A few weeks ago, I spent 30 minutes on a Wednesday afternoon taking selfies at very obscene, up-close-and-personal angles. No, I wasn’t sending the pictures to a guy I matched with on Hinge, I was emailing my dermatologist photos of my acne ahead of a teledermatology appointment.
I started breaking out a few days into quarantine. With all of the uncertainty surrounding the coronavirus, it was impossible not constantly worry over getting sick and what the future would look like — and the stress showed up on my skin. First, I had a red bumpy rash around my mouth. Then, I got a mix of whiteheads and big, painful cystic welts on the lower half of my face. While my go-to clay mask and spot treatment did make these zits heal faster, for every pimple that went away, two more would pop up. After three weeks of breaking out, I called my dermatologist's office and made a telemedicine appointment.
Since the World Health Organization declared COVID-19 a global pandemic on Mar. 11, non-essential in-person visits to the doctor's office have been put on hold. And in order to practice social distancing, many dermatologists have shifted to telemedicine so that they can keep treating patients via Zoom video call or over the phone.
Given that dermatology is such a visual form of medicine, I'll admit I was skeptical about whether the doctor would be able get the full scope of how bad my acne had gotten. Pictures aren't three dimensional, objects (like swollen cystic zits) don't always photograph to scale, and colors can be off.
Still, I sent my selfies off to my dermatologist and had a phone call with him an hour later. He started off by asking me about the nature of my breakouts, my history with acne, the products I'm using in my skincare routine, my general health background, and what medications I'm currently taking. In approximately 10 minutes, he sent a prescription for a retinoid (adapalene), benzoyl peroxide gel, and a three-month supply of spironolactone (a blood pressure medication that's used off-label to treat hormonal acne in women) to the nearest pharmacy. (Full disclosure: Because I have previously taken spironolactone for hormonal acne and recently had blood work done to check my hormone and thyroid levels, the dermatologist felt comfortable recommending spironolactone on top of a topical treatment.)
Even though my dermatologist told me mid-phone call that the selfies I took weren't the best, my teledermatology appointment was a success and my acne is slowly, but surely getting under control.
With teledermatology being the new "normal" way to seek treatment for skin concerns, I reached out to top dermatologists to find out what conditions are best suited for telemedicine, what to expect during an appointment, and tips on how to take proper photos for your doctor.
What Skin Conditions Can Be Treated Through Teledermatology?
Given that dermatology is such a visual specialty, a huge part of dermatologists' training involves looking at before-and-after photos of various skin conditions in order to learn how to diagnose them. "There are certain conditions that are actually great for teledermatology," says Dr. Melissa Kanchanapoomi Levin, board-certified dermatologist and founder of Entière Dermatology in New York City. "Inflammatory conditions or lesions on the face such as acne, rosacea, eczema, psoriasis, and lesions of concern that are changing like a rash on the body."
A dermatologist can also review your skincare routine during a teledermatology appointment. "Video visits are a great way to review basic a skincare routine to use when you are quarantined or for after," says Dr. Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. "I'm able to design a custom skincare regimen for my patients based on their particular needs and set them up to have physician-grade skincare mailed directly to them."
Dr. Zeichner also notes that right now is a good time to take care of conditions you previously haven't made time to treat, such as excessive underarm sweating.
What Skin Conditions Aren't Suited for Teledermatology?
Along with actual procedures, there are some conditions that aren't suited for teledermatology appointments. Full-body skin checks top this list. However, if you have a mole that's of concern, it's better to play it safe and have it checked out to find out it needs further screening. "It is difficult to evaluate new or changing moles through video," Dr. Zeichner says. "However, if you do have a new or changing spot, I still recommend getting the visit. In some cases we can make a diagnosis electronically. Regardless, we can advise the patient whether a follow up visit for a biopsy is necessary."
Hair loss and scalp issues can also be tough to treat over Zoom because, as Dr. Morgan Rabach, board-certified dermatologist and co-founder of LM Medical in New York City, points out, it can be difficult to take proper photos of your own scalp.
How to You Prepare for a Teledermatology Appointment?
First things first: A teledermatology appointment isn't a phone call with your friend, so it should be treated like an in-person doctor's visit. "There’s still a sensitivity and privacy to these appointments, so I recommend sitting in a quiet, well-lit room because the dermatologist might ask to look at certain spots on your body," Dr. Levin explains. "Sometimes I have to ask a patient to lift their shirt in order to see their chest or back, so it should be private."
Dr. Zeichner suggests to sit facing a window so that the light hits your face. This makes it easier for the doctor to see your skin. If a window seat isn't available, try your bathroom.
Ahead of your appointment, it's also important to send your doctor photos of your skin condition, write down any questions you want to ask them, and download the video software they're using.
How Do You Take Photos for a Teledermatology Appointment?
Whether your dermatologist prefers a video or phone call, they're going to want you to take photos of your skin condition. When I was taking selfies of my acne, my thought process was to send my doctor a handful of close-up photos of the lower half of my face. It turns out, that's what you shouldn't do.
Dr. Levin says that you should take photos as soon as your skin flares up, but they should also be realistic. "For any sort of rash or spots you want the doctor to look at, you should take photos three distances away," she explains. "The first one should be farther away so that the doctor can identify you, the second one should be mid-distance to show the doctor where the spot or rash is on your face, and the last photo should be a close up so the doctor can identify what they're looking at."
The photos should be taken against a solid background in a well-lit room with your makeup removed, hair pulled back, and the flash on your camera turned off.
How Much Do Teledermatology Appointments Cost?
Insurance companies are currently waiving any fees for coronavirus-related care. While teledermatology is typically covered by insurance companies, check in with yours to see if your appointment is covered and if you'll be charged a co-pay.
If you don't have insurance, or your doctor is out of network, reach out to their office. Some doctors have reduced their fees in response to the economical implications of the pandemic. Take LM Medical, for example. "For people who don’t have insurance or who have insurance we don’t take, we have been doing a 'pay what you can' model," says Dr. Rabach. "Everyone needs to do their part in keeping people home and out of the hospitals, so we are also trying to do our part."
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What About Cosmetic Treatments?
Doctors can't perform actual procedures during a telemedicine appointment, but they can provide consultations for future cosmetic treatments. Dr. Melissa Doft, board-certified plastic surgeon and founder of Doft Plastic Surgery in New York City says since doctors aren't treating patients in-person right now, they have more time to meet with patients to go over procedures, like face lifts. During these consultations, you can learn more about the process, see before-and-after photos of the doctor's work, and take initial photos ahead of an in-office consultation and then, surgery.
Dr. Rabach says that cosmetic dermatology treatments like Botox, fillers, chemical peels, Ultherapy, and microneedling are also possible. These services typically don't require another in-person consultation and can be booked for when doctors' offices re-open.
As for cost? Some doctors offer free consultations for cosmetic procedures, while others charge a fee that will go towards the treatment or surgery.