Reliability of Clinical Scoring Tools in Teledermatology Compared to Face-To-Face Assessment: A Systematic Review and...

Teledermatology improves access to care, but its reliability for scoring skin diseases compared with face-to-face assessments remains underexplored. We undertook a systematic review of studies comparing teledermatology and in-person assessments using validated scoring tools. Following PRISMA guidelines, we searched MEDLINE and Embase for English-language studies up to 16 December 2024. Eligible studies reported agreement metrics between photographic and in-person evaluations. Two reviewers independently screened and extracted data. Meta-analysis was performed for EASI and PASI using a random-effects model. Risk of bias was assessed with QUADAS-2. No funding was received. This project was registered on PROSPERO [CRD420251026970]. Sixteen studies involving 927 participants were included: six on atopic dermatitis, five on plaque psoriasis, three on patch testing, and two on acne. Reported reliability metrics included the intraclass correlation coefficient (ICC) and kappa values. These ranged from moderate to excellent. Reliability was influenced by assessor experience, image quality, and disease severity. Nine studies were at risk of bias due to unclear methodology. Pooled ICCs demonstrated excellent reliability for atopic dermatitis (0.90) and good reliability for psoriasis (0.87). These findings suggest that teledermatology appears as reliable as in-person review for atopic dermatitis and psoriasis, supporting its role in clinical practice. Standardisation of image capture and further research across a broader range of dermatological conditions is required.