Bridging gaps in pediatric dermatology via telemedicine: An analytical cross-sectional study on 961 children in resource-limited areas of North India using the e-Sanjeevani 2.0 platform

Background Pediatric tele-dermatology (PTD) offers a potential solution for delivering specialised dermatological care to children in remote areas. Objectives To evaluate the scope, utilisation, receptivity, and factors influencing the optimisation of PTD practice within the context of a developing country's demographic. Methods The study analysed 961 PTD consultations over six months, conducted in underserved areas of North India via an assisted telemedicine platform, e-Sanjeevani 2.0. Data were gathered cross-sectionally through standardised forms, complemented by a retrospective survey to capture the perceptions of referring healthcare providers (RHPs). Patient clinico-demographics and various consultation characteristics were assessed for their impact on clinical decision-making. Results Among the 961 cases studied (median age 5 years, IQR: 2-11; 52.1% female), the majority consisted of infections, infestations, and dermatitis, 1.35% cases were acute/emergency dermatoses managed empirically, and only 4.47% required referral. Friedman test revealed highly significant differences in perceived helpfulness amongst the four consultation variables (p<0.001) - image quality being the most helpful, followed by audiovisual/text interaction, multiple images, and past/medical/family history. Wilcoxon Signed Ranks tests indicated significant differences in perceived helpfulness between each pair of variables (p<0.001). The RHP survey reflected a strong endorsement of the process and a high perceived parent/guardian satisfaction rate (4.47 ± 0.87 on a 5-point scale). Limitations The study did not evaluate diagnostic or management concordance due to a lack of in-person evaluation. Other limitations included a low follow-up rate, short duration of study that may have missed seasonal variations in paediatric dermatoses. Additionally, clinical outcomes, cost-effectiveness, and technical factors such as connectivity and video quality were not assessed. Conclusion The findings support the use of real-time PTD to manage less complex, non-procedural cases, reduce in-person consultations, and improve access to paediatric dermatology care in resource-constrained settings. High-quality images and effective audiovisual communication are pivotal for its optimisation. The service had clinical and educational value and was well-received by parents and providers. The integration of eSanjeevani into India's healthcare infrastructure offers a functional foundation for larger scale expansion of PTD services. Further studies in diverse settings are needed to identify operational barriers to broader implementation and evaluate diagnostic accuracy through direct comparisons with in-person evaluations.