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Diagnostic Concordance and Interobserver Variability Between Tele-Dermatology (Store-and-Forward) and In-Person
Pratibha Gupta1, Deepika Pandhi1, Chander Grover1
1Department of Dermatology and STD, University College of Medical Sciences, University of Delhi, Guru Teg Bahadur Hospital, Delhi, India.
Indian Dermatology Online Journal
|April 15, 2026
Summary
Tele-dermatology shows high diagnostic concordance for inpatient consultations, serving as a viable alternative to non-dermatologist evaluations. Certified dermatologists (CD) achieved 88% concordance, supporting its use for supplementing in-person care.
Area of Science:
- Medical Informatics
- Dermatology
- Telemedicine
Background:
- Limited dermatologist availability and high skin disease burden in hospitalized patients necessitate innovative solutions.
- Tele-dermatology offers a potential method to bridge gaps in dermatological care for inpatients.
- Data on the diagnostic accuracy and interobserver variability of tele-dermatology in inpatient settings are scarce.
Purpose of the Study:
- To evaluate the diagnostic agreement between tele-dermatology (store-and-forward) and in-person assessments for hospitalized patients.
- To determine interobserver variability in diagnosing skin conditions among different dermatology providers via tele-dermatology.
Main Methods:
- One hundred hospitalized patients requiring dermatology consultations were assessed.
- In-person evaluations were conducted by certified dermatologists (CD) and trainee dermatologists (TrD).
- A separate group of CD and TrD performed tele-evaluations using store-and-forward technology. Diagnoses and recommended investigations were compared against a gold standard established by in-person CD evaluations.
Main Results:
- Certified dermatologists (CD) using tele-dermatology achieved 88% partial diagnostic concordance, with high agreement in biopsy (89%) and dermoscopy (85.7%) recommendations.
- Tele-dermatology was effective for diagnosing infections, pediatric, papulosquamous, and hair/nail disorders by CD.
- Trainee dermatologists (TrD) showed accuracy in diagnosing infections, eczematous, and papulosquamous disorders via tele-dermatology, though less so for drug-induced and contact dermatitis.
Conclusions:
- Teleconsultation by certified dermatologists (CD) and trainee dermatologists (TrD) can serve as a valuable alternative to non-dermatologist evaluations for inpatients.
- Tele-dermatology may complement in-person consultations, particularly for complex or high-risk dermatological cases.
- The study, while single-centered and excluding emergencies, suggests tele-dermatology's utility in expanding inpatient dermatological services.
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