JDERM JMIR Dermatol JMIR Dermatology 2562-0959 JMIR Publications Toronto, Canada v6i1e43983 36938315 10.2196/43983 Review Review Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review Dellavalle Robert Kaliyadan Feroze Long Valencia Miller John BA 1 https://orcid.org/0000-0001-9132-5254 Ioffreda Patrick BA 1 https://orcid.org/0000-0001-5600-1078 Nugent Shannon BSc 1 https://orcid.org/0000-0002-7643-5890 Jones Elizabeth MD 2
Department of Dermatology and Cutaneous Biology Sidney Kimmel Medical College Thomas Jefferson University 833 Chestnut Street Philadelphia, PA, 19107 United States 1 215 955 6680 elizabeth.jones@jefferson.edu
https://orcid.org/0000-0001-7091-4340 Sidney Kimmel Medical College, Thomas Jefferson University Philadelphia, PA United States Department of Dermatology and Cutaneous Biology Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, PA United States Corresponding Author: Elizabeth Jones elizabeth.jones@jefferson.edu 2023 28 2 2023 6 e43983 1 11 2022 25 12 2022 15 1 2023 16 1 2023 ©John Miller, Patrick Ioffreda, Shannon Nugent, Elizabeth Jones. Originally published in JMIR Dermatology (http://derma.jmir.org), 28.02.2023. 2023

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 Background

Patient-to-provider teledermatology relies on a patient’s access to technology to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States—leading to the digital divide. While teledermatology has been recognized as a model to improve access, little is known about how often demographic data associated with digital inequity are captured in studies.

 Objective

Given the expansion of teledermatology over the past decade, we sought to determine how often demographic data associated with digital inequity are reported in patient-to-provider teledermatology studies.

 Methods

A scoping literature review search was conducted using the search term teledermatology in the following databases: PubMed, Embase, and the Cochrane Database of Systematic Reviews. All studies published between December 31, 2011, and December 31, 2021, that evaluated patient-to-provider teledermatology were eligible.

 Results

In total, 1412 publications describing teledermatology were identified, of which 46 met the inclusion criteria. Race or ethnicity was the most frequently reported demographic characteristic (28/46, 61%). However, only 41% (19/46) of studies were representative of race or ethnicity, defined as including >20% nonwhite participants. Studies rarely reported the number of participants greater than 65 years of age (14/46, 30%), preferred language (9/46, 20%), income (6/46, 13%), highest level of education (5/46, 11%), or access to a device (4/46, 9%). Studies conducted after the onset of the COVID-19 pandemic were significantly more likely to report preferred language (9/25, 36% vs 0%; P=.002) and appeared more likely to report other demographic data associated with digital inequity, without reaching statistical significance (P>.05).

 Conclusions

Demographic data associated with digital inequity are rarely reported in patient-to-provider teledermatology studies to date. These studies frequently lack adequate representation of racial and ethnic minorities. With increased calls for equitable representation in dermatology studies, future teledermatology studies can improve the reporting of race and ethnicity and consider demographic data associated with digital inequity as an important criterion in research design.

 teledermatology equity inequity scoping review digital divide dermatology racial minority ethnic minority digital inequity patient care COVID-19 Introduction

Unlike traditional in-person care, patient-to-provider teledermatology relies on a patient’s access to a compatible device and broadband internet to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States—creating what is referred to as the digital divide [1,2]. Populations less likely to report a broadband internet subscription include those with less formal education or lower income, racial and ethnic minorities, persons greater than 65 years of age, and residents of rural communities [3].

Demographics that report less access to broadband internet and technology recorded lower telehealth utilization rates during the COVID-19 pandemic. For instance, older age and persons who reported a non-English language as their primary language were associated with fewer completed telemedicine visits [4-6]. Inequity in access to telemedicine care exists. However, it is unknown whether demographic data associated with digital inequity are frequently reported in teledermatology studies.

Demographic data associated with digital inequity should be included in patient-to-provider teledermatology studies to ensure conclusions that reflect all populations. We conducted a scoping review of patient-to-provider teledermatology studies conducted in the United States to characterize how often patients vulnerable to the digital divide are represented. Given the expansion of teledermatology during the COVID-19 pandemic, we also compared how often demographic data associated with digital inequity were reported in studies conducted prior to and after the declaration of the pandemic.

