Teledermatology in Pediatric Infectious Dermatoses Outbreaks: Extending Care Beyond Tertiary Clinics

Madam, We read with interest the article by Yashik et al. describing the burden of impetigo among children attending a tertiary care dermatology clinic in Rajasthan.[1] From our own experience managing a community-onset impetigo outbreak in underserved areas of Haryana via real-time teledermatology (TD) (e-Sanjeevani platform), we found that TD enabled outbreak detection, mapping of case clusters, coordinated management, and family-level counseling in resource-limited settings.[2] In addition, a cross-sectional study from our center involving 961 children from resource-limited areas of North India showed TD to be a viable option for managing common pediatric dermatoses, including impetigo.[3] Both studies demonstrate that TD widens the outreach of specialist services beyond tertiary centers in such situations, allowing rapid triage, early diagnosis, and timely treatment while reducing complications, transmission, and the costs and delays associated with travel.[2-4] Clinic-based studies such as that of Yashik et al. are useful for quantifying disease load, but they inevitably reflect only those children who reach higher centers.[1] Many milder or remote cases may get missed, underestimating the hidden community burden. TD, especially when integrated at primary health centers, helps capture these cases and provide a more representative assessment of outbreaks.[2] Yashik et al. also highlight humidity as the main factor for the rise in cases.[1] However, other determinants e. g. healthcare-seeking behavior during school vacations, may also influence clinic attendance.[1] TD systems, by linking epidemiological with meteorological data, may help clarify whether variables like humidity truly correlate with impetigo incidence–an interesting direction for future research. The authors also call for awareness campaigns to improve hygiene.[1] While public awareness has merit, the proportion of impetigo observed in their clinic does not by itself establish community burden without population-level prevalence data. In such situations, broad campaigns may not be justified and could instead carry the risk of encouraging self-diagnosis, misinterpretation of other dermatoses as impetigo, and inappropriate antibiotic use– especially in children, where dosing is weight-and age-dependent. TD offers a practical solution by allowing direct interaction with specialists as well as targeted counseling of families.[5] It can also help identify similar lesions in siblings, neighbors, or schoolmates, allowing counseling and treatment to extend beyond the index case–something frequently observed during our impetigo outbreak study.[2] These are issues that generic campaigns cannot address. Assisted TD further helps in capacity-building of referring healthcare providers by educating them about such contagious dermatoses, making the model sustainable beyond a single outbreak.[2,3] Follow-up through shared images allows monitoring of response, compliance, and relapse. In our experience, both families and referring health providers reported clinical improvement and satisfaction with teleconsultations, indicating that the service was acceptable and useful.[2,3] Even in the absence of formal government platforms like e-Sanjeevani, several dermatology departments in India have successfully created dedicated channels for patient communication through widely available means like WhatsApp during the COVID-19 pandemic.[5-7] If needed, these models can be applied to pediatric dermatoses and adapted for impetigo control in underserved regions during seasonal outbreaks. In conclusion, the article by Yashik et al. draws attention to an important paediatric dermatosis.[1] TD can complement and extend their findings in outbreak settings by widening outreach, improving data collection, allowing triage, and providing follow-up and counselling to communities beyond tertiary centres.[2] Future research integrating TD with data from secondary/tertiary hospital outpatient departments would not only allow timely management but also yield useful epidemiological insights for public health planning. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.