• Telemedicine is the use of two-way communication technology to provide health care.
• More people than ever are using telemedicine during the COVID-19 public health emergency.
• Following simple tips to prepare for telemedicine appointments can help ensure a useful and effective session with your doctor.
• Being open with your doctor about your symptoms is necessary to receive high-quality health care.
• People who receive psoriasis care via telemedicine have similar outcomes to those who visit their dermatologist in person.

Telemedicine, or telehealth, is the use of two-way communication technology to provide health care services. While its use has been limited in the past, the U.S. Department of Health and Human Services (HHS) began encouraging providers to offer telehealth services more widely in March as a safer way to deliver health care during the COVID-19 pandemic. While telemedicine cannot be used for every aspect of psoriasis care, it can be an effective, convenient, and valuable way to access your health care provider.

Telemedicine for Psoriasis

Treatment of psoriasis — a chronic inflammatory skin disease — requires ongoing care by a dermatologist. Routine checkups are important for managing inflammation, slowing progression of the disease, and preventing complications. For that reason, telemedicine has become a key part of psoriasis care since COVID-19.

Quality of care and outcomes in teledermatology (telemedicine for dermatology) have proven equivalent to in-person visits. In a 2018 randomized clinical trial, people who received psoriasis care virtually experienced a similar reduction in psoriatic severity as those who visited dermatologists in person.

Telemedicine reviews are generally positive, as well. Some people report their doctors spend more time with them through telemedicine and actively engage in their care. Others are grateful for the ability to visit with doctors from the comfort and safety of their own homes. Getting medication refills via telemedicine is another big plus. And virtual visits reduce fear and worry among high-risk individuals.

When Telemedicine Works Best for Psoriasis

Telemedicine for psoriasis is best suited for:

• Initial screenings — Dermatologists can virtually examine the skin to determine if an in-person visit is needed.
• Follow-ups — For those who’ve been diagnosed at an in-person visit and are in treatment, telemedicine can be useful for follow-ups, particularly when the disease is stable.
• Refilling or adjusting medications — Based on a virtual exam, your dermatologist can prescribe, refill, change, remove, or tweak medications to control symptoms and side effects.

What To Expect From a Telemedicine Visit

Although doctors can’t perform a hands-on examination during a virtual visit, they can get a good look at existing patches and plaques, and assess disease severity by observing how much psoriasis covers your body.

During your televisit, the dermatologist will:

• Take a full medical history in the initial appointment.
• Examine psoriasis patches on camera or review photos sent in advance. They will be able to see redness and scaliness but not elevation or hardness of lesions.
• Discuss and evaluate any recent symptoms, complications, and medication side effects.
• Review any lab results and biopsies.

How frequently you’ll need to be seen virtually depends on disease severity and whether additional tests or treatments are required. Some people may need to physically visit a laboratory or hospital for blood work and biopsies, prior to a telemedicine appointment. Others may be asked to come to an in-person appointment after a virtual assessment of their condition.

What Can’t Be Done by Telemedicine

Without a hands-on physical exam, dermatologists may not be able to examine certain body parts. Certain areas of the body — the scalp, for example — are harder to view on camera. In those cases, your doctor may ask you to take photos of these areas and send them via email.

Dermatologists will also be unable to administer medication infusions through telemedicine. Certain types of biologic drugs that treat moderate to severe psoriatic disease are only administered via infusion at a medical office.

Guidelines for treatment during the COVID-19 pandemic recommend that people who aren’t infected with the new coronavirus continue biologic or oral therapies in most cases. If you’ve been receiving biologic infusions or injection therapy, speak with your doctor about the best way to manage your treatment during the pandemic.

Tips for Telemedicine Appointments

While remote visits are safe and effective, there are some limitations. With a little preparation, you can ensure your telemedicine appointment is effective and useful. Here are some tips to help make your telehealth meeting successful:

• Have the meeting in a quiet place with privacy and good lighting.
• Make sure the device you are using — whether a cell phone, tablet, or computer — is fully charged and has a stable connection via Wi-Fi, internet cable, or your cellular service.
• If your internet connection tends to be slow, consider asking others in your household to suspend streaming, downloading, or online gaming activities during your appointment.
• Do a test run before your appointment. Check your audio and video. Log in to the designated platform at least 15 minutes before your appointment time.
• Write down your questions for the doctor in advance.
• Keep a pen and paper handy to take notes or ask a family member to attend the appointment with you and take notes for you.
• If possible, take your vital signs in advance to share with the health care provider. If you have the ability, measure and write down your weight, temperature, and blood pressure.
• Be ready to describe your psoriasis symptoms, as well as any changes you’ve experienced since your last visit.
• Note any changes to psoriasis medications or other treatments.
• Gather the labels or containers of all your medications, vitamins, and supplements. Have them ready to show in case your doctor has questions about symptoms and side effects.

