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Teledermatology Practice in a Department that Was Relocated Multiple Times during the COVID-19 Pandemic

Authors Tatu AL 

Received 15 December 2023

Accepted for publication 11 February 2024

Published 14 February 2024 Volume 2024:17 Pages 447—449


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jeffrey Weinberg

Alin Laurentiu Tatu1– 3

1Dermatology Department, “Sfânta Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania; 2Clinical Medical Department, Faculty of Medicine and Pharmacy, „Dunărea de Jos” University, Galati, Romania; 3Multidisciplinary Integrated Center of Dermatological Interface Research Center (MIC-DIR), “Dunărea de Jos” University, Galati, Romania

Correspondence: Alin Laurentiu Tatu, Tel +40 728267435, Email [email protected]

Abstract: The COVID pandemic inherently impacts clinical activity in Dermatological practices throughout all sectors. Under these circumstances, our service has implemented teledermatology in order to act both as a filter for reducing in-hospital admittance or face-to-face interactions, and as a straightforward solution to solve the issues faced by patients and family doctors within our area. Live consultations rely on the resident physician’s capacity to take a detailed patient history in the limited time allotted, while the subsequent case-discussion with the leading-physician has good didactic value. The establishment of a quality international collaboration through teledermatology would further facilitate a more accurate and faster diagnosis, even for patients traveling for business or tourism.

Keywords: teledermatology, resident training, research tool, dermatology, COVID-19, residency training

In Romania, an emergency state has been declared, with a series of military ordinances being published during the previous months in order to clear hospital beds by only admitting urgent cases and limiting resident physicians’ exposure to the circulating virus by implementing shift work with reduction in the total number of in-clinic hours. All the while, it remained possible that resident physicians could be called in to fulfill other necessary activities outside of our current module in order to help combat COVID infection.1,2 This inherently impacts the clinical activity in Dermatological practices throughout all sectors. Our department, a subunit of the Clinical Infectious Disease hospital “Sfânta Cuvioasa Parascheva” in Galati, was moved to another hospital in order to facilitate the availability of beds for COVID patients. Initially, the hospital in question was the Railroad Hospital, but after this was also charged with providing intensive care for COVID patients, our department was once again relocated to another hospital, the Psychiatry Hospital, in a common ward with our colleagues from the infectious disease hospital who were treating non-COVID cases. Under these circumstances, our service took the decision of implementing teledermatology in order to act both as a filter for reducing in-hospital admittance or face-to-face interactions, and as a straightforward solution to solve the issues faced by patients and family doctors within our area. This was put into practice by using dedicated emails and Skype services, and we are currently instituting Zoom as an alternative method of communication to try and maximize patient access by diversifying the means through which we can be contacted. This embodies opportunities for resident physicians to consult and treat multiple clinical cases from a distance, without having the constraint of seeing only the typical hospital admittances. Live consultations rely on the resident physician’s capacity to take a detailed patient history in the limited time allotted, while the subsequent case-discussion with the leading-physician has good didactic value. Positive feedback was received from the resident physicians, and by using this method, we were also able to meet with the residency program requirements. During the first 7 days, when our service was still rather unknown to the public, we registered 107 teleconsultations. In this timeframe, the legislation was changed in order to allow consultations to be given both to the insured and uninsured. We believe teledermatology is an important method, both for strengthening the collaboration with physicians outside of the dermatology area, and for accommodating efficient monitoring of the patients’ evolution and treatment effectiveness. From our department’s experience, the first 26 cases that have been consulted through teledermatology have had good treatment response, confirmed by patient feedback through emails. Two of these cases had difficulties accessing their family doctor, and they would certainly have been unable to access further specialist care (one patient was from the rural area, and the other has nosocomephobia). The advantage of this technique stems from the fact that most patients possess camera cell phones with internet access, facilitating access to the teledermatology platform. There is also a potential for dermoscopy device use, such as Dermlite HUD (3Gen Dermlite), in order to monitor skin lesions without having the patient leave his/her home. Concerns have been raised over the limited patient interaction through the use of images and that their quality is highly variable. By correctly educating and informing the population one can ensure the efficient use of teledermatology. Resident physician training can indeed benefit from the use of teledermatology – its use may indeed gain a more permanent place in the day-to-day medical practice of the future. With the current legislation giving resident physicians the opportunity to manage cases under the guidance of attending physicians, it would be prudent to have university hospitals create protocols that make use of resident physicians in order to further resident training and also work out problems which may be encountered during this time of decreased in-person patient-physician interaction.3

