Without exception, dermatologists love to guide our patients toward clear skin. As the experts on acne, we know the long-lasting physical and psychological effects that acne and its resultant scars can have on our patients. Countless times we have seen the total transformation in confidence and well-being that a young patient with deep acne has gained when they return to the office for their isotretinoin follow-up with glowing, radiant skin. For many of us, this life-changing impact of our profession is why we love what we do. Thus, when the pandemic hit, we struggled with the specter of not being able to see, and therefore help, our most vulnerable patients.
Patients taking isotretinoin are amongst the most vulnerable. These patients are mandated to meet monthly with their dermatologist, though many of them are unwilling (and justifiably so) to risk a doctor’s visit during the height of the pandemic. Almost immediately dermatologists have risen up to meet the challenge of the day. Many of us quickly began offering telemedicine to our patients in lieu of office visits. The regulations that sometimes stood between us and our patients (for example, those restricting at-home pregnancy tests and those creating telemedicine reimbursement issues) have relaxed. Even our venerated dermatology mentors who have been seeing patients face-to-face for decades have shed the comforts of this routine to meet our patients virtually in their time of need.
Telemedicine is not a panacea. Many types of patient visits are inappropriate for telemedicine (like skin checks that require dermatoscopic lesion evaluation or biopsies), and perhaps this forced foray into telemedicine was required for us to make this collective realization. However, some visit types, such as acne, may be just as well suited via telemedicine. In fact, telemedicine may be able to offer things that in-office visits cannot (even in the absence of a pandemic). For example, consider the patient with acne that needs isotretinoin but whose work schedule does not permit monthly visits. Think of the college student who frequently moves and does not want to keep switching dermatologists. Often out of desperation these patients end up online being treated by a non-dermatologist or non-physician via a service that takes a one-size-fits-all cookbook approach to acne. These patients are done a disservice, because not only are they being treated by a non-expert (and all the risks involved with such), but they are being offered a narrowed spectrum of acne treatment. For patients with the most severe acne, their options should include isotretinoin.
The solution, of course, is not for non-dermatologists to begin offering online isotretinoin alongside their erectile dysfunction pills. Instead, the solution is to place the board-certified dermatologist at the heart of the patient’s online acne experience. Too often, startups and technology companies try to “scale” medicine by cutting corners on the expertise behind the medical decision making. We started AcneAlly to take the opposite approach: to offer the full spectrum of acne treatment, including isotretinoin, to patients under the care of the board-certified dermatologist. In doing so, we hope to maximize access to the life-changing potential that dermatologists can unlock, while offering the pinnacle of safety and expertise offered by credentialed experts.
The COVID-19 pandemic has forced us all to find new ways to reach our most vulnerable patients. In doing so, dermatologists have discovered tools , including new methods and apps for telemedicine, that help us reach people who otherwise would never have been able to see us. These patients may have an uncompromising work schedule, move frequently for school, or simply live too far away from a dermatologist. Dermatologists should make themselves available to these patients so that they do not suffer needlessly without treatment or with dubious treatment from a nonprofessional. n
Dr Riyaz is a Mohs surgeon and dermatologist with Integrated Dermatology in the Washington, DC, metro area. Dr Porto is a Mohs surgeon, dermatologist, and founder of SkinCare.MD in
Boston, MA.
Disclosure: Drs Riyaz and Porto are the founders of AcneAlly.com.
