Editor
Acne is a chronic inflammatory skin disease affecting the 9.4% of global population.
1
Although it usually occurs in adolescents aged from 15 to 24 years old, it is not
uncommon to develop in adults either.
2
Boys are more frequently affected, particularly with severe forms of the disease.
An adequate and continuous treatment of the disease is required in order to reduce
acne lesions, prevent permanent scarring and limit the duration of the disorder.
3
Disease severity could also affect patients’ quality of life, sometimes causing anxiety,
depression and even suicide.
4
With the implementation of new technologies, particularly mobile technologies, there
is a growing use of smartphones and personal computers among the whole population,
especially among teens and younger adults. Since the coronavirus disease 2019 (COVID‐19)
outbreak, different measures have been applied in hospitals in order to avoid or limit
as much as possible coronavirus infection spread, including the reduction of face‐to‐face
visits and the implementation of teledermatology.
5
,
6
Objective of our study was to assess how teledermatology visits were subjectively
experienced by the patient as well as to identify how to improve the doctor–patient
relationship and to satisfy patients’ expectations. An observational prospective study
was conducted at the Dermatology Unit of the University of Naples Federico II, Italy.
Patients aged >18 years and already attending the Acne Care Centre before COVID‐19
outbreak, who received their control visit through live interactive video‐call visits,
were asked to complete a 6‐item questionnaire using a 0‐10 scale (score 0‐3: negative;
4‐6: not bad not good; 7‐10: positive) to assess how teledermatology visits were subjectively
experienced. Informed consent was obtained during the visit, and the questionnaire
was completed anonymously. Fifty‐two patients (24 males and 28 females; aged 18–27 years;
mean 22.5 years) were consecutively enrolled in the study. Overall, 48 (92.3%) out
of 52 patients rated the attention paid by the dermatologist regarding their disease
as favourable (score = 7–10). Similar outcomes (86.5%) were also reported from data
regarding the evaluation of the time spent by the dermatologist for the visit.
Regarding the treatment received, 71% (37/52) of patients were satisfied with the
treatment they received (score = 7–10), while 80.7% (n = 42; score = 7–10) reported
high well‐being after treatments. 46.1% of the patients (n = 24; score = 0–3) reported
that side‐effects did not represent a significant obstacle to continue the systemic
therapies, and 50 patients (96.1%) related they will continue to consult the same
dermatologists (score = 7–10). All the scores reported for each question and the complete
questionnaire are reported in Table 1. Data from literature indicate teledermatology
as a popular service among both patients and clinicians.
7
Merthens et al.
4
in their 14‐year retrospective study in UK, based on 40201 teleconsultations, revealed
that teledermatology service had been useful to prevent 16 282 face‐to‐face appointments.
In line with literature,
8
,
9
,
10
our questionnaire showed that the majority of patients (92.3%) appreciated the visits
and the attention that physicians gave them, as well as the treatment received, with
90.3 % assessing they will continue to consult the same dermatologists. This is the
first study assessing the grade of satisfaction of patients affected by acne disease
after video‐call visits. Limitations of our study were the lack of a validated questionnaire
assessing the grade of patients’ satisfaction for telemedicine services and the lack
of randomization. Further studies on larger sample size regarding teledermatology
in acne patients should extend beyond satisfaction and agreement to health outcomes
and cost‐effectiveness. However, because guidelines or official recommendations about
the use and the efficacy of these new technologies are lacking, different experiences
and strategies applied in different hospitals should be shared in order to find a
common method well appreciated from both patients and physicians.
