Teledermatology vs In-Person Visits: When to Choose Which

As of November 12, 2024.

Canadians wait an average of four to six months to see a dermatologist in person. That delay is not a minor inconvenience for someone watching a suspicious mole change colour, or a teenager whose acne is affecting how they show up at school. Virtual dermatology (also called teledermatology) has moved from a pandemic workaround to a permanent fixture of Canadian skin care, and the question most patients now ask is practical: which option actually fits my situation?

This article answers that question directly, drawing on published diagnostic concordance data and 28 years of clinical dermatology practice. No single model is always better. The right choice depends on what you need to find out and how fast you need to find it.

What is teledermatology and how does it work?

Teledermatology is the delivery of dermatology care at a distance, either through real-time video or by submitting photos for a specialist to review. In Canada, most platforms use a "store-and-forward" model where you upload images and receive a written assessment, often within 24 hours. The two main formats are store-and-forward (photos reviewed asynchronously) and live video consultation (real-time). Both are medically valid for the majority of common skin concerns.

Store-and-forward teledermatology means you photograph the affected skin area and submit those images, along with a brief history, to a dermatologist. The specialist reviews them on their own schedule and sends back a written report. Live video teledermatology means you speak with a dermatologist in real time, which allows for direct questions but depends on image quality from your device camera. A 2022 review published in PMC (National Institutes of Health, NIH) found that both formats achieved high diagnostic accuracy for the most common skin presentations, and that patient satisfaction was comparable to in-person care for conditions that do not require physical examination. The artificial intelligence (AI) triage tools that platforms like DermaDex now use can flag urgent findings and route cases before a dermatologist even reviews the file, which further reduces delays.

Is teledermatology accurate?

For the majority of common skin conditions, yes. Published concordance studies show agreement between teledermatology and in-person diagnoses ranging from 46% to 99%, with the highest accuracy for conditions that present visually and the lowest for conditions requiring touch or biopsy. The most reliable results are seen for acne, eczema, psoriasis, and seborrheic keratoses, which together account for the bulk of dermatology referrals in Canada.

The wide concordance range is the honest answer. A 2021 NIH-funded review by Bastola et al. found concordance sits above 85% for conditions like acne, eczema, psoriasis, and seborrheic keratoses, which together represent the bulk of dermatology referrals. Concordance drops for pigmented lesions that require dermoscopy, bullous diseases that need palpation, and inflammatory conditions where distribution across the body matters. What this means practically: if your concern is a rash, acne, or a mole that looks stable and has not changed recently, a virtual assessment is medically sound. If a mole has changed in the last four to six weeks, bleeds, or has irregular borders, an in-person examination with dermoscopy is the safer path.

How much does virtual dermatology cost in Canada?

Cost varies by province and platform. Some virtual dermatology services are covered under provincial health plans, including Ontario Health Insurance Plan (OHIP) for physician-referred teleconsults, while direct-to-patient platforms typically charge between $50 and $150 per consultation. Patients who access virtual care through a GP referral often pay nothing out of pocket, while self-booked appointments on consumer platforms carry a flat fee that most extended health plans will reimburse.

In Ontario, a teledermatology consultation requested by a family physician can be billed through OHIP at the same rate as a specialist referral, meaning no out-of-pocket cost for the patient. British Columbia, Alberta, and Quebec have similar provisions under their respective provincial plans. Direct-access platforms that allow patients to book without a GP referral generally charge a flat fee, though several offer extended health insurance receipts. The cost advantage of virtual care compounds when you factor in transportation, time off work, and parking for in-person specialist visits, especially for patients in rural or northern communities. Health Canada's health care system framework identifies improving access in underserved regions as a primary driver for telemedicine investment across Canada.

When should you choose teledermatology vs in-person?

Choose teledermatology for stable, visually diagnosable conditions and follow-up care. Choose in-person when physical examination, dermoscopy, or a biopsy is needed, or when a lesion has changed rapidly. For the majority of Canadians dealing with acne, eczema, psoriasis, or prescription renewals, a virtual visit is the faster and equally effective option. In-person care remains necessary when the clinical question cannot be answered from a photograph alone.

The table below summarises the decision criteria across common scenarios.

