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TELEDERMATOLOGY MUTIRON AT POLICLINICA BARRAL Y BARRAL

IN RIO BRANCO – ACRE IN 2023

Carlos Renne Silva de Castro1

Miracelia dos Santos da Silva Castro2

Douglas José Angel3

Abstract: Dermatological diseases are one of the main causes of people seeking care in Primary

Health Care (PHC), often being treated by non-specialized doctors, which leads to an increase in

unnecessary referrals to dermatologists and an overload on specialized services. This scenario is,

in part, caused by the limited academic training of professionals, affecting their ability to diagnose

and treat dermatological conditions appropriately. Teledermatology appears as a promising solution

to optimize care, using information and communication technologies to facilitate remote diagnosis,

allowing PHC doctors to receive reports from dermatologists within 72 hours, without the need for

unnecessary travel. Objective: To report the experience of the Teledermatology joint effort held at

Policlínica Barral Y Barral in the municipality of Rio Branco in the State of Acre, aimed at reducing

waiting times and improving access to dermatological care. Method: This is a literature review

study in the form of a professional experience report with critical analysis. The data was collected

from medical and administrative records that provided the necessary information to carry out the

experience and its results. Results: During the joint effort, 200 PHC patients were expected, with 142

treated, 128 exams validated and 50 cases treated directly in PHC, avoiding unnecessary referrals.

The results showed a predominance of injuries classied as green (secondary) and blue (primary care)

risk, with some serious cases, such as skin cancer, being referred to specialized care. Conclusion:

1 Resident Physician in Family and Community Medicine – Acre Hospital Foundation (FUN-

DHACRE)

2 Undergraduate student in Medicine at Centro Universitário Uninorte

3 Teacher of the medical course at the Uninorte University Center

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Teledermatology proved to be effective in speeding up diagnosis and treatment, improving the

resolution of PHC and optimizing public resources. The experience highlighted the importance of

training PHC professionals to diagnose and treat dermatological diseases, highlighting the need to

integrate telemedicine into health practices, contributing to more efcient and accessible care.

Keywords: Dermatological diseases; Primary Health Care (PHC); Teledermatology.

INTRODUCTION

Skin diseases represent one of the main reasons for seeking care in primary health care, and

are often treated by physicians who are not specialists in dermatology (Bernardes et al., 2015).

Since dermatology nds a wide range of health conditions that vary greatly in complexity, it

is observed that in the Unied Health System (SUS) many cases referred for specialized consultation

could be resolved in Primary Health Care (PHC). This increases the waiting time for the consultation,

occupies the specialty queue with cases that can be solved in PHC, can delay the start of treatments,

causes unnecessary displacements and lower efciency of public spending. (Telehealth/UFSC (2024).

This reality is due, in part, to the limited learning during the academic training of these

professionals, which can negatively impact their ability to properly diagnose and treat these conditions.

As a result, many patients end up being referred to dermatologists, which not only increases the

burden on specialized services, but also increases the costs associated with treatment (Campos et al.,

2022 apud Jessica Corrêa Pantoja, 2024, pg. 2).

Thus, teledermatology emerges as a promising alternative, using information and

communication technologies to facilitate the exchange of medical information between non-

dermatologists and specialists. This approach, known as secondary teledermatology, offers the

possibility of optimizing care, making it faster and less costly. In this way, Teledermatology focuses

specically on the diagnosis and treatment of dermatological conditions through Information and

Communication Technologies (ICTs). “This approach uses tools such as videoconferencing, high-

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resolution digital images, and electronic information exchange to enable interaction through a

platform” (YARAK, RUIZ, and PISA, 2017, P. 3).

Within 72 hours, dermatologists evaluate the cases and provide reports to the requesting

doctors. In addition, they classify lesions by risk level and guide management, determining whether

the patient should be treated exclusively in PHC or should be referred to specialized care to continue

treatment, as in the case of cancer, for example.

