Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology

Area of Science:

• Dermatology
• Medical Technology
• Telemedicine

Background:

• Limited data exists on the efficacy of teledermatology for patch testing.
• Patch testing is crucial for diagnosing allergic contact dermatitis.

Purpose of the Study:

• To compare the accuracy of teledermatology (TD) patch test readings with in-person dermatologists (IPDs).
• To evaluate the reliability of remote interpretation of patch test reactions.

Main Methods:

• Eight teledermatologists reviewed patient photographs of patch tests at 48 hours and second readings.
• Teledermatologists graded reactions and provided final interpretations, rating image quality and confidence.
• Agreement between teledermatologists and in-person dermatologists was calculated based on clinical significance.

Main Results:

• Pooled failure rates were 13.6% at the second reading and 24.6% for final interpretation.
• Confidence in teledermatology readings correlated with image quality and disagreement.
• Data availability varied across different reading times.

Conclusions:

• Teledermatology presents significant limitations for patch testing due to high pooled failure percentages.
• The findings suggest caution when using teledermatology for critical dermatological diagnostic procedures like patch testing.