Prior to the Covid-19 pandemic, most dermatologists had very limited experience of consulting with patients remotely, and this required a rapid shift in the way that we work. This has not been without challenges, however it has become clear to me that remote consultations 'teledermatology' can work remarkably well for certain conditions and I am sure that this will lead to long term changes in the way that I practice.

Key advantages for patients include convenience - I can usually see patients within a couple of days and aften the same day. Medications are usually delivered to your home the next day. The major challenge is a lack of face-to-face interaction, although this can be mitigated by video consultation.

Which conditions are suitable for remote consultation?

As I have gained more experience of remote consultations it has become clear to me that certain conditions are amenable to remote consultation and others are less suited.

Conditions for which remote consultation can work well:

• Acne
• Rosacea
• Melasma and other causes of dark marks (hyperpigmentation) on the skin
• Vitiligo
• Eczema
• Male pattern hair loss
• Excessive sweating (hyperhidrosis)
• Fungal nail disease

Conditions for which remote consultation is not advised:

• Suspected skin cancer can rarely be adequately evaluated without dermoscopy (skin surface microscopy) and for this reason I do not advise assessing suspected skin cancer and concerning moles by remote consultation. .
• Widespread or severe skin disease or blistering skin disease.
• Conditions affecting the mouth and genitals - it is difficult to capture these accurately with photography and therefore difficult to assess remotely.
• More complex causes of hair loss - where the cause of hair loss is not clear it is important to perform a full scalp examination with trichoscopy (microscopic examination of the hair follicles) and this cannot be performed remotely.

Some important points to note

• High quality (in focus, good lighting) photographs are essential for an accurate diagnosis. This is the case even for video consultation since the quality of video is rarely sufficient for accurate diagnosis.
• In some cases additional tests such as skin swabs, scrapings or nail clippings are required to make a diagnosis. If you live far from London this can be more difficult to arrange although it may be possible at your GP.
• Occasionally a skin biopsy is needed to help with diagnosis - for example if there is uncertainty as to the cause of a rash or if you have hair loss where the cause is not clear. If you live a long distance from London this may be difficult to arrange.
• Some treatments such as phototherapy (which is commonly used to treat psoriasis, eczema and vitiligo) require repeated visits to the hospital. This is available in Harley Street, however if you live far from London I can refer you to a local hospital or clinic of your choice.
• Certain powerful tablet medications - whilst generally very safe - do have the potential for side effects. In addition to a remote consultation I would need to briefly assess you in person prior to starting treatment, however I would not charge extra for this and follow up appointments can be arranged remotely.

Before your consultation

1. Contact my practice management team to arrange a time for your consultation and to decide whether you would like a video consultation or phone call. I use Zoom for video consultation and my secretary will schedule a time with you and ensure that you have a link for the consultation.
2. Take clear photographs showing your condition (in focus, good lighting, showing all affected areas) and send to my secretary ahead of your consultation.
3. Write down any questions that you wish to discuss with me. Make sure that you have a list of any current medications.

During your consultation

1. Don't worry if there is a technical problem with video conferencing or we get cut off - I will call you on the phone number that you have provided and we will have the photographs available that you sent through prior to the consultation.
2. Ask me if there is anything that is not clear.
3. Discuss any questions that you have with me.
4. Don't worry about making notes as I will send you a detailed letter summarizing our conversation.

After your consultation

1. I will send you a letter summarizing the consultation, my opinion and the management plan.
2. I will arrange for any medication that is required to your home usually the next day.
3. My secretary will contact you or your insurance company to arrange payment.
4. Do not hestitate to contact my secretary if there is anything that was unclear during the consultation or if you have additional questions.

My all-inclusive fee for a virtual consultation is £160. You will also be charged for the cost of any medication. Almost all of the medical insurance companies are funding virtual consultations at least for the duration of the Covid-19 pandemic, although you should check in advance. If you are not sure whether your condition is suitable for virtual consultation please do not hesitate to contact my secretary to discuss further.