Burn, Cryotherapy, Poliosis, Teledermatology



  1. Jacob, Sharon E.
  2. Gust, Peter


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of white hairs on the arms.


Article Content

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.




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.



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).

Figure 1 - Click to enlarge in new windowFIGURE 1. On the bilateral forearms are symmetric patches of pink atrophic skin with associated poliosis.


Lesion A

Findings suggest post-steam-burn sequelae.



Return visit to primary care for reassurance.



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.




Freiman A., Bouganim N. (2005). History of cryotherapy. Dermatology Online Journal, 11(2), 9. Retrieved from[Context Link]


Giovanella B. C., Stehlin J. S., Morgan A. C. (1976). Selective lethal effect of supranormal temperatures on human neoplastic cells. Cancer Research, 11, 3944-3950. [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287. [Context Link]


Unger J. (2016). Cryotherapy. Retrieved from article/1125851-overview#a1 [Context Link]


1The standardized teledermatology reader report format is available for authors on the journal's Web site ( and on the submissions Web site online at [Context Link]