Asynchronous Teledermatology for Lichen Planus: A Retrospective Study

Summary: Background: Teledermatology (TD) has seen a surge in adoption within the medical community, improving healthcare accessibility across diverse demographics and regions, particularly in underserved rural areas grappling with a shortage of dermatologists. Beyond improving access, TD can reduce waiting times for in-person office visits, curtail resource misuse, and improve overall healthcare efficiency. Previous studies have shown a substantial level of diagnostic agreement between TD and in-person dermatological consultations, ranging from 60-100%. However, while TD has proven effective for various inflammatory skin conditions like atopic dermatitis and psoriasis, there remains a gap in peer-reviewed literature regarding its impact on lichen planus (LP)—a chronic inflammatory skin condition affecting nearly 1% of the global population. Objective: This study aims to evaluate the utility of teledermatology in the diagnosis, treatment, and management of patients with LP. Methods: A retrospective analysis of electronic medical records from 2020 to 2024 included all UPMC in-person (n=57) and asynchronous TD (n=45) visits for patients diagnosed with LP, the latter encompassing eVisits (patient-to-physician) and eConsults (physician-to-physician). Cases were analyzed for demographic data, diagnostic concordance between consulting physicians and teledermatologists, management of the disease, follow-up outcomes, and other relevant information. Our findings indicate that asynchronous TD can improve access to dermatological care for patients with LP, while demonstrating comparable diagnostic accuracy and disease management to traditional, in-person dermatology. The average consult submission to response time of 15 hours significantly contrasts with the several weeks patients typically wait for dermatological care, highlighting TD's ability to expedite access for LP patients. The diagnostic concordance (90.5%) between initial TD assessments and subsequent in-person dermatology follow-ups underscores TD's diagnostic accuracy in identifying LP. However, the low concordance (22%) between consulting PCPs and teledermatologists reveals a gap in diagnostic accuracy among PCPs for LP, highlighting the role of TD in bridging this gap with rapid, specialized care. Our study also showed TD adherence to established standards of care for LP, including screening for HCV infection (91.1%) and drug-related causes (97.8%). Teledermatologists consistently prescribed (90%) topical corticosteroids as a first-line treatment for new LP cases, further aligning with these standards. Demographic disparities were also observed, with a statistically significant difference between the percentage of Black eVisit patients (38.9%) and Black in-person patients (8.8%). These findings emphasize the need for targeted interventions to address disparities in dermatological care access and outcomes among diverse patient populations. However, our findings indicate lower adherence to follow-up requests among asynchronous TD patients, particularly in the younger eVisit demographic (55.8%). This trend is similarly reflected in patient compliance with HCV testing, where eVisit patients complied 66.7% of the time compared to 90.9% compliance among in-person patients. Improving patient engagement strategies tailored to this group could enhance compliance and optimize care outcomes in asynchronous TD settings.