in managing HS patients, and compares differential perspectives of its use on HS and AD patients. The findings of this study suggest that teledermatology is overall unsuitable for use in HS, but may be considered and useful in selected settings, for instance, for patients with quiescent or mild HS, patients with less HS involvement in intimate body areas, patients who were more willing to share documentation if required of affected body areas and in patients who already have an established and strong doctor-patient relationship with their HS provider. Physicians’ efforts should be focused on streamlining patient selection and optimizing consult environments for patients with HS.

CLINICALTRIAL

NA