For cases referred, the risk classication allows, through the regulation service, a faster

resolution of serious cases. Teledermatology - Telehealth UFSC (2024). The classication is carried

out through the analysis of elementary lesions according to color modication, solid constitution,

liquid content, thickness modication, skin continuity solution or tissue losses (those that tend to

spontaneous elimination) and sequelae (scarring lesions). BAETA (2021). As specied in gure 1,

guiding the prioritization of the patient within the care network.

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Figure 1: Risk classication in Dermatology

Source: Telesaúde Acre and Santa Catarina, 2024

The reports issued, accompanied by diagnosis and clinical conduct, allow PHC physicians to

solve many cases without unnecessary travel or specialized consultation.

The objective of the present study is to report the experience of the teledermatology care

project carried out at the Barral Y Barral Polyclinic in the city of Rio Branco - AC, with the purpose

of speeding up the care of the most severe cases, reducing the queue in specialized care, expanding

access and saving public resources.

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EXPERIENCE REPORT

From August 31 to September 1, 2023, the teams of Telessaúde Acre and the Municipal

Health Department - SEMSA Rio Branco carried out a “joint effort”, lasting 2 days, to intensify

Teledermatology actions with the objective of reducing the queue of referrals from the Regulation

System (SISREG) and increasing the resolution related to cases already referred. With the support

of the national Teledermatology offer of the Telehealth Center of the Federal University of Santa

Catarina (UFSC).

“Teledermatology is an important tool that has provided diagnosis via the

internet, through the STT portal, which enables and facilitates the approxi-

mation of Primary Care to specialized care. The innovative technology used

by STT is developed by the Federal University of Santa Catarina, through

INCoD (National Institute for Digital Convergence). The great differential

of this form of Teledermatology is in the use of clinical protocols for photo-

graphic registration of lesions that allow the physician to describe the lesion,

classify the risk and, when necessary, suggest the clinical conduct in Primary

Care.” (Telehealth UFSC, Telemedidina Santa Catarina, 2024, online).

It took place at the Barral Y Barral Polyclinic, located in the urban area of the Municipality

of Rio Branco-AC, the unit acts as a Health Center/Basic Unit, and comprises several specialties,

including teleconsulting.

The experience is about Teledermatology care with the use of information technologies

capable of offering specialized care through medicine in primary care

During the action, a team of four teleconsultants from the Telehealth Acre, Family and

Community Medicine (FCM) residents and interns of the internship of the Medicine Course at the

Federal University of Acre - UFAC joined the SEMSA Rio Branco team to carry out the exams at the

Barral y Barral Polyclinic, with the forecast of offering 200 teledermatology exams to patients who

are in line waiting for care with a dermatologist. The exam was reported by dermatologists from the

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Telehealth Center of Santa Catarina within a maximum period of 72 hours.

The action was carried out with Primary Care patients who were identied with a skin lesion

that made the doctor suspect something to refer him to the specialist. The patients referred were

reassessed by this task force, in order to identify those who could be treated in Primary Care and

stratify the risk, thus being able to prioritize the care of patients referred to the Specialized Outpatient

Clinic of the Acre State Hospital Foundation (FUNDHACRE). This action took place for 2 days,

through risk classication and after these consultations, the results of the tests received were analyzed.

It was extremely important to participate in this service, offering quality care, with agility to

patients already referred by the basic care, but who, due to the extensive, costly and limited demand,

would wait a long period for this care to reach the specialized professional, causing severity to the

prognosis of the lesions.

METHODOLOGY

This is a literature review study in the form of an experience report, with a deductive method,

descriptive objective, basic nature and a qualitative-quantitative approach.

Data were obtained from the databases of the regulation system of the Municipal Health

Department of the Municipality of Rio Branco, to obtain the waiting list for dermatological care and

from the patients themselves at the time of care to assess the need for care.