 Methods Study Design

A scoping review search was performed on PubMed, Embase, and the Cochrane Database of Systematic Reviews from December 31, 2011, through December 31, 2021. We used the search term teledermatology. This study is registered with the International Prospective Register of Systematic Reviews (CRD42022325030) and followed the relevant portions of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

 Eligibility Criteria

Studies were included if they evaluated an asynchronous or synchronous model of patient-to-provider teledermatology. Both quantitative and qualitative studies evaluating teledermatology were included to represent the broad scope of research. Only studies conducted in the United States were included. No restrictions were placed on the age or gender of study participants. Telephone-based studies were excluded as these encounters involve separate technology and resources unrelated to measures of broadband connectivity and access to a device.

 Article Selection and Data Extraction

Two reviewers (PI and JM) sequentially evaluated titles, abstracts, and then the full text of all publications based on the inclusion criteria. Studies were assessed based on whether they reported demographic data associated with digital inequity as described in a national report by the Pew Research Center [3]. These included participant income, highest level of education, race or ethnicity, number of participants greater than 65 years of age, and residents of rural communities [3]. Studies were defined as unrepresentative of race and ethnicity if they included less than 20% nonwhite participants, consistent with the methodology of a previous study by Chen et al [7].

 Data Analysis and Synthesis

The primary outcome was the frequency of reported demographic characteristics associated with digital inequity. The secondary outcome was the likelihood of reporting demographic characteristics associated with digital inequity in studies conducted prior to versus during the COVID-19 pandemic. The Fisher exact test was used to analyze the secondary outcome. Analysis was performed using Stata software (version 17.0; StataCorp LLC). P<.05 was considered statistically significant.

 Results Selection of Articles

Among 1412 potential studies, 46 satisfied the inclusion criteria [8-53]. Figure 1 shows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart illustrating the publication selection process. The full list of included studies and general study characteristics are presented in Multimedia Appendix 1.

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for publication selection.

 Demographic Data Associated With Digital Inequity

Demographic data associated with digital inequity reported in patient-to-provider teledermatology studies are presented in Table 1. Studies most often reported race or ethnicity (28/46, 61%), but a representative sample was present in only 41% (19/46). Of 46 studies, 14 (30%) reported the number of participants greater than 65 years of age. Studies infrequently reported preferred language, income, highest level of education, or access to a device (Table 1). No studies reported participant-reported internet quality or the number of rural residents included.

Demographic data reported in patient-to-provider teledermatology studies.

Characteristic reported Studies (N=46), n (%)
Race or ethnicity 28 (61)
Representative of racial and ethnic minoritiesa 19 (41)
Number of participants >65 years of age 14 (30)
Preferred language 9 (20)
Income 6 (13)
Highest level of education 5 (11)
Access to a device 4 (9)
Internet quality 0 (0)
Number of rural residents 0 (0)

aStudies were representative of racial and ethnic minorities if they included >20% nonwhite participants.

 Demographic Data Reported and COVID-19

Demographic data reported in patient-to-provider teledermatology studies conducted before (n=21) and after (n=25) the declaration of the COVID-19 pandemic are presented in Table 2. Studies conducted after the onset of the COVID-19 pandemic appeared more likely to report race or ethnicity, number of participants older than 65 years, income, highest level of education, and access to a device, without reaching statistical significance. Studies conducted during the COVID-19 pandemic were significantly more likely to report the participant’s preferred language (9/25, 36% vs 0%; P=.002). Studies conducted before and after the declaration of the COVID-19 pandemic were representative of racial and ethnic minorities at comparable rates.

Demographic data reported in patient-to-provider teledermatology studies conducted before and after the declaration of the COVID-19 pandemic.

Characteristic reported Studies conducted before COVID-19 (n=21), n (%) Studies conducted after COVID-19 (n=25), n (%) P value
Race or ethnicity 11 (52) 17 (68) .22
Representative of racial and ethnic minoritiesa 9 (43) 10 (40) .54
Number of participants >65 years of age 4 (19) 10 (40) .11
Preferred language 0 (0) 9 (36) .002
Income 2 (10) 4 (16) .42
Highest level of education 1 (5) 4 (16) .23
Access to a device 1 (5) 3 (12) .37

aStudies were representative of racial and ethnic minorities if they included >20% nonwhite participants.

