INTER-RATER VARIABILITY IN PATCH TEST READINGS AND FINAL INTERPRETATION USING STORE-FORWARD TELEDERMATOLOGY.

BACKGROUND Data regarding teledermatology for patch testing are limited. OBJECTIVES Compare patch test readings and final interpretation by 2 in-person dermatologists (IPDs) with 8 teledermatologists (TDs). METHODS Patch tested patients had photographs taken of 70 screening series allergens at 48-hour (48H) and second (2nd) readings. 8 TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48H and 2nd readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) were calculated. Primary outcome was agreement at 2nd reading. RESULTS Data were available for 99, 101, and 66 participants at 48H, 2nd reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at 2nd reading was 13.6% (range 7.9-20.4%). Pooled failure at 48H and final interpretation was 5.4% (range 2.9-6.8%) and 24.6% (range 10.2-36.8%). Confidence in readings was statistically correlated to quality of images and disagreement. CONCLUSION For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for 2nd readings and 24.6% for final interpretation. This article is protected by copyright. All rights reserved.