The COVID pandemic, as an epidemiological security problem, gave us through teledermatology the opportunity to communicate and convey information and images in order to exchange details and deepen research both in the field of Dermatology and other medical specialties; these collaborations materialized in the form of 14 publications in the international flow, our team including national and international researchers, both dermatologists and other specialities - infectious diseases, internal medicine, cardiology, psychiatry, gastroenterology, rheumatology, surgery, radiology.4–17 The addressed issues were related to COVID-19 and skin manifestations, sexual transmission, prevention, inflammation, interleukin IL-6, vesicular lesions and the Koebner phenomena, Demodex and SARS-CoV-2, psychiatric symptoms, psoriasis-vaccine induced flares.4–17 This prolific collaboration was the basis of research continuity and multidisciplinary collaboration even after the pandemic state ended, strengthening the integration teledermatology use as a clinical, imaging and research tool.18–21

The limitations of teledermatology consisted in technological ones: connectivity problems for elderly people and concerns related to data protection or privacy.22

Our patients with inflammatory skin conditions like acne, atopic dermatitis, psoriasis, and hidradenitis suppurativa benefitted consistently from the teledermatology services provided.22

As dermatology services were considered to be vectors for COVID-19 transmission and up to even 20% of COVID-19 cases were associated with skin diseases,23,24 the teledermatology service set up by our department provided a safe virtual consultancy space for patients of all ages. The relatively high patient teledermatology services addressability provided a large number of patients for the resident physicians to care for and allowed the latter the continuation of their residency programme; these services also provided patients with continuous medical care and allowed a multidisciplinary physician collaboration with important international results.

The establishment of good international collaboration through teledermatology would further facilitate a better and a faster diagnosis, even for patients traveling for business or tourism.

In the future, teledermatology should be considered as a day-by-day procedure for stand-alone use or with the help of artificial intelligence, being resourceful tools for our patients and speciality.


The current paper was academically supported by the “Dunarea de Jos” University of Galati, Romania, through the Multidisciplinary Integrated Center of Dermatological Interface Research (MIC-DIR) [Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica (CIM-CID)].


This article has no funding source.


The author reports no conflicts of interest in this work.


1. ORDINANCE OF THE ACTION COMMANDER Secretary, Chief of the Department for Urgent Situations nr. 74527 from 23.03.2020 regarding measures necessary for limiting the spread of the infection with the SARS-CoV-2 virus in public and private health units. Available from: Accessed February 12, 2024.

2. ORDER nr. 570 from 6th of April 2020 regarding the modification of Ordinance of the Health Ministry nr.436/2020 for the approval of the specific Protocol regarding management in case of exitus of patients infected with the new coronavirus (SARS-CoV2). Available from: Accessed February 12, 2024.

3. Oldenburg R, Marsch A. Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic. J Am Acad Dermatol. 2020;82(6):e229. doi:10.1016/j.jaad.2020.03.097

4. Tatu AL, Nadasdy T, Nwabudike LC. Observations about sexual and other routes of SARS-CoV-2 (COVID-19) transmission and its prevention. Clin Exp Dermatol. 2020;45(6):761–762. doi:10.1111/ced.14274

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6. Tatu AL, Nadasdy T, Bujoreanu FC. Familial clustering of COVID-19 skin manifestations. Dermatol Ther. 2020;33(6):e14181. doi:10.1111/dth.14181

7. Tatu AL, Nadasdy T, Nwabudike LC. New data about sexually transmitted COVID-19. Dermatol Ther. 2020;33(6):e14426. doi:10.1111/dth.14426

8. Tatu AL, Nadasdy T, Bujoreanu FC. Inflammation and vascular injury as the basis of COVID-19 skin changes: preliminary analysis of 23 patients from the literature [Letter]. Clin Cosmet Invest Dermatol. 2021;14:185–186. doi:10.2147/CCID.S305847