 Discussion Principal Findings

The findings of this study highlight that demographic data associated with digital inequity are infrequently included in patient-to-provider teledermatology studies. With the explosion of telemedicine during the pandemic, our study noted a promising trend toward the inclusion of patient demographic information associated with digital inequity regarding race or ethnicity, participants older than 65 years, income, highest level of education, and access to a device. Preferred language was the only demographic characteristic that was significantly more likely to be reported in teledermatology studies following the pandemic onset. Even so, an overall lack of reporting of demographic data associated with digital inequity persisted.

 Demographic Data Associated With Digital Inequity

Demographic data associated with digital inequity may be an indicator of the likelihood to complete teledermatology visits. Patients greater than 65 years of age, those who reported a non-English language as their primary language, and participants with lower income were less likely to complete teledermatology visits compared to their counterparts [5,6,8,9]. Other studies noted patients older than 65 years and those reporting lower income were less satisfied with the visit experience [10-12]. Demographic data associated with digital inequity should be reported more often to inform inclusive research design and ensure generalizable conclusions.

The deficiencies in racial and ethnic representation identified in this review are consistent with those reported in dermatology clinical trials over the past decade [7]. It is critical to capture race and ethnicity data in patient-to-provider teledermatology studies as Black race and Latinx ethnicity were associated with lower use of video-based telemedicine during the pandemic [4]. Future teledermatology studies can improve the reporting of race and ethnicity and should consider this important criterion in research design.

 Demographic Data Reported and COVID-19

Our study noted a trend toward the inclusion of demographic data associated with digital inequity in studies conducted after the COVID-19 pandemic compared to before. Dermatologists quickly adopted and expanded their teledermatology programs at the onset of the pandemic [54]. The sheer increase in the volume of care due to a lack of access to alternatives and improved reimbursement likely drove a wider demographic reach in the patient population. This trend coincides with increased calls for equitable inclusion in dermatology studies [55] and studies highlighting how teledermatology may exacerbate digital inequity [4,56-60]. As a result, lack of access combined with increased awareness of social inequities in care possibly encouraged researchers to be more intentional in seeking broader demographic variables to ensure their teledermatology programs represented underserved and underrepresented communities. Despite the positive trend, reporting of inclusive demographic data is insufficient to date and can be improved upon in future research design.

 Limitations

This study is limited in its design. The studies included in our review had variable primary outcomes. Of note, our study did not determine whether a study’s primary outcome correlated with the inclusion of demographic data associated with digital inequity. It is also possible that studies captured demographic data associated with digital inequity in their methods but did not report these findings. This trend is consistent with medical studies’ failure to report sociodemographic variables consistently [61]. Studies will be unable to correct health inequity if these variables are not reported more consistently [61]. Lastly, this study only reflects demographic reporting trends in studies conducted in the United States.

 Conclusion

This study highlights the need for equitable representation of racial and ethnic minorities and improved reporting of demographic data associated with digital inequity in patient-to-provider teledermatology studies over the past decade. With increased calls for equitable representation in dermatology studies, future teledermatology studies can improve reporting of race and ethnicity and consider the inclusion of demographic data associated with digital inequity an important criterion in research design. Professional and telehealth societies can help drive change by creating guidelines that reflect the value of reporting demographic data associated with digital inequity. Continued research and education can increase awareness of the digital divide’s impact on patient care and help optimize teledermatology’s potential to serve vulnerable populations.

General characteristics of included studies.

 Abbreviations PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

 PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

None declared.

