Teledermatology Within Correctional Settings in the United States: A Narrative Review of the Literature

Teledermatology is an emerging modality of care delivery. To broadly understand the role of teledermatology in the US correctional system, we conducted a narrative review using PubMed, Scopus, Embase, and gray literature. We identified 5 studies (Figure 1) analyzing over 1261 teledermatology encounters within correctional settings in the United States (summary characteristics are in Table 1; the search strategy used is in Multimedia Appendix 1).

The first published study on the use of teledermatology for incarcerated populations was in 1996 from East Carolina University in Greenville, North Carolina [1]. Since then, several single-center observational and cohort studies have reported the implementation of teledermatology across several localities, including Utah and Connecticut [2-4]. All studies have indicated the partnership between the dermatology providers and the state prison system. The Federal Bureau of Prisons (BOP) also established a teledermatology program in 2012 covering over 50 institutions. The collaboration between dermatologists and a government agency is critical and unique for teledermatology in correctional settings [5].

Teledermatology has proven to improve access to care and efficiently diagnose a broad spectrum of skin disorders, particularly inflammatory conditions, and skin infections. Common diagnoses reported included cutaneous infection [4], acne (9%-14.9%) [2-4], eczema (9.3%-18%) [2-4], psoriasis (28.1%) [3-4], and prurigo nodularis or lichen simplex chronicus (10%) [2]. One study showed that 86.3% of cases could be managed via teledermatology alone, with 86% of patients prescribed new topical therapeutics and 57.9% receiving systemic therapies, including biologics [4]. Medical management via teledermatology was confirmed to be successful and continued to serve patients well according to medical records [4]. When compared with face-to-face visit cohorts, teledermatology cohorts involved more medication recommendations (84.8% vs 48.4%; P<.001) and fewer procedures and referrals (P<.001), likely resulting from appropriate triage by a prison primary care physician [3].

Different teledermatology modalities have been adopted. Live videoconference is the most commonly implemented modality via various videoconference platforms, including Picture Tel, Skype, Zoom, etc. Store-and-forward has also been used alone or in combination with live video teledermatology (Table 1). Due to a lack of private internet access for inmates, all teledermatology encounters were conducted via institution health care staff, the provider-to-provider module. Teledermatology and face-to-face encounters can be transitioned both ways. Patients who need procedures or biopsies for diagnosis often require face-to-face visits but may transfer back to teledermatology for continuous care after surgery or a definite diagnosis [3,4].

In addition to improved access, teledermatology in one program decreased wait time with an average turnover time of 1-2 weeks compared with 4-12 weeks for an in-person consultation [5]. The economic benefits are significant. According to the BOP report, there is an average of US $895 in savings per teledermatology consult from administration costs, particularly regarding securing transportation [5].

Overall, patients who are incarcerated are an underserved population with limited access to specialty care. Teledermatology has increased access and shown capability in addressing wide-spectrum conditions with economic benefits. Future teledermatology initiatives in correctional settings may prioritize high-quality photographs with video, integrate teledermoscopy to aid in diagnosing, emphasize the continuity of care, and expand to more sites.

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