Table 1
6‐item questionnaire using a 0‐10 scale (score 0‐3: negative; 4‐6: not bad not good;
7‐10: positive): scores reported in 52 acne patients
Scores
1a
1b
1c
1d
1e
1f
% of patients (number of patients)
% of patients (number of patients)
% of patients (number of patients)
% of patients (number of patients)
% of patients (number of patients)
% of patients (number of patients)
0
0 (n = 0)
1.9 (n = 1)
0 (n = 0)
1.9 (n = 1)
1.9 (n = 1)
9.6 (n = 5)
1.9 (n = 1)
5.8 (n = 3)
0 (n = 15)
46.1 (n = 24)
0 (n = 0)
3.8 (n = 2)
1
0 (n = 0)
0 (n = 0)
3.8 (n = 2)
3.8 (n = 2)
7.7 (n = 4)
0 (n = 0)
2
0 (n = 0)
0 (n = 0)
1.9 (n = 1)
0 (n = 0)
5.9 (n = 3)
1.9 (n = 1)
3
1.9 (n = 1)
1.9 (n = 1)
1.9 (n = 1)
1.9 (n = 1)
3.8 (n = 2)
1.9 (n = 1)
4
0 (n = 0)
5.8 (n = 3)
1.9 (n = 1)
11.5 (n = 6)
1.9 (n = 1)
19.2 (n = 10)
0 (n = 0)
5.8 (n = 2)
27 (n = 14)
46.1 (n = 24)
1.9 (n = 1)
5.8 (n = 2)
5
1.9 (n = 1)
1.9 (n = 1)
1.9 (n = 1)
0 (n = 0)
15.4 (n = 8)
1.9 (n = 1)
6
3.8 (n = 2)
7.7 (n = 4)
15.3 (n = 8)
3.8 (n = 2)
3.8 (n = 2)
0 (n = 0)
7
7.7 (n = 4)
92.3 (n = 48)
5.8 (n = 3)
92.3 (n = 45)
7.7 (n = 4)
71.1 (n = 37)
3.8 (n = 2)
80.7 (n = 47)
3.8 (n = 2)
92.3 (n = 4)
0 (n = 0)
92.3 (n = 48)
8
11.5 (n = 6)
3.8 (n = 2)
11.5 (n = 6)
1.9 (n = 1)
3.8 (n = 2)
11.5 (n = 2)
9
19.2 (n = 10)
19.2 (n = 10)
13.5 (n = 7)
55.7 (n = 29)
1.9 (n = 1)
15.4 (n = 8)
10
53.8 (n = 28)
57.7 (n = 30)
38.5 (n = 20)
28.8 (n = 15)
0 (n = 0)
73.1 (n = 38)
(1a) How do you rate the attention paid by the doctor to your disease? (1b) How do
you rate the time spent by the doctor with you? (1c) Are you satisfied about the treatment
you are doing for acne? (1d) How do you rate your well‐being after the treatment?
(1f) Do side‐effects represent an obstacle to continue the therapy? (1f) Do you think
you will consult the same dermatologist?
John Wiley & Sons, Ltd
This article is being made freely available through PubMed Central as part of the
COVID-19 public health emergency response. It can be used for unrestricted research
re-use and analysis in any form or by any means with acknowledgement of the original
source, for the duration of the public health emergency.
References
1
Hay
RJ
,
Johns
NE
,
Williams
HC
et al
The global burden of skin disease in 2010: an analysis of the prevalence and impact
of skin conditions. J Invest Dermatol
2013; 134: 1527–1534.24166134
2
Fox
L
,
Csongradi
C
,
Aucamp
M
,
du Plessis
J
,
Gerber
M
. Treatment Modalities for Acne. Molecules
2016;21: 1063. Published 2016 Aug 13.
3
Webster
GF
. Clinical review: Acne vulgaris. Br. Med. J.
2002; 325: 475–479.
4
Mehrtens
SH
,
Shall
L
,
Halpern
SM
. A 14‐year review of a UK teledermatology service: experience of over 40 000 teleconsultations.
Clin Exp Dermatol
2019; 44: 874–881.30767255
5
Marasca
C
,
Ruggiero
A
,
Annunziata
MC
,
Fabbrocini
G
,
Megna
M
. Face the COVID‐19 emergency: measures applied in an Italian Dermatologic Clinic
[published online ahead of print, 2020 Apr 15]. J Eur Acad Dermatol Venereol. 2020;10.1111/jdv.16476.
6
Villani
A
,
Scalvenzi
M
,
Fabbrocini
G
. Teledermatology: a useful tool to fight COVID‐19. Journal of Dermatological Treatment
2020; 31: 325.32238000
7
Ford
JA
,
Pereira
A
. Does teledermatology reduces secondary care referrals and is it acceptable to patients
and doctors?: a service evaluation. J Eval Clin Pract.
2015; 21: 710–716.25903046
8
Demo
MLO
,
Marcon
CEM
. Comment on: 'A 14‐year review of a UK teledermatology service: experience of over
40 000 teleconsultations'. Clin Exp Dermatol.
2019; 44: e242.31055840
9
Marasca
C
,
Ruggiero
A
,
Fontanella
G
,
Ferrillo
M
,
Fabbrocini
G
,
Villani
A
. Telemedicine and support groups in order to improve the adherence to treatment and
health related quality of life in patients affected by inflammatory skin conditions
during COVID‐19 emergency [published online ahead of print, 2020 Apr 18]. Clin Exp
Dermatol
2020;10.1111/ced.14245.
10
Lowitt
MH
,
Kessler
II
,
Kauffman
CL
,
Hooper
FJ
,
Siegel
E
Burnett
JW
. Teledermatology and in‐person examinations: a comparison of patient and physician
perceptions and diagnostic agreement. Arch Dermatol.
1998; 134: 471–476.9554300