The patients were called from the waiting list for dermatology consultations in the

municipality of Rio Branco-AC, composed of approximately 771 patients at that moment , the rst

200 were called for care. The service had a platform with internet access, which enabled agility in

the service, in this way the evaluations through image that are carried out at the Telediagnosis Point

existing in the municipality or by the doctor himself with the use of the cell phone and ruler next to

the lesion, to estimate the size.

The photos were taken with rulers, so that we could characterize each injury. The description

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began with the patient’s initial letters, age, mention of the existence or not of comorbidity and the

duration of the disease. Next, a summary was made of the evolution of the lesions, the medications in

use, the evolution and the current situation, as shown in the example of Figure 2. The same example was

used to refer the patient’s case via the internet to the specialized care at the STT of Teledermatology.

Figure 2: Example of a case summary to send for Teledermatology care

Source: prepared by the task force team

Then, the photo was sent to a dermatology specialist at the Santa Catarina Center through

the Telehealth platform for the issuance of the report. In the report, the specialist already makes the

risk classication.

FINDINGS

The data were provided by the Teledermatology Task Force at the Barral y Barral Polyclinic

in August/September 2023. The task force aimed to serve 200 patients with referrals to a dermatology

3 , 5 x 4

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began with the patient’s initial letters, age, mention of the existence or not of comorbidity and the

duration of the disease. Next, a summary was made of the evolution of the lesions, the medications in

use, the evolution and the current situation, as shown in the example of Figure 2. The same example was

used to refer the patient’s case via the internet to the specialized care at the STT of Teledermatology.

Figure 2: Example of a case summary to send for Teledermatology care

Source: prepared by the task force team

Then, the photo was sent to a dermatology specialist at the Santa Catarina Center through

the Telehealth platform for the issuance of the report. In the report, the specialist already makes the

risk classication.

FINDINGS

The data were provided by the Teledermatology Task Force at the Barral y Barral Polyclinic

in August/September 2023. The task force aimed to serve 200 patients with referrals to a dermatology

3 , 5 x 4

specialist in Rio Branco - Acre. Of these, 142 exams were performed, and a total of 128 of them were

considered valid by the specialist via Teledermatology. Of the 128 valid lesions classied through

Teledermatology, only 77 of them were diagnosed and received care according to their diagnosis, and

50 were guided and treated in PHC, they did not need to go to the Dermatology service.

In the experience, there was no emergency classication - red, with only: yellow - tertiary

referral with 9 consultations 7%, green classication - secondary network 69 patients 53.9%, being

the most prevalent classication, followed by blue - UBS protocol with 35 patients 27.3% and white

- UBS orientation with 15 diagnoses, 11.7% who could have received only guidance in primary care.

And the 9 tertiary referral visits included three non-melanoma cancer diagnoses. As shown in Table

1 below:

Table 1: Risk classication

Source: Prepared by the task force team

Of the 77 diagnostic hypotheses, the following were included: 14 Nevi, keratosis and warts

18.2%; 11 Sun dermatoses 14.2%; 10 Eczema 13%; 10 Diseases caused by fungi 13%; 9 Acne 11.7%; 6

Autoimmune diseases 7.8%; 5 Diseases of the annexes 6.5%; 3 Diseases caused by bacteria and mites

3.9%; 3 Skin cancer 3.9% and 3 dermatitis linked to atopy 3.9%. Table 2 shows:

Colour N %

White 15 11,7

Blue 35 27,3

Green 69 53,9

Yel low 9 7

Red 0 0

Tot al 128 100

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Table 2: Disease groups

Source: prepared by the task force team

Within the disease groups, the patients received the following diagnoses: 9 Diagnosis of

Acne 11.7%, 8 Melanocytic Nevus 10.3%, 6 Contact Dermatitis 7.8%, 6 Chronic Photodamage 7.8%,

5 Pityriasis versicolor 6.5%, 4 Seborrheic Keratosis 5.2%, Vitiligo 5.2%, 4 Alopecia 5.2%, 3 Non-

melanoma cancer 3.9%, 3 Eczema 3.9%, 3 Melasma 3.9%, 2 Atopic dermatitis 2.6%, Folliculitis

