I Tried It: Teledermatology

For decades I’ve regularly visited the dermatologist in the clinic to check on my psoriasis and eczema. But when COVID-19 started spreading in my community, I decided to cancel my next appointment. I figured I would reschedule once things calmed down.

Instead of easing, the pandemic in my area of California has continued to worsen.

Concerns related to the pandemic also kept my family members from seeing their doctors and therapists, and they’d turned to telemedicine. I didn’t think it would be right for me. With psoriasis, I figured it would be better for my dermatologist to see my skin in the examining room.

Preparing for My First Telehealth Appointment

I began to prepare for the appointment that afternoon in the same way I would for a regular in-clinic visit, by using the Notes app on my iPhone to write down any questions or thoughts. In a new note, I jotted down my questions related to continuing my biologic, phototherapy dosing, and long-term topical steroid use.

Dr. Carroll already had pictures of active psoriasis and eczema areas on my skin that I’d sent a week earlier when I’d had a flare. I’m glad my wife helped me take those, so I didn’t need to do it again. It had been relatively simple to attach them to a message I sent through the clinic’s patient portal.

The medical assistant emailed a link to Dr. Carroll’s virtual Zoom waiting room. I don’t like video calls in general, but the shelter-in-place orders required me to learn the technology to participate in virtual meetings for work.

Thankfully, testing my video and microphone with the Zoom app went well; I didn’t want a glitch to cause me to miss my appointment or cut it short.

The clinic also sent me a link to an online check-in system. I answered questions about COVID-19 symptoms, my pain level, and my reason for wanting to visit the doctor. I took care of my copay at the end of the check-in process.

Seeing My Dermatologist Virtually

Oddly, the medical assistant called me five minutes before the appointment. He asked if I had checked in and answered the prescreening question. After I told him I completed it earlier in the morning, he admitted there are still bugs in the new telehealth system.

I saw my dermatologist through a screen five months to the day since my last clinic appointment. During the 20-minute session she seemed relaxed and more willing to chat than usual. I appreciated how she asked me about my work situation, which she remembered caused me stress that could flare my skin.

After we caught up a bit, I asked if she wanted to see my skin through the webcam. She told me that wouldn’t be necessary since she had those recent photos. She looked at them on her screen once again before addressing my questions.

First, she felt I should continue taking my biologic, Skyrizi, per my regular dosing schedule. While I shared my concern about taking an immune-suppressive medication during the pandemic, she felt if I remained careful to avoid exposing myself to the novel coronavirus it would be better to not disrupt my treatment. (My psoriasis has flared badly when I’d stopped medications in the past.)

Next, we talked about phototherapy. Dr. Carroll thought I should try to return to my previous light therapy doses that worked well in managing my eczema before I became photosensitized with a new asthma controller. She referred me to her colleague, an allergist, to evaluate my asthma and prescribe a new asthma controller. I felt relieved that I could see the allergist through a virtual visit as well.

Finally, she assured me that I could continue using the medium-strength topical steroid. While I do have some skin atrophy from long-term use, it is not enough to discontinue the steroid quite yet. Besides, she reasoned, I need to feel comfortable enough to function. The steroid works together with my other treatments to afford me that comfort level.

My Next Teledermatology Appointment

After giving me instructions to get blood tests at the clinic lab (she assured me that the lab uses an appointment system that ensures patients don’t overlap), Dr. Carroll and I discussed when to schedule my return visit. I will get my regular shipment of Skyrizi from the specialty pharmacy before then, so I can update her on how that dose goes.

I definitely won’t mind visiting my healthcare providers more frequently online. Maybe by the fall I can see them in person again too.

You can read more about my experiences in my blog for ishonest and on my website.

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