Dermatology, Pediatrics, Perioral Dermatitis, Teledermatology



  1. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, there is 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 Teledermatology Viewpoint column is such that cases are presented in a standardized teledermatology reader format rpeflective of an actual teledermatology report. This is a case of pink papules around the mouth.


Article Content


Chief complaint

Presenting for diagnosis and therapeutic options.


History of Present Illness

A 5-year-old boy presents with recurrent groups of small red lesions on his face. Prior treatment: none. His primary symptom: mild stinging; these are not pruritic. Prior biopsy: none.



Unsatisfactory. Image is poorly focused (see Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. Facial photo showing scattered pink lesions.


One image was provided of Problem A. The image poorly shows the patient's face. There are multiple pink-to-red lesions periorally. The lesions are out of focus.




The morphology and distribution of the lesions and history of episodic nonpruritic flares are most consistent with the diagnosis of perioral dermatitis; however, the poor quality of the images makes this diagnosis uncertain.



Skin Care and Treatment Recommendations

The patient should be referred back to teledermatology health technician for appropriate image capture and reconsultation to the teledermatology provider.



Perioral dermatitis is an uncommon disorder of childhood, for which the exact origin is not known (Laude & Salvemini, 1999). It is thought to be an idiosyncratic response to exogenous factors, such as topically applied creams and lotions to the face. Generally, it presents as inflamed papules that wax and wane. The treatment is aimed at the discontinuation of temporally associated hygiene products or fluorinated corticosteroids and may include topical antibiotics. In children, it is thought to likely be a juvenile form of rosacea.


This reader report serves to highlight the necessity of appropriate image capture for teledermatology and the potential outcome of the patient being referred back for appropriate image capture if the consult-associated images are unsatisfactory. Although a diagnosis may be able to be rendered, it is less certain with poor image quality.


In summary, photographic images should be attained with diffuse, indirect lighting from full-spectrum light bulbs. Incandescent lighting should be avoided. Prudent use of flash is advised to limit the potential for "whiting-out" the lesion if the flash is too close and there is too much light. Three to five images should be captured of each lesion, including one with the camera perpendicular to the skin lesion being imaged. Different views should be attained to show both overall location (showing body part) and closeup details of the lesion utilizing the macro/optical zoom functions. Finally, a solid color background should be used to diminish visual distractors (McKoy, Norton, & Lappan, 2012).


The standardized teledermatology reader report format is available for authors on the submissions Web site and outlined in Table 1.

Table 1 - Click to enlarge in new windowTABLE 1 Teledermatology Viewpoint: Column Template



Laude T. A., & Salvemini J. N. (1999). Perioral dermatitis in children. Seminars in Cutaneous Medicine and Surgery, 18(3), 206-209. [Context Link]


McKoy K., Norton S., & Lappan C. (2012). American Telemedicine Association-Quick guide to store-forward teledermatology for referring providers: Taking the image. Retrieved from[Context Link]


Roman M., & Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal Dermatology Nurses Association, 6(6), 285-287.