Ten years of teledermatology

Using telemedicine health professionals can communicate with each other and with their patients over a distance. Teledermatology, dermatology application of telemedicine, is one of the most often applied telemedicine applications worldwide. Various studies have been performed to evaluate the effectiveness and efficiency of and satisfaction with teledermatology. Up to now no or limited valid scientific evidence has been found that teledermatology is beneficial for any group of users. This study aimed to perceive insight into the evolution of evaluation studies of teledermatology over the past ten years in terms of the telemedicine evaluation framework by Holle and Zahlmann consisting of four continuous phases. We added the phase "post implementation studies" that evaluate teledermatology as a fully integrated service in regular care. Retrieved literature from Medline was reviewed by two reviewers independently in order to include studies and classify them into the five phases. Ninety-nine studies out of 372 found unique references were included and classified into the phases. Most represented phase was phase II with 72 (72%) studies. The number of phase II studies is continuously growing since the introduction of evaluation in teledermatology. There were eight reported RCTs found (two in phase III, six in phase IV). The number of phase III and IV studies is too low to draw conclusions about the trends in their publication and stress the need for more such studies. Phase I and post implementations studies are probably under-represented as they might often not be published separately in scientific journal papers