Store-and-forward teledermatology versus in-person visits: A comparison in pediatric teledermatology clinic

Background: The role of teledermatology in the diagnosis of pediatric skin conditions has not been studied exclusively. Objective: To determine the ability of a pediatric dermatologist to correctly diagnose rashes by history and digital images. Methods: Consecutive, new referrals to the pediatric dermatology clinic with a rash were enrolled in the study. A history, demographic data, and digital photographs were obtained from each patient. The data were reviewed by a pediatric dermatologist who made a preliminary diagnosis. The child was then seen in person and a final diagnosis was made. Concordance and kappa values were calculated. Cases of diagnostic disagreement were analyzed for their effect on management. Results: One hundred thirty-five patients were enrolled. Diagnostic concordance was 82% (95% confidence interval [CI], 73%-88%), and the kappa value was 0.80. Clinically relevant disagreement occurred in 12% of cases. Limitations: The study was performed at a single site, theoretically limiting generalizability. Conclusion: Teledermatology appears to have a useful role in the care of children with rashes.