The store-and-forward feature of teledermatology allows patient medical information (including history and visual data) obtained from one provider's location to be electronically transferred to a provider 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 of lesions.
History of Present Illness
A 52-year-old white male, kitchen-steamer worker presents with white hair on his arms. He states that he has had several steam burns at work when using a pot holder instead of gloves. Prior treatment for skin condition: none. Primary symptom: pruritus. Prior biopsy: none.
Image Quality Assessment
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
One image was provided with this consult, which shows pink patches of atrophic-appearing skin on the forearms with associated white hairs (poliosis). Notably, the hands and upper arms are spared (Figure 1).
INTERPRETATION OF IMAGES
Lesion A
Findings suggest post-steam-burn sequelae.
RECOMMENDATIONS
Return visit to primary care for reassurance.
CLINICAL PEARL
Remarkably, cryotherapy has been implemented since the late 1800s (Freiman & Bouganim, 2005). Dermatology providers have utilized cryotherapy with increasing utility, since the turn of the century. It is well known that melanocytes are relatively more vulnerable to the effects of freezing as compared with keratinocytes. Destruction of melanocytes takes place at a temperature of -5[degrees]C. In comparison, keratinocytes show resilience to destruction all the way down to -50[degrees]C (Unger, 2016). Because of this, caution must be taken when utilizing cryotherapy on darker-skinned individuals to prevent hypopigmentation. Of interest, it is not often discussed that these melanocytes likewise have an increased relative fragility to heat. Normal melanocyte destruction from heat has been reported at levels above 43[degrees]C. In addition, it has also been reported that malignant melanocytes have a greater sensitivity than normal melanocytes when subjected to elevated temperatures (Giovanella, Stehlin, & Morgan, 1976). In this patient with a history of steam burns, the pink atrophic skin and associated poliosis are most likely sequelae of the steam burns.
REFERENCES