Making Teledermatology Services Work: A Realist Review of Success Factors.

The implementation of teledermatology, as with other telehealth services, varies across settings. The aim of this study was to use a modified realist review methodology to synthesise factors that lead to successfully implementing and running teledermatology services. PubMed was searched in July 2025 to identify articles published internationally from 2020 to 2025 that provided a description of a teledermatology service and contained the authors' interpretation as to what contributed to the success of the service. The search returned 992 articles and 100 were included in the review after screening. Data was extracted independently by two authors who discussed terminology and interpretation of the independent data extracts. The authors modified the extracted data to ensure consistency in concepts and wording. From the included articles, 45 success factors were identified and coded using qualitative methods into eight themes: (1) Technology and imaging; (2) Hybrid model-of-care; (3) Communication; (4) People and staffing; (5) Quality of information; (6) Education and training; (7) Optimisation; and (8) Funding. The top three factors from each theme are explained in detail in this paper, and a full list of all items attributed to successful services is included in Supporting Information. The most common factors mentioned were having high quality images and using a comprehensive referral template. Some factors, such as the broader funding landscape, were acknowledged as contributing to success and represent opportunities for further advocacy. Our findings can be used to develop guidance on future teledermatology service implementation and optimisation.