 Bakhtiar M Elbuluk N Lipoff JB The digital divide: how COVID-19's telemedicine expansion could exacerbate disparities J Am Acad Dermatol 2020 11 83 5 e345 e346 10.1016/j.jaad.2020.07.043 32682890 S0190-9622(20)32212-X PMC7365110 Okoye SM Mulcahy JF Fabius CD Burgdorf JG Wolff JL Neighborhood broadband and use of telehealth among older adults: cross-sectional study of national survey data linked with census data J Med Internet Res 2021 06 14 23 6 e26242 10.2196/26242 34125071 v23i6e26242 PMC8240798 Perrin A Mobile technology and home broadband 2021 Pew Research Center 2021 06 03 2022-07-22 https://www.pewresearch.org/internet/2021/06/03/mobile-technology-and-home-broadband-2021/ Eberly LA Kallan MJ Julien HM Haynes N Khatana SAM Nathan AS Snider C Chokshi NP Eneanya ND Takvorian SU Anastos-Wallen R Chaiyachati K Ambrose M O'Quinn R Seigerman M Goldberg LR Leri D Choi K Gitelman Y Kolansky DM Cappola TP Ferrari VA Hanson CW Deleener ME Adusumalli S Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic JAMA Netw Open 2020 12 01 3 12 e2031640 10.1001/jamanetworkopen.2020.31640 33372974 2774488 PMC7772717 Eberly LA Khatana SAM Nathan AS Snider C Julien HM Deleener ME Adusumalli S Telemedicine outpatient cardiovascular care during the COVID-19 pandemic: bridging or opening the digital divide? Circulation 2020 08 04 142 5 510 512 10.1161/CIRCULATIONAHA.120.048185 32510987 Duan GY Ruiz De Luzuriaga AM Schroedl LM Rosenblatt AE Disparities in telemedicine use during the COVID-19 pandemic among pediatric dermatology patients Pediatr Dermatol 2022 07 39 4 520 527 10.1111/pde.14982 35302248 PMC9115291 Chen V Akhtar S Zheng C Kumaresan V Nouri K Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review JAMA Dermatol 2022 03 01 158 3 288 292 10.1001/jamadermatol.2021.5596 35080592 2788392 PMC8792791 Miller RC Stewart CR Lipner SR Retrospective study of trends in dermatology telemedicine and in-person visits at an academic center during COVID-19 J Am Acad Dermatol 2021 03 84 3 777 779 10.1016/j.jaad.2020.11.015 33221466 S0190-9622(20)33043-7 PMC7832782 Blundell AR Kroshinsky D Hawryluk EB Das S Disparities in telemedicine access for Spanish-speaking patients during the COVID-19 crisis Pediatr Dermatol 2021 07 38 4 947 949 10.1111/pde.14489 33368668 Yeroushalmi S Millan SH Nelson K Sparks A Friedman AJ Patient perceptions and satisfaction with teledermatology during the COVID-19 pandemic: a survey-based study J Drugs Dermatol 2021 02 01 20 2 178 183 10.36849/JDD.5714 33538563 S1545961621P0178X Su MY Smith GP Das S Trends in teledermatology use during clinic reopening after COVID-19 closures J Am Acad Dermatol 2021 04 84 4 e213 e214 10.1016/j.jaad.2020.12.019 33316330 S0190-9622(20)33172-8 PMC7833605 Kaunitz G Yin L Nagler AR Sicco KL Kim RH Assessing patient satisfaction with live-interactive teledermatology visits during the COVID-19 pandemic: a survey study Telemed J E Health 2022 04 28 4 591 596 10.1089/tmj.2021.0200 34152849 Hamad J Fox A Kammire MS Hollis AN Khairat S Evaluating the experiences of new and existing teledermatology patients during the COVID-19 pandemic: cross-sectional survey study JMIR Dermatol 2021 5 5 4 1 e25999 10.2196/25999 34028471 v4i1e25999 PMC8104278 Pearlman RL Le PB Brodell RT Nahar VK Evaluation of patient attitudes towards the technical experience of synchronous teledermatology in the era of COVID-19 Arch Dermatol Res 2021 11 05 313 9 769 772 10.1007/s00403-020-02170-2 33403572 10.1007/s00403-020-02170-2 PMC7785034 Afanasiev OK Hung DY Yan S Huang SJ Cho BK COVID-19: a catalyst for innovative hybrid teledermatology workflows to increase access and improve patient care at a large group practice J Am Acad Dermatol 2021 07 85 1 206 209 10.1016/j.jaad.2021.03.098 33839210 S0190-9622(21)00666-6 PMC8032400 Cline A Kim C Deitz M Rizzo A Thagirisa A Asrani F