In teledermatology, 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 TeleDermViewPoint column is presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT
History
Chief complaint: presenting for diagnosis and therapeutic options for hair loss and inflammatory papules.
History of present illness
A 52-year-old male presents with hair loss in association with itchy papules on the scalp that has progressively worsened over the last 5 months. He has similar papules on his face and arms. Prior treatments for his skin condition included three separate courses of a 60-mg prednisone taper over 3 weeks with partial improvement. No prior biopsy has been taken.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT1
There is one image provided with this consult. The image shows patches of hair loss with scattered pink inflammatory papules. See Figure 1.
INTERPRETATION OF IMAGES
Lesion A
Findings
The morphology of the lesions, distribution, and history are characteristic for contact alopecia.
RECOMMENDATIONS
Refer for face-to-face evaluation with a dermatologist for a confirmatory biopsy of the inflammatory papules and potential patch test.
RECOMMENDED FOLLOW-UP
Type of Visit
In-person evaluation with the dermatologist.
CLINICAL PEARL
Allergic contact dermatitis (ACD) is a delayed-type hypersensitivity reaction in which T cells are elicited by exposure to a chemical that the patient is already sensitized to. ACD of the scalp with resultant alopecia is a rarely reported phenomenon (Ono, Takapuna, & Tanaka, 2016; Tosti, Piraccimi, & van Neste, 2001). Reported causes of ACD alopecia have included hair dyes and topical medications (Tosti et al., 2001). Contact alopecia from fluocinolone oil containing the ingredient balsam of Peru and other balsam derivatives has been reported (Admani, Goldenberg, & Jacob, 2017). Hair shedding and subsequent loss of hair can be mild to severe and usually occur 2-4 months after the episode of scalp dermatitis (Tosti et al., 2001). A biopsy of the inflammatory papules can be useful in distinguishing this diagnosis from both nonscarring autoimmune alopecia and scarring alopecia. Avoidance of the sensitizing chemical is the critical intervention in care, and with time, the patients may have full recovery of their hair growth (personal observation, S. E. J.).
REFERENCES