How teledermatology works

The models at a glance

Store-and-forward

Also called asynchronous care: you send information, and a clinician reviews it when they can. The AAD lists sending pictures and written descriptions through a secure portal as one of the main forms of teledermatology.^[1]

1. Create an account and say where you are. Your location decides which clinicians can treat you.
2. Answer the intake questions. Expect questions on how long you've had the problem, how it has changed, symptoms like itch or pain, what you've tried, other conditions, medications, allergies, and pregnancy where relevant.
3. Upload photos. Usually a close-up and a wider shot of each area. Some services ask for a minimum number; First Derm asks for two.^[5] The AAD recommends a camera of at least 800×600 pixels, which any recent phone exceeds.^[2]
4. A clinician reviews the case. Services state their own turnaround: DermatologistOnCall says typically within 24 hours, Teladoc 24 hours or less, First Derm within 48 hours.^[3,4,5]
5. You get a diagnosis and plan. Often with a prescription sent to your pharmacy, or a request for more photos if the first ones weren't clear.
6. Follow-up through messages. The window varies: DermatologistOnCall includes 30 days, Teladoc allows questions for up to 7 days.^[3,4]

Some states treat store-and-forward differently from video for licensing and payment; the Center for Connected Health Policy tracks which states reimburse it.^[9]

Live video

A real-time visit, the closest thing to sitting in the exam room. Many dermatology practices offer it; the AAD's Find a Dermatologist search lets you filter for teledermatology.^[1,10]

1. Book a time through the practice or service, and complete intake forms beforehand.
2. Send photos ahead if asked. Video compresses images; a still photo often shows more detail.
3. Join from a quiet, well-lit room. The AAD's standards set minimums for camera resolution and connection speed on both ends.^[2]
4. Talk it through. The clinician asks questions and may ask you to move the camera closer, press on the skin or show other areas.
5. Leave with a plan. Diagnosis, prescriptions and, if needed, an in-person appointment for a biopsy or procedure.

Video matters most for a first visit: the AAD recommends dermatologists establish a relationship before offering direct-to-patient care, and use live-interactive communication to do it when an in-person visit isn't possible.^[2]

AI-assisted with clinician review

A newer model in which software does the first pass. It is still asynchronous; the difference is what happens before the clinician sees your case.

1. Scan and answer. You take photos in an app or browser, often guided on angle and lighting, and answer questions.
2. The software makes an initial assessment. It looks for patterns in the images and answers, and can track change over time.
3. A licensed clinician reviews. In a service built responsibly, no diagnosis or prescription goes out without a licensed clinician approving it.
4. Treatment starts and is tracked. New photos each month show how your skin is responding, and the plan is adjusted.

AI has real limits, including weaker performance on darker skin tones in at least one independent test.^[11] See AI in teledermatology for what to ask.

eConsults for clinics

For clinicians and clinic staff: in an eConsult, a primary care clinician sends a dermatologist photos and a question, and gets advice back without the patient needing a separate visit. The AAD supports physician-to-physician consultative telemedicine and its reimbursement, as a way to widen access to specialist advice.^[2]

1. Capture standardized photos (overview, mid-range, close-up) and a structured history.
2. Submit through the health system's referral or eConsult platform.
3. Receive a recommendation: manage in primary care, start treatment, or refer, and how urgently.

Prescriptions

The AAD recommends that platforms collect an adequate history and examination before allowing a prescription.^[2] In practice, prescriptions reach you in one of two ways:

• Sent to your pharmacy, where you pay for the medicine (and insurance may cover it).
• Shipped by the service, often a custom compounded cream, priced into a subscription.

Not every service prescribes. First Derm, for example, says its answer is professional guidance, not a formal diagnosis or a prescription.^[5]

Follow-up and in-person care

Most skin treatment takes weeks to judge, so ask how follow-up works before you start: a message window after a single visit, monthly check-ins on a subscription, or booked video follow-ups. The AAD recommends every platform offer a path to in-person care when it is needed or preferred.^[2]

Ready to start? Prepare your visit covers photos, symptoms and reading the plan you get back.

Questions