Effectiveness of Telemedicine for Patients with Psoriasis: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Psoriasis is a chronic inflammatory skin disease requiring long-term management. Telemedicine may improve continuity of care, treatment adherence, and self-management; however, evidence regarding its effectiveness across clinical and patient-centered outcomes remains inconsistent. OBJECTIVE To systematically evaluate the effectiveness and safety of telemedicine-based interventions for patients with psoriasis across multiple clinical, psychological, behavioral, and patient-reported outcomes. METHODS We searched 10 databases, including PubMed, Embase, the Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, CBM, CNKI, and Wanfang, from inception to March 31, 2026. Randomized controlled trials comparing telemedicine-based interventions with routine care or conventional follow-up were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted using mean differences (MD), standardized mean difference (SMD), or risk ratio (RR), with corresponding 95% confidence intervals (CI). Subgroup analyses were performed to explore potential sources of heterogeneity. Sensitivity analyses were conducted using the leave-one-out method, in which each study was sequentially excluded to assess the robustness of the pooled estimates. Publication bias was assessed using Egger’s and Begg’s tests. RESULTS Twenty-four articles involving 2546 patients were included. Risk of bias assessment identified some concerns in 11 studies and high risk in 9, with no studies rated as having a low overall risk of bias. Telemedicine significantly reduced PASI scores (MD=−2.97, 95% CI −5.69 to −0.25; P=.03; I²=98.6%; P<.001) and DLQI scores (MD=−2.29, 95% CI −3.79 to −0.79; P=.003; I²=84.0%; P<.001). Self-management ability (SMD=1.21, 95% CI 0.44 to 1.98; P<.001; I²=93.6%; P<.001) and psoriasis-related health behaviors (SMD=1.46, 95% CI 0.81 to 2.11; P<.001; I²=85.7%; P=.01) also improved significantly. Treatment adherence rates increased (RR=1.17, 95% CI 1.07 to 1.27; P<.001; I²=27.9%; P=.24), whereas adherence scores (SMD=3.88, 95% CI: 0.23 to 7.54; P=.04; I²=98.8%, P<.001) showed substantial heterogeneity and limited robustness. Anxiety assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale improved significantly (MD=−1.56, 95% CI −2.73 to −0.39; P=.01; I²=0%; P=.45). Depression and patient satisfaction did not improve significantly overall (SMD=−0.66, 95% CI: −1.59 to 0.27; P=.16; I²=95.4%; P<.001). However, Social functioning-related outcomes improved (SMD=−2.45, 95% CI −4.49 to −0.41; P=.02; I²= 98.1%). The pooled incidence of adverse events was lower in the intervention groups (RR=0.74, 95% CI 0.56 to 0.99; P=.04; I²=0.0%, P=0.41), although sensitivity analysis indicated limited robustness. One study suggested potential cost savings with online care. CONCLUSIONS Telemedicine may improve psoriasis severity, quality of life, self-management, health-related behaviors, and treatment adherence. However, its effects on psychological outcomes and patient satisfaction remain uncertain, and evidence regarding safety and cost-effectiveness is limited. Substantial heterogeneity and methodological limitations warrant cautious interpretation. Future trials should use standardized outcome measures, longer follow-up, and rigorous assessments of safety and economic outcomes. CLINICALTRIAL International Prospective Register of Systematic Reviews CRD420261294958; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261294958