Safai B Marmon S Real-world direct-to-patient teledermatology in a low-income, elderly population J Am Acad Dermatol 2021 07 85 1 e19 e20 10.1016/j.jaad.2021.01.038 33476731 S0190-9622(21)00187-0 Vasavda C Tang O Kwatra SG Ho BK Grossberg AL Asymmetric patterns of patient access to in-person and teledermatologic health care during the COVID-19 pandemic J Am Acad Dermatol 2023 01 88 1 167 169 10.1016/j.jaad.2021.12.025 34933041 S0190-9622(21)02991-1 PMC9726204 Gu Lilly Diaz Susana Martinez Lipner Shari R Retrospective study of acne telemedicine and in-person visits at an academic center during the COVID-19 pandemic J Cosmet Dermatol 2022 01 19 21 1 36 38 10.1111/jocd.14606 34757675 PMC8661784 Cline A Kim C Berk-Krauss J Kazemi A Ginsberg D Sarriera-Lazaro CJ Mansouri Y Safai B Jacobs AK Marmon S Bridging the digital divide: The use of text message-enabled video in the public safety-net setting J Am Acad Dermatol 2021 08 85 2 e97 e99 10.1016/j.jaad.2021.03.085 33823199 S0190-9622(21)00649-6 Franciosi EB Tan AJ Kassamali B O'Connor DM Rashighi M LaChance AH Understanding the impact of teledermatology on no-show rates and health care accessibility: a retrospective chart review J Am Acad Dermatol 2021 03 84 3 769 771 10.1016/j.jaad.2020.09.019 32926984 S0190-9622(20)32604-9 PMC7484689 Havele SA Fathy R McMahon P Murthy AS Pediatric teledermatology: a retrospective review of 1199 encounters during the COVID-19 pandemic J Am Acad Dermatol 2022 87 3 678 80 10.1016/j.jaad.2021.11.038 34838881 S0190-9622(21)02907-8 PMC8613007 Krueger S Leonard N Modest N Flahive J Guilarte-Walker Y Rashighi M LaChance AH Identifying trends in patient characteristics and visit details during the transition to teledermatology: experience at a single tertiary referral center J Am Acad Dermatol 2021 12 85 6 1592 1594 10.1016/j.jaad.2020.11.040 33253853 S0190-9622(20)33084-X Pannu S Nguyen BM Yang FC Rosmarin D Predictors of patient experience with teledermatology in setting of COVID-19 pandemic in a single medical center Int J Dermatol 2021 05 31 60 5 626 627 10.1111/ijd.15394 33381862 Moore B Washington A Butt M Silva C Green B Helm M Patient satisfaction of real-time teledermatology: a cross-sectional survey Int J Dermatol 2022 02 26 61 2 e69 e71 10.1111/ijd.15618 33899221 Das S Su MY Kvedar JC Smith GP Asynchronous telemedicine for isotretinoin management: a direct care pilot J Am Acad Dermatol 2022 01 86 1 184 186 10.1016/j.jaad.2021.01.039 33484765 S0190-9622(21)00188-2 Drugge E Sarac R Fay P Drugge R Semi-automated total body photography supports robust delivery of skin cancer monitoring services during the SARS-COV2/COVID-19 pandemic Dermatol Online J 2021 04 15 27 4 33999574 13030/qt2202r5hk Johnson A Shukla N Halley M Nava V Budaraju J Zhang L Linos E Barriers and facilitators to mobile health and active surveillance use among older adults with skin disease Health Expect 2021 10 30 24 5 1582 1592 10.1111/hex.13229 34190397 PMC8483196 Hekman D Maldonado S Wolverton J Rahnama-Moghadam S Video visits for isotretinoin patients are perceived as safe, effective, and convenient Dermatol Online J 2021 04 15 27 4 33999588 13030/qt7g46f701 Asabor EN Bunick CG Cohen JM Perkins SH Patient and physician perspectives on teledermatology at an academic dermatology department amid the COVID-19 pandemic J Am Acad Dermatol 2021 01 84 1 158 161 10.1016/j.jaad.2020.09.029 32946971 S0190-9622(20)32615-3 PMC7491373 Kazi R Evankovich MR Liu R Liu A Moorhead A Ferris LK Falo LD English JC Utilization of asynchronous and synchronous teledermatology in a large health care system during the COVID-19 pandemic Telemed J E Health 2021 07 01 27 7 771 777 10.1089/tmj.2020.0299 33074786 McGee JS Reynolds RV Olbricht SM Fighting COVID-19: early teledermatology lessons learned J Am Acad Dermatol 2020 10 83 4 1224 1225 