Teledermatology is Useful and Effective for Treating CSU Patients

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Telehealth can be a viable alternative to standard dermatological practice in patients with chronic spontaneous urticaria (CSU), according to a recent trial.¹ High acceptance and satisfaction rates as well as minimal technological issues demonstrate that digital treatment can be beneficial for both physicians and patients.

The prospective, observational study was held in Germany at the Department of Dermatology and Allergology, Klinikumrechts der Isar, Technical University of Munich from March 2022 to December 2023. The trial included 24 patients (62.5% female, 37.5% male) within a wide age range between 18 and 55 years.

Each had a controlled Urticaria Control Test (UCT) score greater than or equal to 12. Nearly half of participants had CSU for over 2 years and had visited more than one practice for diagnosis and treatment. Additionally, participants had undergone several types of medication-based treatments, such as biologics and simple (1 time daily) or multiple (2 to 4 times daily) antihistamine use. Antihistamines were taken regularly in 41.7% of patients and over 60% were treated with biologics or other modern therapies.

The video consultation platform, “medflex”, allowed the secure transmission of calls, messages, photos, and documents between patients and clinicians. Scheduled interactions occurred every 3 months with additional appointments as needed. Only 20.8% of patients had previous experience with digital health video consultations.

Symptoms, quality of life (DLQI), and happiness scores were tracked using electronic patient-reported outcomes and online questionnaires, which were given after each individual visit and at the conclusion of the study. Physicians were given surveys about their own clinical experiences, including overall satisfaction platform user-friendliness, and any technical challenges.

The majority of participants (92%) believed telehealth could be an alternative to face-to-face consultations and felt a strong sense of trust and confidence with the digital platform. Surveys revealed that the digital platform saved time and allowed participants to be more flexible in their lives. In terms of complete reliance, 79% were able to avoid in-person visits to their physician.

Disease control remained stable as UCT scores decreased from a mean of 13.67 at month 1 to 12.58 at month 12 (p = 0.35). Quality of life also greatly improved; DLQI scores averaged 7.25 during the first month and decreased to 3.54 at the 12th month. These scores were correlated using the Wilcoxon Signed-Rank Test.

Moreover, the 4 dermatologists who participated believed the platform reduced consultation time and remained reliable with high-quality images and ease of use. Two of the physicians had prior experience with telemedicine. There were minimal to no technical problems regarding sound, video, messaging, and data transfer for both patients and clinicians.

The researchers did note some study limitations such as the small sample size monocentric design, and lack of a control group. Further research with larger, more diverse groups is necessary to optimize a digital care structure and understand the long-term impact on patients of CSU.

Current CSU treatments can be unsatisfactory due to the intensity and quickness of flare-ups.² Additionally, the condition, which primarily affects patients between 40 and 59 years of age, does not need extensive laboratory interventions during routine treatment.³ Because of this, digital health care could be a promising and accessible solution for CSU patients.

“Incorporating Store-and-Forward technologies and real-time online interactions like chat-based consultations and video conferencing offers significant potential to enhance early and ongoing patient engagement,” the authors wrote.“These digital interventions facilitate seamless communication and efficient appointment scheduling and will prove useful in case of an emerging need for infection control measures.”

References

1. Hindelang M, Sitaru S, Fischer C, Biedermann T, Zink A. Bridging the gap through telemedicine: Pilot study on the acceptance and use of teledermatology for urticaria. J Dtsch Dermatol Ges. Published online October 20, 2024. doi:10.1111/ddg.15557

2. Antia C, Baquerizo K, Korman A, Alikhan A, Bernstein JA. Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes. J Am Acad Dermatol. 2018;79(4):617-633. doi:10.1016/j.jaad.2018.01.023

3. Wertenteil S, Strunk A, Garg A. Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis. J Am Acad Dermatol. 2019;81(1):152-156. doi:10.1016/j.jaad.2019.02.064