If you live with extended family or roommates, it may be difficult to find a private or quiet space in your home. Consider conducting the appointment in a parked car or garage, if you have access to one. Before the meeting, check to make sure you have a stable internet connection in this location.

Come Prepared and Be Honest

A health care appointment can only be effective when you are honest and open about the symptoms and side effects you’re experiencing. This is just as important during a telemedicine appointment as an in-office visit.

Being open with your health care provider is the only way to get the care you need to stay your healthiest and feel your best. Many people are uncomfortable talking about their health problems, even with doctors. They may feel embarrassed or as though they are complaining or being bothersome. Since telemedicine is providing a new way to connect with health care providers, it can be an opportunity to change this habit and begin sharing full details about your condition with those whose job it is to take care of your health.

Addressing Concerns About Telehealth

Some people may have concerns about using telemedicine for the first time, especially if they’re generally uncomfortable using technology.

Technical Difficulties

Keep in mind that technical difficulties are normal, even for those who are experts. Be patient and do not panic if the video freezes or the sound cuts out for a moment. You may need to repeat yourself or ask your health care providers to repeat themselves at times. If technical issues arise, your health care provider will work with you to resolve them.

If you’ll be using a video meeting platform (such as Zoom, Skype, FaceTime, or Google Hangouts) with which you are not familiar, consider practicing with a friend or family member in advance of the appointment. This will help you build familiarity and confidence with the technology.

The doctor’s office will generally email you a link to register for the virtual visit or an app you can download. The app will connect you to a patient portal where you will be able to speak “face-to-face” with your doctor at your appointment time.

Before your meeting, look up your doctor’s office phone number. Keep it handy in case audio, video, or internet connection fails on either side. Confirm with the office that this is the correct number to call back in case of technical difficulties. If they need to see you in person to examine swollen joints or range of motion, ask about rescheduling the appointment.

Privacy and Security

Prior to the COVID-19 pandemic, the Health Insurance Portability and Accountability Act (HIPAA) tightly controlled the ways technology could be used to share health information. On March 17, 2020, the HHS waived penalties for potential HIPAA violations against health care providers using “everyday communications technologies” as long as they are serving patients “in good faith” during the COVID-19 pandemic.

The privacy and security of your health information depends largely on which technology platform you’re using for telemedicine. Direct phone calls and texted photos are easier to secure than other forms of technology. If you have been using your health care organization’s portal to share information with your doctor, this platform is just as secure as ever. If you have concerns about sharing particularly sensitive information with your doctor over a video communication platform, consider asking whether you could have a traditional phone call instead, or follow up a video appointment with a phone call to share any especially private information.

Telemedicine and Cost

In some cases, copays or other costs associated with telehealth appointments are the same as those for in-person visits. Some commercial health insurance companies are waiving copays for telehealth appointments. America’s Health Insurance Plans (AHIP), an organization representing insurance providers that cover hundreds of millions of Americans, has provided an alphabetized list of its members that have taken actions to address COVID-19. The list includes several providers that are waiving telehealth copays or expanding access to telehealth. Call your health insurance supplier to find out how they are covering telemedicine appointments.

During the COVID-19 pandemic, the U.S. federal government has temporarily lifted restrictions to allow people using Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to more easily access expanded telemedicine services. Similarly, federally qualified health centers and rural health clinics have been cleared to provide telehealth.

For those on Medicare, in most cases telemedicine will cost the same amount as if they received the services in person. Note that the Medicare Part B deductible applies.

Telehealth: The Future of Psoriasis Treatment?

Telemedicine is proving indispensable as a way to access health care while avoiding the risk of infection during the coronavirus pandemic. As people with psoriasis and their health care providers become familiar and comfortable with telehealth technology, it may prove useful in the future, even after the pandemic has come to an end.

Hopefully, expanded access to telehealth will become a trend that improves health care for people living with psoriasis.

Have you used telemedicine appointments to access health care for psoriasis or psoriatic arthritis? Share your experiences in the comments below or post on MyPsoriasisTeam.