Clinical Management & Treatment Protocols for Telehealth Dermatology

Algorithm-Driven Topical Corticosteroid Selection vs. Clinical Judgment

Clinical Decision Support Systems

The integration of artificial intelligence in clinical decision-making represents a paradigm shift in how healthcare providers approach treatment selection. OpenTelemed's algorithm analyzes patient-uploaded photographs using computer vision to assess erythema, scaling, and inflammation severity, then suggests appropriate corticosteroid potency classifications.

However, clinical expertise remains paramount. Registered nurses bring contextual understanding of patient history, previous treatment responses, and individual risk factors that algorithms cannot fully comprehend. The optimal approach combines algorithmic efficiency with clinical wisdom, creating a collaborative human-AI partnership.

Research demonstrates that when AI suggestions are overridden by experienced clinicians based on patient-specific factors, outcomes often improve significantly, particularly in terms of treatment adherence and adverse event reduction.

1. Photo Analysis — AI algorithm processes uploaded images and assigns severity score based on visual markers including erythema intensity, lesion distribution, and scaling patterns.
2. Clinical Override Assessment — Registered nurse reviews AI recommendation against patient history, previous reactions, and contextual factors not visible in photographs.
3. Personalized Treatment Selection — Final treatment decision incorporates both algorithmic analysis and clinical judgment to optimize efficacy while minimizing adverse effects.

Remote Patch Testing Protocols for Contact Allergen Identification

Home-based patch testing represents a significant advancement in identifying contact allergens that exacerbate chronic eczema. This innovative approach enables patients to conduct standardized allergen exposure tests in their own environment while maintaining clinical oversight through digital platforms.

The protocol involves shipping pre-loaded allergen patches to patients with comprehensive instructions and scheduled check-in protocols. Patients apply patches according to standardized procedures, then photograph reaction sites at predetermined intervals for professional interpretation by telehealth nurses.

Critical success factors include patient education on proper application technique, standardized photography protocols to ensure consistent image quality, and clear guidelines for emergency situations requiring immediate patch removal. The remote model significantly reduces patient travel burden while maintaining clinical accuracy comparable to in-office testing.

1. Day 0: Kit Delivery — Patient receives patch test kit with detailed instructions, allergen patches, and emergency contact information.
2. Day 0: Application — Patient applies patches under video guidance from telehealth nurse, ensuring proper placement and adhesion.
3. Day 2: Initial Reading — First photo documentation of reaction sites with structured assessment questionnaire completion.
4. Day 4: Final Reading — Comprehensive photo documentation and clinical interpretation by certified dermatology nurse.

Virtual Guided Wet Wrap Therapy Implementation

Wet wrap therapy represents one of the most effective interventions for severe eczema flares, yet its complexity often leads to improper application and reduced efficacy. Virtual guidance through real-time video consultation enables patients to master this technique under direct professional supervision.

The protocol requires careful preparation including appropriate bandage materials, topical medications, and step-by-step instruction materials. Telehealth nurses guide patients through each phase: medication application, wet layer placement, dry layer application, and securing techniques. Real-time feedback ensures optimal execution and immediate correction of technique errors.

Success metrics include patient confidence scores, technique accuracy assessments, and clinical improvement measures. Studies demonstrate that virtual guidance achieves comparable outcomes to in-person instruction while providing greater convenience and reducing healthcare system burden.

• Pre-Session Preparation — Materials checklist verification, medication preparation, and comfortable positioning for video consultation.
• Live Instruction Phase — Step-by-step guidance through topical application, wet layer placement, and proper wrapping technique.
• Technique Validation — Real-time assessment of wrap tightness, coverage areas, and patient comfort with immediate corrections.
• Follow-up Protocol — 24-hour check-in for comfort assessment and removal guidance with outcome documentation.

Telehealth-Enabled Antimicrobial Stewardship

Distinguishing between eczematous inflammation and secondary bacterial infection through remote assessment requires sophisticated clinical skills and high-quality imaging technology. The ability to accurately identify impetiginization versus viral complications directly impacts antibiotic prescribing patterns and patient outcomes.

Telehealth nurses utilize multiple assessment modalities including high-resolution photography, detailed symptom questionnaires, and structured clinical interviews to differentiate infection types. Key diagnostic indicators include exudate characteristics, lesion distribution patterns, and associated systemic symptoms. This comprehensive approach enables appropriate antimicrobial selection while avoiding unnecessary broad-spectrum antibiotic use.

The integration of decision-support algorithms assists nurses in identifying subtle visual cues that may indicate specific pathogens. However, clinical judgment remains essential for interpreting findings within the broader patient context, including immunocompromise status, previous infection history, and local antimicrobial resistance patterns.

Biologics Management Through Comprehensive Telehealth Programs

Remote Monitoring Framework

The integration of biologic therapies into telehealth platforms requires sophisticated monitoring protocols to track efficacy, adverse events, and treatment adherence. Dupilumab management exemplifies the complexity of remote biologic oversight, requiring systematic assessment of injection site reactions, efficacy measures, and potential complications.

Patient-Oriented Eczema Measure (POEM) scores provide standardized outcome tracking, while conjunctivitis monitoring protocols enable early detection of ocular complications. Digital dashboards consolidate multiple data streams to provide comprehensive patient status overviews for clinical decision-making.

Success in biologic management requires proactive monitoring systems that identify complications before they become severe. Early intervention protocols for conjunctivitis, injection site reactions, and treatment efficacy assessment ensure optimal patient outcomes while maintaining treatment continuity.

Outcomes & Metrics

This section consolidates key quantitative outcomes referenced throughout the document for quick review and decision support.