Background: There is a shortage of medical specialists within the provincial departments of health in South Africa. Telemedicine is a potential way of providing specialist services, at a distance, to rural areas. This study assesses patient and staff satisfaction and issues, technological and operational, associated with the establishment of a videoconference-based teledermatology service.

Methods: An ISDN-based videoconference link was established between Port Shepstone Hospital and the Nelson R Mandela School of Medicine in Durban. Patients with a dermatological problem that would have necessitated transfer to the academic hospital for diagnosis and/or management were entered into a prospective study which evaluated the ability to make a diagnosis and prescribe a management plan by videoconference and the patients' and doctors' satisfaction with the consultations.

Results: A total of 69 patients were seen during 12 videoconferenced consultation sessions. Seventeen patients (24.6%) were subsequently referred to the academic hospital: nine patients were sent because a definitive diagnosis could not be made; and eight patients were transferred for specialist management based on the diagnosis made. The patients' and referring doctors' satisfaction with the consultation was 80.3% and 82.1% respectively, while the dermatologist was satisfied 67.6% of the time. The dermatologist was dissatisfied with ten (14.7%) of the consultations and this was related to difficulties in making a definitive diagnosis. The referring doctors found 59 (85.9%) of the consultations to be of educational value. No problems were noted in diagnosing lesions in dark-skinned patients.

Conclusion: Videoconferenced teledermatology between district hospitals and regional hospitals is possible and can improve services to rural areas. Further studies on widespread implementation and sustainability are warranted.