WhatsApp messenger as a teledermatology tool during coronavirus disease (COVID‐19): from bedside to phone‐side

The current coronavirus disease (COVID‐19) has forced the shutdown of many nonessential services in most high‐risk countries. Most Dermatology consultations (except emergencies) have been deferred as a precautionary measure to prevent the spread of COVID‐19, but patients continue to arrive at clinics and hospitals. While clinicians want to help, the current COVID‐19 pandemic demands that they be extra vigilant and exercise caution in choosing which patients to see. A solution may be offered in the form of teledermatology using everyday tools/devices.

Telemedicine is defined as the use of electronic information and communication technologies to provide healthcare support when distance separates patients from healthcare professionals with expertise in the field.¹, ² Vital information can be shared between the two groups in the form of text, audio, still images and video.³, ⁴ It is true that we were not prepared for this pandemic, and many healthcare setups are still not well equipped for telemedicine. Few clinicians have a thorough knowledge of telemedicine/teledermatology and fewer patients are aware that this exists in medicine. The current situation of teledermatology is even worse in developing countries. However, the use of mobile technology is rapidly expanding within the field of telemedicine.⁵ Audiovisual communication, aided by smartphone applications, is a novel concept in teledermatology.

WhatsApp is currently one of the most popular applications worldwide,⁵ and allows its users to communicate via text/voice messages, photos and videos.³, ⁴ The need for only a mobile Internet connection, with no extra cost for sharing unlimited information, makes it a useful platform for social interaction.³ Although sparse, there is literature exploring WhatsApp as a potential telecommunication tool in medicine.

Dermatology is one of the few fields of medicine where visual inspection is paramount for making a diagnosis. The ease of use, portability, speed, cost‐effectiveness and simplicity makes WhatsApp a good adjunctive teledemedicine tool.⁶ Familiarity with the application is the biggest advantage and fosters patient confidence. The options to send pictures and to interact via text/voice messages or video calls can offer sufficient material for management of a dermatosis, provided a diagnosis can be made. This method of communication is especially beneficial for those with an established diagnosis who need follow‐up. The utility of this application in sharing investigation reports and previous treatment charts is another added advantage. Generally, teledermatology can be delivered as real‐time video consultation (RT‐TD) or as an asynchronous store‐and‐forward (SAF) service.⁷ WhatsApp can deliver both RT‐TD (through video and/or audio chat) and SAF (patient can send the picture and/or text, and the dermatologist can reply at a convenient time).

Limitations such as poor‐quality pictures, medicolegal responsibility, privacy and ethical issues (as with any other mode of teledermatology) remain.³, ⁷ Consultation fees and mode of payment are other unclear areas. More importantly, further research is warranted in this field to define the role of such apps in dermatology.

In these times of COVID‐19 and the need for social distancing, not many dermatologists are familiar with teledermatology, and WhatsApp can serve as an interface between patients and dermatologists. What other option do we have? We should have been better prepared. Perhaps this presents an opportunity to invest in learning and implementing teledermatology in clinical practice so we can face any future challenges.