9. Niculet E, Chioncel V, Elisei AM, et al. Multifactorial expression of IL-6 with update on COVID-19 and the therapeutic strategies of its blockade (Review). Exp Ther Med. 2021;21(3):263. doi:10.3892/etm.2021.9693

10. Tatu AL, Baroiu L, Fotea S, et al. A working hypothesis on vesicular lesions related to covid-19 infection, koebner phenomena type V, and a short review of related data. Clin Cosmet Invest Dermatol. 2021;14:419–423. doi:10.2147/CCID.S307846

11. Tatu AL, Nadasdy T, Nwabudike LC. Chitin-lipid interactions and the potential relationship between Demodex and SARS-CoV-2. Dermatol Ther. 2021;34(3):e14935. doi:10.1111/dth.14935

12. Baroiu L, Lese AC, Stefanopol IA, et al. The role of D-Dimers in the initial evaluation of COVID-19. Ther Clin Risk Manag. 2022;18:323–335. doi:10.2147/TCRM.S357214

13. Tatu AL, Nadasdy T, Nwabudike LC. Koebner phenomenon with lichen planus in an area of previous vitiligo after COVID-19 vaccination and the creation of a locus minoris resistentiae. J Eur Acad Dermatol Venereol. 2022;36(4):e265–e266. doi:10.1111/jdv.17864

14. Baroiu L, Lese AC, Stefanopol IA, et al. The role of D-Dimers in the Initial Evaluation of COVID-19 [Response To Letter]. Ther Clin Risk Manag. 2022;18:593–594. doi:10.2147/TCRM.S373236

15. Sârbu F, Oprea VD, Tatu AL, et al. COVID-19-related psychiatric manifestations requiring hospitalization: analysis in older vs. younger patients. Exp Ther Med. 2022;24(2):497. doi:10.3892/etm.2022.11424

16. Vasile CI, Vasile MC, Zlati ML, et al. Post COVID-19 infection psychosis: could SARS-CoV-2 virus infection be a neuropsychiatric condition that triggers psychotic disorders? A case-based short review. Infect Drug Resist. 2022;15:4697–4705. doi:10.2147/IDR.S373578

17. Ständer S, Zirpel H, Bujoreanu F, Tatu AL, Ludwig RJ, Thaçi D. Case report: clinical features of COVID-19 vaccine-induced exacerbation of psoriasis-A case series and mini review. Front Med. 2022;9:995150. doi:10.3389/fmed.2022.995150

18. Tatu AL, Nwabudike LC. Reply to: Kubiak et al.Endosymbiosis and its significance in dermatology. J Eur Acad Dermatol Venereol. 2018;32(9):e346–e347 . doi:10.1111/jdv.14921

19. Tatu AL, Clatici VG, Nwabudike LC. Rosacea-like demodicosis (but not primary demodicosis) and papulopustular rosacea may be two phenotypes of the same disease - A microbioma, therapeutic and diagnostic tools perspective. J Eur Acad Dermatol Venereol. 2019;33(1):e46–e47. doi:10.1111/jdv.15166

20. Brănișteanu DE, Pintilie A, Dimitriu A, et al. Clinical, laboratory and therapeutic profile of lichen planus. Rev Med Chir Soc Med Nat. 2017;121(1):25–32.

21. Tatu AL, Ionescu MA, Cristea VC. Demodex folliculorum associated Bacillus pumilus in lesional areas in rosacea. Indian J Dermatol Venereol Leprol. 2017;83(5):610–611. doi:10.4103/ijdvl.IJDVL_921_16

22. Martora F, Fabbrocini G, Megna M, et al. Teledermatology for common inflammatory skin conditions: the medicine of the future? Life. 2023;13(4):1037. doi:10.3390/life13041037

23. Temiz SA, Dursun R, Daye M, Ataseven A. Evaluation of dermatology consultations in the era of COVID-19. Dermatol Ther. 2020;33(5):e13642. PMID: 32441360; PMCID: PMC7267098. doi:10.1111/dth.13642

24. Daye M, Temiz SA, Işık B, Dursun R, Ataseven A. Evaluation of the effect of COVID-19 pandemic on dermatological diseases with dermatological quality life index. Dermatol Ther. 2020;33(6):e14368. PMID: 33021333; PMCID: PMC7646022. doi:10.1111/dth.14368

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