10.1016/j.jaad.2020.06.027 32553677 S0190-9622(20)31088-4 PMC7294281 Yi JZ Reynolds RV Olbricht SM McGee JS Moving forward with teledermatology: operational challenges of a hybrid in-person and virtual practice Clin Dermatol 2021 07 39 4 707 709 10.1016/j.clindermatol.2021.05.016 34809777 S0738-081X(21)00081-X Edison KE Fleming DA Nieman EL Stine K Chance L Demiris G Content and style comparison of physician communication in teledermatology and in-person visits Telemed J E Health 2013 07 19 7 509 14 10.1089/tmj.2012.0227 23682591 Creighton-Smith M Murgia RD Konnikov N Dornelles A Garber C Nguyen BT Incidence of melanoma and keratinocytic carcinomas in patients evaluated by store-and-forward teledermatology vs. dermatology clinic Int J Dermatol 2017 10 20 56 10 1026 1031 10.1111/ijd.13672 28631824 Parsi K Chambers CJ Armstrong AW Cost-effectiveness analysis of a patient-centered care model for management of psoriasis J Am Acad Dermatol 2012 04 66 4 563 70 10.1016/j.jaad.2011.02.022 21835497 S0190-9622(11)00257-X Fathy R Briker S Rodriguez O Barbieri JS Comparing antibiotic prescription rates between in-person and telemedicine visits J Am Acad Dermatol 2022 08 87 2 438 440 10.1016/j.jaad.2021.08.064 34499992 S0190-9622(21)02441-5 PMC9222146 Chambers CJ Parsi KK Schupp C Armstrong AW Patient-centered online management of psoriasis: a randomized controlled equivalency trial J Am Acad Dermatol 2012 06 66 6 948 53 10.1016/j.jaad.2011.05.047 21890236 S0190-9622(11)00687-6 PMC3233643 O'Connor Daniel M Jew OS Perman MJ Castelo-Soccio LA Winston FK McMahon PJ Diagnostic accuracy of pediatric teledermatology using parent-submitted photographs: a randomized clinical trial JAMA Dermatol 2017 12 01 153 12 1243 1248 10.1001/jamadermatol.2017.4280 29141082 2663278 PMC5817452 Kornmehl H Singh S Johnson MA Armstrong AW Direct-access online care for the management of atopic dermatitis: a randomized clinical trial examining patient quality of life Telemed J E Health 2017 09 23 9 726 732 10.1089/tmj.2016.0249 28570163 10.1089/tmj.2016.0249 Armstrong AW Johnson MA Lin S Maverakis E Fazel N Liu F Patient-centered, direct-access online care for management of atopic dermatitis: a randomized clinical trial JAMA Dermatol 2015 02 01 151 2 154 60 10.1001/jamadermatol.2014.2299 25338198 1918745 Armstrong AW Chambers CJ Maverakis E Cheng MY Dunnick CA Chren M Gelfand JM Wong DJ Gibbons BM Gibbons CM Torres J Steel AC Wang EA Clark CM Singh S Kornmehl HA Wilken R Florek AG Ford AR Ma C Ehsani-Chimeh N Boddu S Fujita M Young PM Rivas-Sanchez C Cornejo BI Serna LC Carlson ER Lane CJ Effectiveness of online vs in-person care for adults with psoriasis: a randomized clinical trial JAMA Netw Open 2018 10 05 1 6 e183062 10.1001/jamanetworkopen.2018.3062 30646223 2705854 PMC6324453 Armstrong AW Ford AR Chambers CJ Maverakis E Dunnick CA Chren M Gelfand JM Gibbons CM Gibbons BM Lane CJ Online care versus in-person care for improving quality of life in psoriasis: a randomized controlled equivalency trial J Invest Dermatol 2019 05 139 5 1037 1044 10.1016/j.jid.2018.09.039 30481495 S0022-202X(18)32831-8 PMC6599714 Ford AR Gibbons CM Torres J Kornmehl HA Singh S Young PM Chambers CJ Maverakis E Dunnick CA Armstrong AW Access to dermatological care with an innovative online model for psoriasis management: results from a randomized controlled trial Telemed J E Health 2019 07 25 7 619 627 10.1089/tmj.2018.0160 30222518 PMC6417973 Fiks AG Fleisher L Berrigan L Sykes E Mayne SL Gruver R Halkyard K Jew OS FitzGerald P Winston F McMahon P Usability, acceptability, and impact of a pediatric teledermatology mobile health application Telemed J E Health 2018 03 24 3 236 245 10.1089/tmj.2017.0075 28731848 Khosravi H Zhang S Siripong N Moorhead A English Iii Joseph C Comparing acne follow-up: teledermatology versus outpatient dermatology