Most studies on patient satisfaction before the COVID 19 pandemic focused on store-and-forward teledermatology. A systematic review from 2010 to 2020 (pre-pandemic) that included literature from 9 different nations reported 23 studies that covered patient satisfaction in teledermatology. Twenty-one studies focused on the traditional form of teledermatology, the store-and-forward method. Only one study focused on the more modern live-interactive form of teledermatology, and another study compared all three modalities (store-and-forward, live-interactive, and face to face dermatology). Most studies assessed satisfaction using self-developed questionnaires. The definition of patient satisfaction included overall accessibility, efficacy, technical quality, and physical environment, but remained inconsistent across all surveys. Interpersonal manners, finances, and continuity were covered the least. All studies demonstrated overall patient satisfaction with most studies reporting positive scores, but only four studies provided statistical analysis [4••]. Patients who required frequent follow-up appointments, such as patients with acne, psoriasis, topical skin cancer therapy, wound monitoring, and post-procedural care, were often very satisfied with the store-and-forward method. Although, several studies reported that about 10–25% of patients have concerns over sending photos. Some feel uncomfortable or embarrassed to have photos taken, while others stressed concerns over social, religious, and privacy issues regarding images [4••]. Most patients agreed the store-and-forward method saved time and provided flexibility, but the majority of patients still chose in-person visits when given the option. These findings were corroborated in several studies. One study reported 42% of patients preferred to see a dermatologist face to face, and an additional 17% felt something was missing in teledermatology when compared with an in-person visit [4••]. This discrepancy may be related to the unavailability of immediate diagnostic/treatment procedures, and the lack of direct patient-provider interaction in teledermatology. Only one cross-sectional survey reported findings of patient satisfaction as it pertains to the live-interactive modality. Most patients were highly satisfied with the ease of the service, but more than half of the respondents still preferred in-person visits [6]. Perceptions regarding teledermatology prior to appointments were neutral and shifted to positive after the appointment. Lower satisfaction was attributed to technical difficulties and unsatisfactory physical examinations. Most participants were White, non-Hispanic, English-speaking females with access to personal devices [6].

Since 2020, more studies have investigated the patient satisfaction of live-video teledermatology, or the hybrid form, allowing us to compare the impact of different teledermatology modalities on the patient experience. A recent study aimed to characterize patient satisfaction with live-interactive visits during the COVID-19 pandemic across four surveyed domains (visit preparation, provider communication, physical examination, treatment/follow-up) [7]. Visit preparation included travel for in-person visits, uploading photographs, and downloading software for a live-interactive visit. Of the 602 respondents, greater than 70% indicated at least equal satisfaction compared with in-person visits across all domains. More than a quarter of patients were dissatisfied with the virtual physical examination, and 57.9% preferred in-person examinations. Male gender was associated with treatment plan/follow-up satisfaction. When compared to younger patients, patients greater than 66 years of age preferred in-person visit preparation, communication, and treatment plan/follow-up. New patients were less satisfied with teledermatology communication and the treatment plan/follow-up when compared to existing patients, but preferred teledermatology visit preparation. The authors suggested that this discrepancy may be due to the patients’ unfamiliarity with teledermatology. The majority of respondents were between 18 and 45 years of age and 70.8% were White females [7].

A Dermatology Unit in Naples, Italy, reported findings from 252 patients who completed questionnaires regarding patient satisfaction with teledermatology in the form of video call visits, phone-based visits, and email support during the COVID-19 pandemic [8]. A high level of satisfaction using both video- and phone-based teledermatology services was found. Video-based visits were preferred over phone-based visits, albeit the results were not significant. Younger populations were more satisfied with both video- and phone-based visits when compared to older patients who preferred face to face in-clinic visits. Although high satisfaction was found among all surveyed, most patients reported teledermatology to be less satisfactory than face to face visits [8].

Miller and Jones reviewed the literature on patient and provider satisfaction of live-video teledermatology from 2020 to 2022. A total of 15 studies on 7871 patients and 146 providers reported overall satisfaction with quality of care, increased access, and patient-provider relationship. While patients were generally satisfied with technical quality, providers were dissatisfied with video/photo quality. Both providers and patients agreed that the patients’ needs were met via live-video teledermatology. Patients were satisfied with patient-provider relationship, accessibility, visit preparation, and discharge. Six studies reported high patient willingness to use teledermatology, while two studies reported low preference compared with in-person visit. Patients with low satisfaction scores were more likely to have experienced an unsatisfied virtual physical exam and technical difficulty (P < 0.01) [5••].

Overall, studies suggest that patients are satisfied with both the store-and-forward and live-interactive teledermatology services. The recent expansion of live-video teledermatology enables us to further understand the benefits and limitation of different teledermatology modalities in terms of patient satisfaction. Patients are generally satisfied with accessibility, convenience, and quality of care. However, teledermatology has its limitation. Technical difficulties, concern over privacy, lack of procedure availability, and limited physical exams have been shown to impact patient satisfaction. Live-video teledermatology seems to score better on patient-provider relationships. However, there are complaints from providers over the quality of video images. Despite high levels of satisfaction with teledermatology services, many patients still prefer in-person visits, a finding seen in various studies [3, 9] but post-pandemic studies have demonstrated increased preference and acceptance of patients for teledermatology.