2.6%, 2 Leucoderma 2.6%, 2 Tinea corporis 2.6%, 2 Tinea pedis 2.6%, 2 Viral wart 2.6%, the others

as shown in table 3 below:

Disease groups N %

Nevi, keratosis and warts 14 18,2

Sun dermatoses 11 14,2

Eczema 10 13

Diseases caused by fungi 10 13

Acne 9 11,7

Autoimmune diseases 6 7,8

Diseases of the annexes 5 6,5

Diseases caused by bacteria and mites 3 3,9

Skin cancer 3 3,9

Dermatitis linked to atopy 3 3,9

Other benign diseases 3 3,9

Tot al 77 100

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Table 3: Diagnoses of the consultations.

Source: prepared by the task force team

DISCUSSION

The proposal was to serve patients referred to dermatology and refer them to Teledermatology,

Diagnostics N %

Acne 9 11,7

Melanocytic nevus 8 10,3

Contact dermatitis 6 7,8

Chronic photodamage 6 7,8

Pityriasis versicolor 5 6,5

Seborrheic keratosis 4 5,2

Vitiligo 4 5,2

Alopecia 4 5,2

Non-melanoma cancer 3 3,9

Eczema 3 3,9

Melasma 3 3,9

Atopic dermatitis 2 2,6

Folliculitis 2 2,6

Leucoderma 2 2,6

Tinea corporis 2 2,6

Tinea pedis 2 2,6

Viral warts 2 2,6

Pilaris cyst 1 1,3

Dyshidrosis 1 1,3

Scabies 1 1,3

Stretch marks 1 1,3

Fibroma 1 1,3

Chronic simple ligem 1 1,3

Onychomycosis 1 1,3

Pityriasis alba 1 1,3

Psoriasis 1 1,3

Syringomas 1 1,3

Tot al 77 100

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to speed up care and optimize waiting time and treatment. According to Cristiana Silva; Murilo Souza

(2009), in telemedicine, in the teleconsultation modality, there are two main forms of data exchange:

“store-and-forward” when the transmitted information is stored until it is accessed and “real-time”

when there is real-time interaction between the parties involved. In this experience, the information

(photos) was sent, along with the detailed anamnesis of the patient, to reduce costs and time, due to

the time zone and availability of professionals.

As already mentioned, the participants were residents of Family and Community Medicine

and medical interns of the Federal University of Acre - UFAC, under the supervision of UFAC

preceptors, who received the patients and made the rst care and referred them to Teledermatology

for evaluation. The photographs taken of the lesions on the skin of each patient were sent to the doctor

responsible for the action, who inserted them into the system. This practice was able to explore to the

fullest the learning from the practice of case monitoring.

In this study, the degree of total agreement between face-to-face and distance diagnosis

was not achieved, since the task force included only the care of patients referred by the UBS and the

sending of data for analysis through teledermatology.

Regarding the security and operation of the system used for the transmission and storage of

data, no type of failure was observed. Nor was any type of difculty in handling the interface used,

and its use was assimilated with great ease by all participants.

FINAL CONSIDERATIONS

Acre has few dermatologists who provide care through the SUS. And in addition to serving

the entire territory of Acre, they serve some municipalities in Amazonas and Rondônia. And taking

into account the great demand, the Teledermatology task force was important to speed up care,

reducing the waiting time for patients to screen for referrals. The task force was able to redistribute

the cases to their appropriate sectors with the specialist’s vision.

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In this way, this experience was potentially positive. All these consultations were carried out

for 2 days, causing this specialty to receive deserved attention, taking into account the delay in the

care of this specialty due to the demand and misdirected screening.

Therefore, the fact of medical deciency in the dermatology specialty, which comes from

academic training, contributes to the increase in referrals that in most cases could be diagnosed and

treated in the basic unit, in some cases only with guidance on the use of sun protection.