visits Dermatol Online J 2020 04 15 26 4 32621674 13030/qt1424r02m Clark JJ Snyder AM Sreekantaswamy SA Petersen MJ Lewis BK Secrest AM Florell SR Dermatologic care of incarcerated patients: a single-center descriptive study of teledermatology and face-to-face encounters J Am Acad Dermatol 2021 12 85 6 1660 1662 10.1016/j.jaad.2020.12.076 33434597 S0190-9622(21)00099-2 Gregory J Taylor E Liu Y Love T Raiciulescu S Meyerle J The burden of skin disease on deployed servicemembers Mil Med 2019 12 01 184 11-12 889 893 10.1093/milmed/usz110 31067306 5487154 Lamel S Chambers Cindy J Ratnarathorn Mondhipa Armstrong April W Impact of live interactive teledermatology on diagnosis, disease management, and clinical outcomes Arch Dermatol 2012 01 01 148 1 61 5 10.1001/archdermatol.2011.1157 22250233 148/1/61 Bosanac S Nguyen V Bui D Eisen D Sivamani R Randomized and controlled pilot study of the pragmatic use of mobile phone based follow up of actinic keratoses treated with topical 5-fluorouracil Dermatol Online J 2018 04 15 24 4 29906015 13030/qt2kh302f2 Rajda J Seraly MP Fernandes J Niejadlik K Wei H Fox K Steinberg G Paz HL Impact of direct to consumer store-and-forward teledermatology on access to care, satisfaction, utilization, and costs in a commercial health plan population Telemed J E Health 2018 02 24 2 166 169 10.1089/tmj.2017.0078 28742431 Wu X Oliveria SA Yagerman S Chen L DeFazio J Braun R Marghoob AA Feasibility and efficacy of patient-initiated mobile teledermoscopy for short-term monitoring of clinically atypical nevi JAMA Dermatol 2015 05 01 151 5 489 96 10.1001/jamadermatol.2014.3837 25629626 2091958 Jacoby T Woolard A Chamoun S Moy R Asynchronous teledermatology assessment of young adult acne likely concordant with in-person evaluation JDD 2021 3 01 20 4 432 435 10.36849/jdd.5688 Pathipati AS Ko JM Implementation and evaluation of Stanford Health Care direct-care teledermatology program SAGE Open Med 2016 07 12 4 2050312116659089 10.1177/2050312116659089 27493756 10.1177_2050312116659089 PMC4959300 Kennedy J Arey S Hopkins Z Tejasvi T Farah R Secrest AM Lipoff JB Dermatologist perceptions of teledermatology implementation and future use after COVID-19: demographics, barriers, and insights JAMA Dermatol 2021 05 01 157 5 595 597 10.1001/jamadermatol.2021.0195 33787839 2778026 PMC8014193 Burgin S Dlova NC Ingram JR Parish LC Goldsmith LA The essential role of dermatology publications in enhancing professional diversity, equity and inclusion Skinmed 2021 19 5 332 333 34861911 Gao JC Zhang A Gomolin T Cabral D Cline A Marmon S Accessibility of direct-to-consumer teledermatology to underserved populations J Am Acad Dermatol 2022 03 86 3 e133 e134 10.1016/j.jaad.2021.10.043 34757145 S0190-9622(21)02727-4 Maddukuri S Patel J Lipoff JB Teledermatology addressing disparities in health care access: a review Curr Dermatol Rep 2021 03 12 1 8 10.1007/s13671-021-00329-2 33747638 329 PMC7953516 Miyawaki A Tabuchi T Ong MK Tsugawa Y Age and social disparities in the use of telemedicine during the COVID-19 pandemic in Japan: cross-sectional study J Med Internet Res 2021 07 23 23 7 e27982 10.2196/27982 34259641 v23i7e27982 PMC8315162 Long V Chandran NS A glance at the practice of pediatric teledermatology pre- and post-COVID-19: narrative review JMIR Dermatol 2022 5 2 e34228 10.2196/34228 35610984 v5i2e34228 PMC9118542 Hooper J Shao K Feng H Racial/ethnic health disparities in dermatology in the United States, part 1: overview of contributing factors and management strategies J Am Acad Dermatol 2022 10 87 4 723 730 10.1016/j.jaad.2021.12.061 35143914 S0190-9622(22)00194-3 Orkin AM Nicoll G Persaud N Pinto AD Reporting of sociodemographic variables in randomized clinical trials, 2014-2020 JAMA Netw Open 2021 06 01 4 6 e2110700 10.1001/jamanetworkopen.2021.10700 34076703 2780555 PMC8173372