Case report: teledermatology and epiluminescence microscopy for the diagnosis of scabies

We wish to share images from a patient seen in our teledermatology program. Due to the absence of on-site dermatology services at the Togus, Maine, Department of Veterans Affairs, and associated community clinics for veterans in Aroostook, Bangor, Calais, and Rumford, we created a program to provide dermatologic expertise from Providence, Rhode Island. Patients referred for this service were evaluated by a nurse practitioner, who obtained a history, performed a physical examination, and captured digital images of the affected area of skin, including epiluminescence microscopic images where indicated. These data were then retrieved at the Providence (host) site and reviewed by a dermatologist, who formulated an impression and plan that was then implemented by the remote site in Maine. This approach, which involves image capture at the remote site and later review of images at the host site, is the "store-and-forward" method, which appears to be a relatively cost-effective means of providing this service from a distance.