From The Straits Times    |

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These days, you don’t have to make a trip to the clinic to see a doctor – teleconsultations and apps have made these services digitally accessible. Joining the wave of “doctors without consultation rooms” is a slew of dermatology diagnostics that’s offered online.

The visual diagnostic nature of skin conditions could be the reason why various online skin health services have been emerging, from telehealth services Doctor Anywhere and White Coat. Even our public health system’s National Skin Centre is onboard the e-healthcare bandwagon.

My four-year old had a scratch on his forehead that didn’t seem to be healing and was oozing pus and blistering for over a week. As it happens, I have a friend who is a dermatologist, and so I texted her about it together with clear photos of my child’s wound.

She diagnosed it as impetigo, a common bacterial skin infection that causes sores and blisters. She added that it’s not usually serious and suggested washing it with chlorhexidine and applying an antibiotic ointment like fucidin before covering it with a light dressing. Thankfully, I had these in my medicine box at home, which resolved the oozing wound in two days.

Although not an official telehealth service, this WhatsApp “consultation” with my dermatologist friend gave me a taste of having an online consultation and advice from a skin specialist. It was really convenient not having to leave my house to get a clear, professional diagnosis and the information to resolve the skin issue and give me peace of mind.

How a teleconsultation works

Through online skin health platforms or apps, you can now have your skin condition assessed by a dermatologist or doctor, concerns addressed, and receive diagnosis for your skin problems as well as personalised prescriptions or recommendations for treatments or skincare products. It’s like having your very own skincare expert at your fingertips.

Before booking your online skin consultation, you’ll typically have to fill up a questionnaire detailing your skin type, concerns, medical history, and current skincare routine. To ensure accurate diagnosis, you may even be asked to upload clear, high-resolution pictures or videos of your skin condition.

Armed with this information, the doctor would carefully analyse your skin and will ask follow-up questions during the teleconsultation to gather additional details needed. These virtual consultations are conducted via secure messaging or video calls, ensuring confidential and private communication.

From addressing acne and dryness to tackling signs of ageing, hyperpigmentation, or eczema, with their expertise, the doctor will advise and prescribe a personalised treatment plan tailored specifically to your skin’s needs. Your doctor may also provide lifestyle and dietary recommendations, as well as any other relevant factors that can have an impact on your skin’s health.

Once the consultation is complete, the prescribed products and medications can be sent right to your doorstep. You’ll also receive a detailed skincare plan or prescription outlining the recommended products and how to use them effectively. You may be advised to follow up with the doctor after a certain period to evaluate the progress or make adjustments to your skin health plan.

Online skin consultations on Doctor Anywhere and White Coat typically cost around $20 to $50 for a GP doctor and from $50 to $80 for a specialist doctor like a dermatologist. As for prescriptions, you can expect to pay anywhere from $20 onwards, depending on the creams and medication needed.

The in-person consultation fees at National Skin Centre (NSC) range from $109 to $155 without subsidies, and from $23 to $53 for patients who qualify for subsidies. Teleconsult fees are similar to outpatient fees at NSC. For subsidised patients, the fee is dependent on the patient’s subsidy tier; for non-subsidised patients, it depends on the grade of their attending doctor.

When is it better to opt for a physical consultation?

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Online skin health services eliminate the need for physical appointments, allowing individuals to seek professional advice and care from their chosen skin specialist at any time. This accessibility is particularly beneficial for those with busy schedules or limited mobility.

According the NSC, teleconsultations are rarely done for new cases; the patient would need to be physically examained by a general practitioner first, before being referred for teleconsultation with an NSC dermatologist. NSC would also require a referral letter, as well as clinical photographs of the patient’s skin condition from the initial consulting physician.

This errs on the side of caution as teledermatology is known to be better for monitoring and managing skin conditions for existing patients. However, if the patient has significant physical and logistical challenges going for an appointment in person, an initial virtual consultation may be considered.

“Patients who are suitable for tele-dermatology are mostly follow-up patients with stable dermatological conditions. For patients who are seeing a dermatologist online for the first time, the condition should preferably be mild and easily discernible visually,” says Dr Kok Wai Leong, dermatologist at Starmed Specialist Centre. He also adds that the limitations of tele-dermatology are numerous. “The main one would be the inability to conduct a physical examination.”

As such, dermatologists may face challenges in assessing certain conditions accurately. While visual aids can provide valuable insights, some conditions may require in-person evaluation for a more comprehensive diagnosis.

For example, acne and rosacea are two common skin conditions that are often confused for each other as rosacea sometimes produces small, red, pus-filled bumps that can often be confused for acne.

An in-person counsultation would allow the doctor to better distinguish the diagnosis based on the appearance of the skin condition and on your medical history. Additionally, tests may be ordered to determine the condition in order to treat it effectively.

A lot of the efficacy of a teleconsultation also relies on technology, such as stable internet connections, and customer service. “At times, the obstacle is infrastructural. For example, diagnosis requires good image quality and limitations with bandwidth may hamper the tele-consultation process.

“For telemedicine providers, there must be an established structure for patient support, follow up and communication. This could be through follow up calls from the clinic for example. There should also be an option for in person consultation or review if needed,” says Dr Kok.

What is the cost of a teleconsultation?

According to MOH guidelines, Singaporeans or PRs aged 60 years old and above can use Flexi Medisave (up to $300 per calendar year) for their prescription only, excluding retail items. And Singaporeans or PRs can use Chronic Disease Management Programme (CDMP) Medisave for Psoriasis (up to $500 per calendar year) for consult and prescription, excluding retail items. A concurrent co-payment of 15 percent applies.

Rule of thumb: Do your homework first

So it goes without saying that you should always use an established platform with doctors that are accredited with the Ministry of Health. Here’s a tip: You can search the name of a doctor on the Ministry of Health Singapore website under ‘Healthcare Professionals Search’ to ascertain a doctor’s accreditation.