Dermatology: Practical and Conceptual Letter to Editor | Dermatol Pract Concept. 2023;13(4):e2023238 1 Step for the Further Introduction of Teledermatology to Daily Practice in Rural and Underserved Areas Kazuhiko Kotani1 1 Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Japan Citation: Kotani K. Step for the Further Introduction of Teledermatology to Daily Practice in Rural and Underserved Areas. Dermatol Pract Concept. 2023;13(4):e2023238. DOI: https://doi.org/10.5826/dpc.1304a238 Accepted: April 10, 2023; Published: July 2023 Copyright: ©2023 Kotani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Kazuhiko Kotani, MD, PhD, Division of Community and Family Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi 329-0498, Japan. Tel: +81-285-58-7394, fax: +81-285-44-0628 E-mail: kazukotani@jichi.ac.jp Dear Editor, We read with great interest the Duniphin study showing that the insurance and income level, as well as rural residence, are related to barriers to the introduction of teledermatol- ogy into the underserved populations [1]. As barrier-focused surveys on teledermatology specifically for rural and under- served areas have rarely been conducted, the study is valu- able for forming a public strategy [1]. As a rural researcher, I would like to add some comments while considering the recent situation of rural and underserved healthcare. Skin problems are one of the most common diseases en- countered in daily practice in rural and underserved areas [2]. The numbers of dermatologists who willingly conduct ru- ral practice are unlikely to increase although programs have been attempting to rectify the geological maldistribution of dermatologists (ie, shortage of dermatologists in rural and underserved areas in comparison to urban areas) [3]. The provision of dermatology training to primary care pro- viders also remains insufficient [2], and the consistency of the diagnosis and treatment of skin diseases between der- matologists and primary care providers working in rural and underserved areas is reported to be relatively low [4]. Accordingly, these regularly require timely access to and quality care by dermatologists. In the time of COVID-19 pandemic, telemedicine has developed to bridge the healthcare disparity over distances, and it is now accepted in rural and underserved areas [5]. Teledermatology is being increasingly used in clinical set- tings with real-time and high-quality views [5]. Advances would allow dermatologists (even those working in urban areas) more chances to practice in rural and underserved areas. The educational effect of teledermatology is also im- plied for primary care providers [4]. Thus, teledermatology not only benefits patients in practice but also offers learning opportunities to primary care providers. There are currently sub-specialized dermatologists and medical staff in the dermatological field, such as pediatric der- matologists, dermatopathologists and skin psychologists [2]. Although it is difficult to meet sub-specialized experts in a 2 Letter to Editor | Dermatol Pract Concept. 2023;13(4):e2023238 single practice in rural and underserved areas, teledermatol- ogy may make such team-based approaches possible. Even though teledermatology does not solve all clinical problems, public policy with financial support may be needed as the next step as suggested by the Duniphin study [1]. More recently, the use of telemedicine has been positioned in government medical plans for rural healthcare in Japan, which are accompanied by financial support. Various public actions are called for the further introduction of telederma- tology into daily practice in rural and underserved areas. References 1. Duniphin DD. Limited access to dermatology specialty care: Barriers and teledermatology. Dermatol Pract Concept. 2023; 13(1):e2023031. DOI: 10.5826/dpc.1301a31. PMID: 36892370. PMCID: PMC9946088. 2. Lewis H, Becevic M, Myers D, et al. Dermatology ECHO - an innovative solution to address limited access to dermatology ex- pertise. Rural Remote Health. 2018;18(1):4415. DOI: 10.22605 /RRH4415. PMID: 29409325. 3. Li A, Toy J, Purdy K, Kirshen C, Liu C. Rural educational op- portunities in dermatology residency programs: The solution to geographic maldistribution and shortage of dermatologists in Canada? J Cutan Med Surg. 2023;27(2):174-175. DOI: 10.1177 /12034754221149653. PMID: 36653960. 4. Becevic M, Ge B, Braudis K, et al. Diagnostic and treatment concordance in primary care participants and dermatologists utilizing Extension for Community Health Outcomes (ECHO). J Telemed Telecare. 2023;:1357633X221147074. DOI: 10.1177 /1357633X221147074. PMID: 36654477. 5. Ahuja S, Briggs SM, Collier SM. Teledermatology in rural, underserved, and isolated environments: A review. Curr Der- matol Rep. 2022;11(4):328-335. DOI: 10.1007/s13671-022- 00377-2. PMID: 36310767. PMCID: PMC9589860.