Comparing teledermatology and in-person dermatology for lichenoid dermatoses

Summary: Abstract Body: Given the paucity of research on teledermatology (TD) in the management of lichenoid dermatoses, this study examines its impact on access to care, diagnostic accuracy, treatment protocols, and follow-up compliance compared to in-person (IP) dermatology. A retrospective analysis of electronic medical records at the University of Pittsburgh Medical Center from January 2020 to June 2024 identified 274 patients with lichenoid dermatoses, including lichen sclerosus (60%) and lichen planus (37%). 24% of cases were TD visits. TD significantly improved access to care, with a mean consult submission-to-response time of 14.7 hours. Diagnostic concordance was high between initial TD assessments and subsequent IP dermatology follow-ups (93%) but significantly lower (19%, p <.001) between consulting PCPs and teledermatologists. Teledermatologists demonstrated high adherence to established standards of care for lichenoid dermatoses, screening for HCV infection (91%) and drug-related causes (98%) in lichen planus patients, while prescribing topical corticosteroids as a first-line treatment in 88% of all lichenoid dermatoses cases. Significant demographic disparities were observed, with Black patients comprising 22% of the TD cohort compared to 8% of IP visits (p <.01). These findings emphasize the need for targeted interventions to address disparities in dermatological care among diverse patient populations. Follow-up compliance was lower in TD patients compared to IP patients, particularly among younger eVisit patients (54%, p <0.001). Similarly, compliance with hepatitis C testing was 67% in TD patients with lichen planus compared to 91% in IP patients with the same diagnosis. Contributing factors may include challenges navigating TD systems and difficulties accessing resources without IP support. Our findings suggest that TD can improve access to high-quality dermatologic care for lichenoid dermatoses patients, while demonstrating comparable diagnostic accuracy and disease management to traditional IP care. Taylor L. Duffy^{2, 1}, Sydney E. DeVore^{2, 1}, Joseph English^{2, 1} 1. Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 2. Dermatology, UPMC, Pittsburgh, PA, United States. Clinical Research: Epidemiology and Observational Research