Therefore, it is essential to involve Primary Health Care professionals in Teledermatology

care, in order to outline possible paths of care based on the specic needs of the communities, thus,

it is crucial to implement measures that improve the problem-solving capacity of PHC, support their

training in general dermatology and assist in the management of referrals to specialized services.

Teledermatology is one of the solutions for improvement.

REFERENCES

BERNARDES, Caroline. “Dermatological Diagnosis and Conducts in a Unit Basic Health Care.”

Revista Brasileira de Educação Médica n. 39: n. pag. 2. JanMar 2015. Available at <https://doi.

org/10.1590/1981-52712015v39n1e02782013> Accessed on Jan. 05. 2025.

BAETA, Isabela Guimarães Ribeiro (ed.). Manual of Dermatology in Attention Basic. 2. ed. Salvador,

BA: Editora Sanar, 2021, pg. 17. Available at: <Excerpt - Manual of Dermatology in Primary Care 2nd

Edição.pdf> Accessed Jan. 23, 2025

Telehealth UFSC, Telemedidina Santa Catarina, Teledermatology, June 2024. Available at: <

Teledermatology - UFSC Telehealth Center> Accessed on Jan. 05. 2025.

PANTOJA, Jessica. Corrêa. Dermatology in Primary Care in Brazil: The process of training general

practitioners. Available at: <https://www.researchgate.net/publication/378476493. Accessed in:

01/09/2025

UBS. MED.BR. Hybrid Infrastructure <Barral Y Barral Polyclinic - Rio Branco - AC - Health

ISSN: 2763-5724 / Vol. 05 - n 01 - ano 2025

Center/Basic Unit (ubs.med.br)> Accessed on: 12/05/024 at 2:00 pm.

Teledermatology. Facilitating access to dermatology with the protagonism of PHC, reducing queues

and prioritizing severe cases. Available at <Teledermatology - UFSC Telehealth Center> Accessed

on: 12/05/24 at 04:20 pm.

Telemedicine Portal. What is teledermatology and what are the advantages - Portal Telemedicina <

What is teledermatology and what are the advantages - Portal Telemedicina> Accessed on: 12/05/24,

at 17:25hs.

RAMIREZ-CORNEJO, Cristian et al. Rapid implementation of teledermatology during the

COVID-19 pandemic: lessons learned from an academic department of Dermatology. Rev. med.

Chile, Santiago, v. 149, n. 10, p. 1467-1472, Santiago Oct. 2021. Available at: <http://dx.doi.org/10.4067/

s003498872021001001467>. accessed on Dec 05 2024.

YARAK, Samira; RUIZ, Evandro Eduardo Seron and PISA, Ivan Torres. Rev. bras. Educ. med.

41 (2). São Paulo, Apr-Jun 2017. Teledermatology in Medical Practice. Available at:< https://doi.

org/10.1590/1981-52712015v41n2RB20160042 linkcopy>. Accessed on 12/07/24.

SILVA, Cristiana Silveira and SOUZA, Murilo Barreto. An. Bras. Dermatol. 84 (5), Oct 2009.

Teledermatology: diagnostic correlation in primary health care. Available at: <https://doi.org/10.1590/

S0365-05962009000500007> Accessed on: 12/07/24.

SACHETT JAG, GONÇALVES ICM, SANTOS WOM. Experience report of the contributions of

telehealth in riverside communities of Amazonas in the pandemic. Rev Bras Enferm. 2022; 75(Suppl

2): e20210820. Available at<https://doi.org/10.1590/0034-7167-2021-0820pt> Accessed Jan. 09. 2025.

NUNES, Daniel Holthausen; ROSA, Ariel Cordova; SOARES, Bárbara Telino; WAGNER, Harley

Miguel. Manual – risk classication for dermatology. INCoD – Institute for Digital Convergence.

INCoD/TELEMED.05.2020.P. Version 6.1. September – 2020. Available at <(PDF) Manual - Risk

Classication for Dermatology> Accessed on Jan 12, 2019. 2025.