Being sequestered at home has brought on a whole new set of skincare challenges — particularly when it comes to needing a dermatology visit. Though dermatologists are currently not seeing patients in the office, the reality is that moles, rashes, and other skin conditions aren’t laying in wait. In fact, with stress and anxiety levels rising with every coronavirus-related news report, it’s safe to say that issues like acne breakouts are having a moment.
“With our current conditions — quarantining, masks, and high stress levels — we’re seeing more stress breakouts, rashes, and chronic flare-ups in rosacea and other inflammatory conditions,” says Ava Shamban, MD, board-certified dermatologist and founder of AVA MD℠ in Santa Monica, California. “Patients are also coming to us with irritated skin conditions from constant hand-washing and exposure to disinfecting ingredients.”
Then, there’s that mole or spot you’ve got your eye on — all this time at home may make you more laser-focused on changes and questionable characteristics that you want to check out, STAT. Even if you’re not dealing with a skin condition, you may just want skincare advice. With constant video chats the new norm, it’s easy to become critical of every line and wrinkle you see on your screen. As a result, doctors are finding that many of their patients are trying their first prescription topical treatments, like a retinoid, since the current stay-at-home situation lends itself to getting through the adjustment period.
Retinol shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. As always, talk to your doctor before starting any new medication.
So, what do you do when your derm is WFH? Like a lot of things these days, your visit is now virtual — which actually bodes well for diagnosing a skin issue, since dermatology is more visual than many other medical specialties. If you’ve got a skin problem that’s interfering with your quality of life (such as acne, a rash, an inflammatory flare-up, or an irregular mark or mole), don’t hesitate to book a telederm appointment. Should you be prone to skin cancers, ask your doctor if they’re doing a virtual body check — some doctors are guiding their patients through one with the camera and a full-length mirror. (It should go without saying that anything that’s a non-emergency and done in-office — hello, injectables and laser treatments! — will have to wait.)
Ready to make the appointment? Since this is new to the majority of us, we asked dermatologists who are offering remote appointments for their advice and tips on how to make the most of your televisit.
How To Prep Pre-Visit For Your Telederm Appointment
At the onset of the pandemic, the government waived HIPAA Compliant TechnologyTM for doctors providing telehealth, which means apps like FaceTime® or Google Duo® are acceptable ways to conduct an appointment. And — like an in-person visit — if your health insurance covers it, then the virtual visit will be covered as well, with the usual copay. You’ll set up the appointment as you would normally, either with an online portal, email, or phone call (most doctors have auto-forwarded the office number to support staff).
Depending on the skin concern, it may be a good idea to email a few snaps of the area before the appointment. The dermatologists we spoke to all agree that seeing a picture of a rash or mole prior to the visit is invaluable. “It’s more helpful, because I can magnify it and get better focus, and see textural detail that I can’t see on a virtual visit,” says Channing Barnett, MD, a board-certified dermatologist in Boca Raton, Florida.
She also suggests scouting out the right spot to do the visit. “I tell my staff to advise the patient to stay away from windows and bright sunny spots, which create too many shadows and white light. The more artificial light, the better,” she adds. Also, don’t forget to consider how you hold the phone during the appointment: Dr. Channing suggests six to 10 inches away, panning it around the area to get a full visual. If you’ve got others at home with you, enlist someone to help hold it, especially if the area in question is in an awkward spot.
What to Expect During a Telederm Appointment
Once you’ve set up an appointment, the support staff will let you know the next steps. You may receive a code — some offices are doing a Zoom® pre-check, which puts you in a virtual waiting room until your doctor is ready to come in via a private video, mimicking the experience of being in the office. (In fact, some doctors are using Zoom’s green screen feature to stage themselves in front of a photo of their office for a more realistic feel.)
For conditions like acne, a rash, or a flare-up of a chronic skin condition, seeing the doctor in many ways will be the same. You’ll discuss details surrounding the onset of the issue, what symptoms you’re experiencing, and showing the area (via video). The doctor may request that you send more photos, per their direction of how to take them. Afterwards, they’ll make a diagnosis, recommend a prescription (if needed), and then discuss a follow-up.
When it comes to looking at suspect moles, though, there are a few more steps to make a remote approach effective. Board-certified dermatologist Orit Markowitz, MD, Director of Pigmented Lesions & Skin Cancer at Mount Sinai® in New York City, recommends patients with skin cancer concerns and history to invest in a niche piece of technology: a dermatoscope.
“Dermatoscopes are handheld microscopes used to evaluate pigmented skin lesions with a high-quality magnifying lens and a polarized LED lighting system that allows for the examination of specific skin features and deeper skin patterns,” explains Dr. Markowitz. “Though the in-office ones are best, in these times, the at-home ones can be particularly good at giving me the type of information necessary for early detection and management of skin cancer.” Try the DermLite HÜD® Home Dermatoscope ($99); the monitoring device attaches to your phone and allows you to capture highly magnified, dermatologist-grade photos of your moles. Bonus: the cost might be covered by your insurance, so be sure to check with your provider before purchasing.
If a patient’s questionable spot looks like melanoma, doctors are also using a tape-stripping pigmented lesion assay (PLA) test, which collects skin cells to determine whether they’re positive. Here’s how it works: You receive a special adhesive from the lab by mail, follow the instructions to apply to the mole (you can talk through it with your doctor on a video call!), peel it off, and send the results to the lab. Within 72 hours, your doctor will receive the results and can determine whether there’s a presence of melanoma. If it’s a non-melanoma skin cancer, like basal or squamous cell, your doctor may prescribe prescription topicals to treat it until it’s safe to go to the office. In the case of a more serious melanoma, it’ll be considered a necessary medical treatment, and you and your doctor will have to work together to determine the next steps for getting it treated.
What to Expect After Your Telederm Appointment
After your virtual appointment, your doctor may request a follow-up to see how you’re doing. Depending on the situation, they may have you snap a few photos and send them via email. In any case, it’s always a smart idea to do a virtual check-in to talk about how the treatment is going. And, while virtual visits feel temporary right now, this realistically could become our new norm.
“In New York City, there’s already been a movement to rely on teledermatology,” says Julie Karen, MD, New York City-based, board-certified dermatologist and spokesperson for The Skin Cancer Foundation℠. “I believe that during the initial phases of re-opening, teledermatology will play a very important role to spread out the schedule for less urgent cases.” It’s easy to see there may be a silver lining to having a virtual visit in the privacy of your own home — with zero commute and no wait time, you’ve got more time to spend on self-care.
Discover more advice from dermatologists:
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- Sunscreen 101: Why You Need It, How Often to Reapply It & More Tips From MDs
Dr. Ava Shamban is a paid Allergan® consultant.