Aspect	Teledermatology	In-Person Visit
Acne (mild to moderate)	Well-suited; diagnosis and prescription in one consult	Option if treatments have failed repeatedly
Eczema / psoriasis management	Well-suited for known, stable disease	Preferred for new presentation or treatment escalation
Suspicious or changing mole	Appropriate for initial triage; refer if flags present	Required for dermoscopy and possible biopsy
Rash of unknown cause	Good for common presentations; image quality matters	Better when distribution, texture, or systemic signs are unclear
Prescription renewal	Fully appropriate	Necessary only if clinical reassessment is needed
Paediatric skin conditions	Feasible for common conditions with clear photos	Preferred for infants and young children
Wound or post-procedure review	Good for stable healing check	Required if infection, dehiscence, or complications arise
Urgent / rapidly progressing rash	Use to triage and route; may direct to ER or urgent clinic	Preferred if patient is systemically unwell

For anyone who wants to understand what the dermatologist is looking for when assessing a mole, the Asymmetry, Border, Color, Diameter, Evolving (ABCDE) skin check guide at DermaDex walks through the criteria step by step before you book any consultation.

Can an online dermatologist prescribe medication?

Yes. In all Canadian provinces, a licensed dermatologist conducting a virtual consultation can prescribe both topical and oral medications, subject to the same clinical standards as an in-person visit. This covers the full range of common dermatology treatments including topical corticosteroids, retinoids, antibiotics, antifungals, and most oral medications. The one notable exception is isotretinoin, which requires at least one in-person visit for mandatory Health Canada monitoring before a prescription can be issued.

This includes topical corticosteroids, retinoids, antibiotics for acne, antifungals, and oral medications such as doxycycline or isotretinoin with appropriate monitoring. The prescribing physician must hold a licence in the province where the patient is located, which is why provincial licensing matters when selecting a platform. Electronic medical record (EMR) integration allows prescriptions to go directly to a pharmacy in most cases. One practical note: isotretinoin requires mandatory pregnancy prevention monitoring under Health Canada regulations, which typically means at least one in-person blood draw and pregnancy test before a prescription is issued, even when the consultation itself is virtual.

What are the red flags that mean you need to see a dermatologist in person?

Rapidly changing pigmented lesions, blistering diseases, skin infections that are spreading, and any presentation accompanied by systemic symptoms such as fever or joint pain warrant an in-person visit. These findings require physical examination, dermoscopy, or biopsy that cannot be replicated remotely. When in doubt, a virtual triage call can still help you get onto the right in-person care pathway faster than waiting for an unguided GP referral.

The Canadian Dermatology Association (CDA) and the American Academy of Dermatology (AAD) both note that the following presentations should not be managed purely by telemedicine:

• A mole or pigmented lesion that has changed in colour, border, or size within four to six weeks
• Any bleeding or crusting lesion that has not healed in more than three weeks
• Widespread blistering rash, especially if mucous membranes are involved
• Skin infections showing red streaks or rapid spread (suggesting cellulitis)
• Nodular or firm lumps beneath the skin surface that cannot be adequately imaged
• Children under two years with an undiagnosed rash and fever

For any of these, use virtual triage only to get the fastest possible pathway to in-person care, not as a substitute for it. If you are unsure about Canada's current dermatology access landscape, the state of dermatology access in Canada in 2024 provides detailed wait-time data by province.

What happens at a teledermatology appointment?

A teledermatology appointment involves submitting photos or joining a video call, providing your skin history, and receiving a diagnosis and treatment plan. The workflow varies slightly by platform but typically concludes with a written report and, where appropriate, an electronic prescription sent directly to your pharmacy. Most store-and-forward consultations are completed within 2 to 24 hours of submission.

For a store-and-forward consultation, you photograph the affected area in good natural light against a plain background, complete a brief intake form covering how long the issue has been present, any triggers, treatments tried, and current medications, then submit everything through the platform. A board-certified dermatologist reviews the file, typically within 2 to 24 hours, and returns a written assessment with a diagnosis or differential, a treatment recommendation, a prescription if needed, and clear guidance on whether an in-person follow-up is required. For a live video appointment, the workflow is similar but happens in real time. Image quality from a smartphone is now sufficient for most visual diagnoses, though a second take in better light is often worth it for lesion close-ups.

Sources

• Bastola M, et al. "Diagnostic Reliability of In-Person Versus Remote Dermatology." PMC / NIH, 2021. https://pubmed.ncbi.nlm.nih.gov/34557862/
• López-Liria R, et al. "Teledermatology versus Face-to-Face Dermatology." PMC / NIH, 2022. https://pubmed.ncbi.nlm.nih.gov/35208024/
• Music M, et al. "Canadian patient attitudes toward virtual dermatology care." PMC / NIH, 2023. https://pubmed.ncbi.nlm.nih.gov/36683398/
• Lee KJ, et al. "Teledermatology: A Review and Update." Dermatology and Therapy, PMC / NIH, 2021. https://pubmed.ncbi.nlm.nih.gov/33449103/
• Health Canada. "Digital health in Canada." Canada.ca, 2024. https://www.canada.ca/en/health-canada/services/health-care-system.html