Psoriasis is a chronic relapsing disease that requires long-term treatments and frequent follow-ups
[6]. Besides in-person consultations, teledermatology has become an opportunity in daily clinical settings for those who, for any reason, cannot attend the visit and at the same time require medical advice
[7][8][9][10][11][12][13][14][15][7,8,9,10,11,12,13,14,15]. In fact, Anderesen et al., through a retrospective review of the teledermatology database in the Faroe Islands, a group of 18 islands in the North Atlantic, concluded that teledermatology is indispensable in specific contexts, such as rural areas, while in non-rural ones, should be destined to evaluate which disease can benefit from either in-person or online visits to give selectivity on resources destined for telemedicine
[12]. Moreover, since the worldwide spread of the SARS-CoV-2 infection at the end of 2019, telemedicine has gained an increasingly important role in daily clinical practice, especially regarding patients affected by chronic diseases, such as psoriasis
[16][17][16,17]. Villani and colleagues implemented an already existing teleconsultation service that was originally reserved for emergencies, and that turned routine during the COVID-19 pandemic, given the need to avoid social contacts
[13]. Such measures appeared to be very important, particularly for those patients under immunosuppressive drugs that were at high risk of contracting the infection
[13]. In general, Beer, Chambers, Pearlman, and Frühauf accordingly reported in their studies that online interactions were well accepted by patients and highly preferred to in-person visits
[16][17][18][19][16,17,18,19]. Moreso, Yi et al. noticed a slight decrease in access to telehealth services for elderly and non-English speaker patients, suggesting potential unequal access to care for these vulnerable patients
[20]. Favoring points for teledermatology were reported to be the easy accessibility, safety, and effectiveness of teleconsultations that were perceived as patient-centered, and the possibility of saving money and time
[14][20][21][22][14,20,21,22]. As a result, patients’ compliance with treatment was shown to be high, and thus, a likely unnecessary worsening of psoriasis severity, given the unattended visits for control and renewal of treatments, was prevented, as reported by Brunasso et al.
[15]. Likewise, telemedicine for psoriasis was appreciated by doctors, as it reduced the burden of visits that could be managed remotely, as well as saving time and money
[17][18][19][20][21][22][23][17,18,19,20,21,22,23]. Moreover, there has been a great push towards digitalization that involved both patients and health care systems, giving teledermatology prospects for being part of clinical practice in the future
[17]. The importance of telemedicine in assessing and monitoring psoriasis and its treatment was already shown previously by Julia Frühauf et al., who ran a pilot study comparing the data of psoriasis severity and therapeutic outcomes of 10 patients under etanercept derived from face-to-face and online visits
[24]. They found no statistically significant differences between the assigned scores and, accordingly, therapeutic decisions in the two settings supported the feasibility of a remote follow-up of psoriasis patients
[24]. Such findings were also confirmed by Balato et al., which demonstrated the usefulness of telemedicine in improving clinical outcomes and achieving better disease control by developing an educational and motivational support service through the reliance of text messages in guiding and reminding psoriasis patients about their treatment
[25]. Moreso, online consultations raised the issue of accurately determining psoriasis severity on which disease progression evaluation and therapeutic decisions are based. In fact, either the quality of cameras, pictures, video calls, or internet connection as well as patients’ ability, may have impaired the assessment of the daily conventionally adopted psoriasis severity scores, such as the Psoriasis Area and Severity Index (PASI) or body surface area (BSA). For this reason, many authors tried to address such topics in different ways. In detail, Armstrong and colleagues developed an effective, innovative, and collaborative health model where patients were directly involved in their disease monitoring through self-calculating the PASI and BSA scores after appropriate training
[23]. Moreso, Singh and colleagues ran the tele-PASI accuracy study with the aim to assess the reliability of PASI scores determined on the basis of standardized digital images—the tele-PASI score
[26]. Twelve patients with confirmed psoriasis were recruited, as well as two dermatologists for a baseline face-to-face visit, and a third independent dermatologist who determined the remote PASI scores at weeks 6 and 14
[27]. Both intra- and inter-observer assessments were performed, showing a good agreement in PASI score determination between the three dermatologists as well as per each one at different times, confirming analogous findings reported by Julia Furhauf et al.
[24]. Furthermore, some authors wondered about the accuracy of a remote determination of conventional psoriasis severity scores, given the specific virtual evaluation. For this reason, Wu et al. developed and validated a new model to estimate a total PASI score in the context of teledermatology (the tele-PASI score) where some characteristics of psoriasis, such as thickness, cannot be assessed, in contrast to erythema, scaling and affected areas of the body
[27]. Hence, the tele-PASI score was the result of the original PASI, excluding thickness
[27]. An amount of 3866 patients with moderate-to-severe plaque psoriasis were included in the study and randomized into three treatments groups: placebo, ixekizumab, and etanercept
[27]. A strong correlation between original and modeled total PASI scores, either at screening, baseline, or during treatment up to week 12, was found, irrespective of treatments, showing that such a proposed modified score may be safely integrated into telematic clinical practice
[27]. Nonetheless, further studies are needed in support of such findings. Concerning psoriasis treatment monitoring, teledermatology has been proven to be useful in prescribing and monitoring not only systemic therapies, i.e., biologicals, but also topicals and phototherapy, thus improving patients’ adherence to treatment and clinical outcomes
[28][29][30][31][32][28,29,30,31,32]. Moreso, telemedicine assisted psoriasis patients not only with the cutaneous aspect of the disease but also on a psychological level
[33]. Indeed, Young and colleagues ran a 12-month randomized controlled equivalency trial to assess the impact of teledermatology on psoriasis patients’ mental health and depression, finding no statistically significant differences compared to in-person care
[33]. Moreover, even if the adult population is the main recipient of telemedicine, studies have also shown that children were directly involved in developing awareness of their disease and evolution during the COVID-19 pandemic
[34]. In general, based on doctors’ perspectives, teledermatology has been proven effective and reliable as it allows to perform visits, maintain continuative medical assistance and improve clinical outcomes; from a patients’ perspective, it helps keep contact with physicians, enhancing straightforward communications, increasing compliance to treatment and moreover, is highly preferred, as it is time and money-saving, giving the feeling of a more free, flexible and empowered lifestyle
[16][18][19][21][16,18,19,21]. Hence,
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searchers believe that telemedicine will keep an important role in daily health settings, especially with a complementary role in the follow-ups of chronic diseases, such as psoriasis. Such an idea is in line with Gisondi et al., that supports the use of online consultations for patients with stable psoriasis on maintenance treatment with biological agents, as routine visits usually end up with a confirmation of ongoing treatment—different from naïve or unstable patients who would rather benefit from in-person visits
[14]. Likewise, Dahy et al. would encourage face-to-face visits for establishing a diagnosis, and online consultations for the follow-ups
[6]. More applications will be found with the incorporation and implementation of digital platforms in health care systems. An emerging role of teledermatology for psoriasis is the possibility for health personnel to discuss the most difficult cases through dedicated social media, improving knowledge and ultimately patients’ clinical outcomes
[35].