In the store and forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
History
Chief complaint: presenting for diagnosis and therapeutic options.
History of present illness
A 67-year-old gentleman presents with a rash on his chest that has progressively worsened over the last 6 months. He is an uncontrolled diabetic (HbA1C Est). Prior treatment for skin condition: none. His primary symptom: mild pruritus. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
There is one image provided with this consult. The image shows waxy-appearing pink scaled papules involving the hair-bearing central chest. See Figure 1.
INTERPRETATION OF IMAGES
Lesion A
Findings
The morphology of the lesions, distribution, and history are most consistent with seborrheic dermatitis (SD). Given the distribution, Grover's disease would be considered in the differential diagnosis. The lack of bouts of intense pruritus, the absence of crusting over the erythematous papules, and the lack of history indicating heat and sweat as aggravating factors suggest against the diagnosis of Grover's disease.
RECOMMENDATIONS
Skin Care Recommendations
As there is no permanent treatment, consider the age of the patient and compliance for effective control (Dessinioti & Katsambas, 2013). It is important to educate the patient on gentle cleansing of the skin and daily use of an appropriate moisturizing lotion with emollients to prevent scales (Clark, Pope, & Jaboori, 2015).
Medication Recommendations
Topical antifungal treatment is effective and tolerated well, including but not limited to ketoconazole shampoo 2% and selenium sulfide shampoo. Shampoos are used two to three times per week and then applied and rinsed after at least 5 minutes of letting the shampoo sit on the scalp or skin.
Keratolytics, for example, topical urea or tar shampoo, salicylic acid lotion, ammonium lactate lotion, and zinc pyrithione shampoos, may also be helpful. Topical steroids used for a short period for anti-inflammatory effect and combined with antifungal shampoos may be used for more severe SD and acute flares (Dessinioti & Katsambas, 2013). Tree tea oil 5% shampoo is a natural and effective therapy when used daily (Clark et al., 2015).
RECOMMENDED FOLLOW-UP
Type of Visit
Return to primary care for initiation of care. Refer to dermatology if no improvement in 10-12 weeks.
CLINICAL PEARL
Seborrheic Dermatitis (SD) is a common, often chronic, inflammatory skin condition characterized by scales and erythema in skin areas rich in sebaceous glands, for example, scalp, nasolabial folds, ears, beard, eyebrows, glabella, and anterior chest. Other names for SD are dandruff, cradle cap, sebopsoriasis, seborrheic eczema, pityriasis capitis, and seborrhea (Dessinioti & Katsambas, 2013). It increases after the age of 50 years and is more common in men. SD tends to be worse during winter and dry climate (Clark et al., 2015).
It presents with mild-to-moderate greasy scaling with erythema and often pruritus. SD has been linked with a rise in hormone levels, mainly androgens, in adolescents and young adults; sleep deprivation; stress; fungal overgrowth and infections, especially of the Malassezia species; altered immunity; food allergies and nutritional deficiencies of riboflavin, biotin, and pyridoxine; and neurogenic and psychiatric conditions, for example, Parkinson's disease, anxiety, and depression (Dessinioti & Katsambas, 2013). Severe medical illnesses including HIV (Clark et al., 2015), head injury, and stroke are also associated with SD.
NURSING PERSPECTIVE
Living with SD can be stressful, and stress itself can be a cause for its exacerbation (Clark et al., 2015). SD can induce immune and inflammatory responses in the skin. Nurses can play a major role in patient education on the benign nature of SD and its management giving the patient control in decreasing their stress level.
REFERENCES