White Spot on the Back Amandeep S

TELEDERMATOLOGY VIEWPOINT White Spot on the Back Amandeep S. Sandhu, Sharon E. Jacob

ABSTRACT: Teledermatology is a term to describe the lar macule, and a small 3-mm raised papule is noted at the provision of dermatologic medical services through 10-o’clock position. telecommunication technology. In this modality, there is transfer of medical information electronically (including INTERPRETATION OF IMAGES history and visual data) on a patient in one location to a provider who is in another location. The construct of this Lesion A column is such that cases are presented in a standard- Findings ized teledermatology reader format. This is a case of a The presented lesion and history are most consistent with white spot on the back. the diagnosis of a nevus anemicus. Notably, the hyper- Key words: Case, Hypopigmentation, Nevus, Teleder- pigmentation and telangiectatic background suggest ac- matology, White tinic changes consistent with poikiloderma and may have increased the noticeability of the lesion. The two lesions noted within the primary lesion are benign in their ap- TELEDERMATOLOGY READER REPORT1 pearance and suggest a solar lentigo or normal melanocytic History nevus (brown macule) and a nevus cell nevus (papule). Chief complaint Presenting for diagnosis of a lesion. RECOMMENDATIONS History of present illness Skin Care and Treatment Recommendations A 56-year-old man presents with a ‘‘white spot’’ on the No treatment is indicated. If cosmetic treatment is desired, back that he states his new wife recently noticed. Prior patient can be instructed to camouflage with concealer treatment: none. His primary symptom: none. Prior biopsy: makeup. none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.

Image Quality Assessment Fully satisfactory.

TELEDERMATOLOGY IMAGING READER REPORT One image was provided that shows a circumscribed 7-cm oval pale patch with scalloped borders on a background of hyperpigmentation and telangiectasia on the left lower back. Inside the patch, there is a small 4-mm brown regu-

Amandeep S. Sandhu, MD, Department of Dermatology, Loma Linda University, Loma Linda, CA. Sharon E. Jacob, MD, Department of Dermatology, Loma Linda University, Loma Linda, CA. The authors declare no conflict of interest. FIGURE 1. Notice the regular brown macule in a Correspondence concerning this article should be addressed to large hypopigmented patch within a background Sharon E. Jacob, MD, Department of Dermatology, Loma Linda of poikilodermatous skin. University, 11370 Anderson Street, Suite 2600, Loma Linda, CA 92354. E-mail: [email protected] 1The standardized teledermatology reader report format is available DOI: 10.1097/JDN.0000000000000158 for authors on the Journal’s Web site (www.jdnaonline.com).

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RECOMMENDED FOLLOW-UP tors such as bradykinin, acetylcholine, and histamine are not helpful in increasing blood flow and erythema to the Type of Visit nevus. More invasive procedures such as axillary sympa- This lesion is benign; we recommend reassurance and thetic block and grafting have been shown to induce follow-up as needed (pro re nata, PRN). erythema at the site but are not indicated. This is a benign finding on physical examination and, for cosmesis, can be CLINICAL PEARL managed by noninvasive therapies such as concealers. Nevus anemicus usually presents as a hypopigmented patch That said, as with any dermatologic condition, if a lesion in infancy or childhood; however, they may become more starts to grow, changes suddenly in appearance, or becomes apparent with increased telangectasias because of actinic symptomatic, that patient should be referred to dermatology damage. It is a congenital vascular anomaly caused by for a face-to-face evaluation. localized hypersensitivity to catecholamies that result in vasoconstriction and pallor that is seen clinically (Davis, 2014). There is a lack of scale (which helps to differentiate REFERENCE it from tinea versicolor), and the major diagnosis in the Davis, L. (2014). Retrieved from http://emedicine.medscape.com/article/ differential is vitiligo. Intralesional injections of vasodila- 1084329-overview

290 Journal of the Dermatology Nurses’ Association