Original article
Mobile teledermatology in the developing world: Implications of a feasibility study on 30 Egyptian patients with common skin diseases

https://doi.org/10.1016/j.jaad.2010.01.010Get rights and content

Background

The expansion of store-and-forward teledermatology into underserved regions of the world has long been hampered by the requirement for computers with Internet connectivity. To our knowledge, this study is one of the first to demonstrate the feasibility of teledermatology using newer-generation mobile telephones with specialized software and wireless connectivity to overcome this requirement in a developing country.

Objective

We sought to demonstrate that mobile telephones may be used on the African continent to submit both patient history and clinical photographs wirelessly to remote expert dermatologists, and to assess whether these data are diagnostically reliable.

Methods

Thirty patients with common skin diseases in Cairo, Egypt, were given a diagnosis by face-to-face consultation. They were then given a diagnosis independently by local senior dermatologists using teleconsultation with a software-enabled mobile telephone containing a 5-megapixel camera. Diagnostic concordance rates between face-to-face and teleconsultation were tabulated.

Results

Diagnostic agreement between face-to-face consultation and the two local senior dermatologists performing independent evaluation by teleconsultation was achieved in 23 of 30 (77%) and in 22 of 30 (73%) cases, respectively, with a global mean of 75%.

Limitations

Limited sample size and interobserver variability are limitations.

Conclusion

Mobile teledermatology is a technically feasible and diagnostically reliable method of amplifying access to dermatologic expertise in poorer regions of the globe where access to computers with Internet connectivity is unreliable or insufficient.

Section snippets

Setting, recruitment, and data collection

The study was conducted in November 2008. The study population included 30 patients with skin disease randomly selected from the outpatient clinic of the Department of Dermatology, Venereology, and Andrology at Al Hussein University Hospital of Al-Azhar University in Cairo, Egypt. Eligibility criteria were the following: (1) a patient with visible skin lesions; and (2) the patient or the patient's guardian indicated willingness to participate in the study through informed oral consent. Both

Results

The software-enabled mobile telephone was successful in transmitting the medical information and dermatologic photographs of 30 patients with skin disease to an online database without any technical issues. The two senior teledermatologists were able to view all 30 cases via the World Wide Web–based interface. Finally, the on-site physician successfully retrieved the diagnoses and comments of the teleconsultants through the same mobile telephone.

Diagnoses rendered by the on-site resident

Findings, limitations, and implications

The requirement for Internet-capable computers has long hindered adoption of store-and-forward teledermatology using digital cameras in underdeveloped parts of the world. Fortunately, in recent years, modern telecommunications technology has rapidly advanced such that mobile telephones are now capable of transmitting high-resolution dermatologic images to remote specialists via wireless connectivity. Coupled with the remarkable expansion of mobile telephone use and cellular network coverage in

References (42)

  • M.A. Loane et al.

    Patient cost-benefit analysis of teledermatology measured in a randomized control trial

    J Telemed Telecare

    (1999)
  • D. Moreno-Ramirez et al.

    Economic evaluation of a store-and-forward teledermatology system for skin cancer patients

    J Telemed Telecare

    (2009)
  • K. Collins et al.

    Patient satisfaction with teledermatology: quantitative and qualitative results from a randomized controlled trial

    J Telemed Telecare

    (2004)
  • L.L. Hicks et al.

    Patient satisfaction with teledermatology services

    J Telemed Telecare

    (2003)
  • J.D. Whited et al.

    Patient and clinician satisfaction with a store-and-forward teledermatology consult system

    Telemed J E Health

    (2004)
  • T. Williams et al.

    Patient satisfaction with store-and-forward teledermatology

    J Telemed Telecare

    (2001)
  • L.W. Chao et al.

    Evaluation of an Internet-based teledermatology system

    J Telemed Telecare

    (2003)
  • E.A. Krupinski et al.

    Diagnostic accuracy and image quality using a digital camera for teledermatology

    Telemed J

    (1999)
  • A.C. Lim et al.

    Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George teledermatology project

    Australas J Dermatol

    (2001)
  • H. Pak et al.

    Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care

    J Telemed Telecare

    (2007)
  • R. Wootton et al.

    Multicenter randomized control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis

    BMJ

    (2000)
  • Cited by (0)

    Development of ClickDoc's teledermatology function was supported by the GSM (Global Systems for Mobile Communications) Association's Development Fund and Qualcomm's Wireless Reach initiative.

    Disclosure: ClickDoc, used in this study, was developed by the United States–based mobile telemedicine company ClickDiagnostics. Mr Chowdhury is Chief Executive Officer and Co-Founder of ClickDiagnostics. Dr Ayad is a consultant for ClickDiagnostics. Drs Tran and Kovarik, Ms Weinberg, Mr Cherng, Dr Monir, and Dr El Hariri have no conflicts of interest to declare.

    View full text