P137 The long-term efficacy of managing and discharging patients from direct-to-patient teledermatology for inflammatory dermatoses

Abstract

Teledermatology for inflammatory dermatoses is well established, predominantly via Advice and Guidance. We introduced a novel direct-to-patient teledermatology (DTPT) service for adults referred with an inflammatory dermatosis and awaiting their first appointment in 2024. Our results demonstrated that > 25% could be managed without requiring face-to-face consultation. One potential criticism was the lack of data regarding re-referral rates. The aim of this study was to establish the rate of re-referral within 1 year. Records for patients involved in the DTPT pilot, conducted during May to October 2024, were reviewed retrospectively in December 2025. Primary measures were whether there was re-referral within 12 months, and if so, the indication and outcome. Overall, 128 of 528 patients using DTPT (24%) were discharged following virtual review. The most common diagnoses were cutaneous infection (n = 26, 20%), psoriasis (n = 18, 14%), eczema (n = 13, 10%), hidradenitis suppurativa (n = 8, 6%) and rosacea (n = 6, 5%). Management recommendations included topical steroid (n = 30, 23%), calcipotriol/betamethasone (n = 10, 8%) and other topical preparations (n = 17, 13%). Oral antimicrobials were recommended for 26 patients (20%). Specific management recommendations were not given in 10 patients (8%). After 1 year, 12.5% (n = 16) had been re-referred. Ten (8%) were for the same indication, while six were referred with new, unrelated issues, primarily skin lesions. The outcomes of the 16 re-referrals were nine to await outpatient review, two listed for surgery, two listed for phototherapy and three discharged with further treatment. These long-term follow-up data confirm the effectiveness of DTPT, with only 8% of patients initially discharged with advice being re-referred for the same condition within 12 months. This reflects an overall 20% reduction in outpatient appointments in this cohort. DTPT reduces demand on outpatient clinics, administrative burden on general practitioners, and unnecessary patient travel, while affording dermatologists flexible and remote work. As the demand on primary care and dermatology increases, DTPT could become a highly effective way to streamline patient pathways.