Nearly 80% of the world's population live in developing countries in Asia, Africa, and Latin America. Many of these countries must face a triple or quadruple burden of disease with severely limited resources and health systems. South Africa (SA) is one such country, and recognises the potential for e-health to moderate these limitations. Dermatological issues remain a concern in SA and globally. Indeed, the World Health Organisation (WHO) has recognised that a number of diseases are most likely to manifest themselves through a dermatological problem before becoming full-blown. However, there is an acute shortage of dermatologists in SA. Teledermatology has promise as a service delivery intervention. This study reports on the current status of teledermatology services in the public health sector of SA.

Methods: The study adopted a qualitative, inductive research approach based on a structured literature review of teledermatology in SA. A modified Momentum-Treat tool was used to critique identified teledermatology services.

Results: 159 resources were identified, of which 68 were excluded. The remaining 91 resources revealed a history of ad hoc teledermatology services, of which few remained active. Requests for teledermatology service confirmations provided some feedback, together with follow-up meetings and interviews.

Discussion: No evidence of scaling of teledermatology services and integration into routine healthcare was found. Of eight services, 4 remain active. Review and modified Momentum-Treat critique showed opportunities for improved readiness assessment, programme governance, and alignment to government policy direction, in order to improve scaling and sustainability.

Conclusions: Full-scale teledermatology integration is possible, but stronger programme development is needed. Findings will inform development of a teledermatology scale-up framework to assist with future integration of teledermatology into routine healthcare.