Teledermatology

What are the factors that have triggered the demand for TELEDERMATOLOGY?

1. The COVID-19 pandemic: Awareness and education about infectious diseases and their transmission have been heightened. Many are still wary of going to crowded places such as the waiting rooms of hospitals and clinics, especially when immunocompromised patients are involved. Patients can now seek medical help without leaving the safety of their homes. They can minimize, or even eliminate the risk of exposure to communicable diseases.

2. Digital photography & smartphones with high-resolution cameras: In a field that is highly dependent on visual assessment, these provide dermatologists with more ease in evaluating overt skin conditions remotely.

3. Online communications via email, videoconference, and messaging apps: Communication between dermatologists and patients has never been easier. Technology has provided the means to have real-time consultations, allowing patients to receive timely medical advice from wherever they are in the country, provided that they have internet access.

4. Heavy traffic, the oil price hike, and busy schedules: Online consultation offers the convenience of not having to deal with heavy traffic and difficult parking. The time needed to travel, as well as the cost of gas prices and parking fees, add to the inconvenience of physically going to the clinics and hospitals.

Although public health awareness and modern-day technology have facilitated the advent of teledermatology, a face-to-face consultation is still the gold standard in the evaluation and management of skin conditions. After a teledermatology consultation, some patients may be asked to consult in person, because a more complete assessment is needed, or because diagnostic tests/procedural treatment have to be performed.

by Natalie Casuela-Quesada, MD

(c) 2022

Autism & Dermatology: The Clinic as a Safe Space

The prevalence of autism around the world has steadily been increasing. Because of this, dermatologists have more or less encountered both children and adults who are on the autism spectrum.

Recent studies show that individuals with autism are more at risk for skin conditions. In addition, assessment and treatment of these skin conditions also pose a challenge due to sensory regulation issues, difficulties in speech that hampers the ability to verbally explain symptoms, and tolerance to topical treatment and/or side effects to oral medications.

As a parent of two children on the autism spectrum, I understand that each patient with autism has a unique sensory, behavioral, and developmental profile. I agree with a commonly heard statement, "When you meet one child with autism, you've met ONE child with autism." It is then important to understand that in the management of these patients, what works for one patient may not work with another.

As a medical professional, it is vital to be educated about autism's issues and challenges from both ends of the spectrum. There is a need to modify assessment techniques, and choose modes of treatment according to each patient's profile.

Visiting a clinic to see a dermatologist involves going to an unfamiliar environment, meeting new people, and being involved in tasks that may be outside one's usual daily routine and comfort zone. This can be overwhelming to most individuals with autism, resulting to heightened stress levels, and sometimes even triggering meltdowns.

Priming the child or adult with autism can be done by showing photos or videos of the people and the rooms at the clinic. Practicing anticipated tasks (e.g waiting for one's turn, allowing the nurse to take one's weight or blood pressure, letting the dermatologist do a physical examination) will aid in decreasing demands, lowering anxiety, and increasing the comfort level of the patient during the actual visit. Scheduling a visit to the clinic prior to the actual appointment can also aid in familiarizing the environment.

Choosing a date and time when there are few other patients, or if possible, arranging to have the clinic set a time exclusive for the patient, will also help in decreasing distractions and alleviating discomfort.

Dimming the lights and minimizing environmental noise will go a long way in making a hypersensitive patient feel at ease. Having an interesting, brightly-colored toy for a young, hyperactive toddler can facilitate sitting tolerance and a more intensive assessment. Asking the caregiver about the patient's behavioral reinforcers and using these during the visit can facilitate cooperation. Giving a mode of communication such as a picture board, or allowing the use of an AAC (augmentative and alternative communication) device gives the non-verbal or partially verbal patient a chance to participate in his/her own evaluation and be involved in choosing among treatment options.

Open and honest communication among the patient, his/her family, the physician, and other health professionals involved, allows coordination of treatment plans, thus maximizing assessment and treatment outcomes for patients with autism. The patient's family/caregiver support and financial background are some other factors that should be also be considered in developing a treatment plan.

Everyone should recognize the need and responsibility of providing a safe place for neurodiverse individuals. They should be given access to the same services and benefits given to the neurotypical population, not just in terms of medical resources, but in all other aspects of society.

by Natalie Casuela-Quesada, MD

(c) 2022

---

Dr. Quesada is a board-certified dermatologist, proud autism parent, and strong advocate for the

awareness, acceptance, and inclusion of neurodiverse individuals.

Double-Blind Randomized Controlled Trial on the Efficacy and Safety of Metformin as an Adjunct to Doxycycline and Tretinoin 0.025% Cream in the Treatment of Moderate to Severe Acne Vulgaris