Teledermatology consultations provide specialty care for farmworkers in rural clinics.

CONTEXT: Rural patients have limited access to dermatologic care. Farmworkers have high rates of skin disease and limited access to care. PURPOSE: This exploratory study assessed whether teledermatology consultations could help meet the needs of health care providers for farmworkers in rural clinics. METHODS: Dermatologists provided 79 consultations, using store-and-forward teledermatology, to farmworkers who presented with a skin disease to rural North Carolina clinics. Clinic providers rated the value of the consultation. FINDINGS: Most requests for consultations (94%) came from family nurse practitioners or physician assistants. Twelve percent of consultations were rated somewhat helpful, and the remainder helpful or very helpful. After receiving the consultation, providers changed the diagnosis in 13% of cases. The consultation led providers to contact or attempt to contact 21% of patients to change treatment recommendations. CONCLUSIONS: Access to expert dermatologic services is needed by rural health care providers. Teledermatology consultations may be a helpful tool to meet this need.

Self-treatment with bleach by a Latino farmworker.

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

Cutaneous larva migrans in a migrant Latino farmworker.

Migrant farmworkers experience a high incidence of skin disease. This report provides information on the case history of cutaneous larva migrans in a Latino migrant farmworker. Treatment options are reviewed, and information for prevention is discussed.

Contact dermatitis in tobacco farmworkers.

Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. We report 5 migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases show a characteristic distribution of contact dermatitis; the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.

Common skin disorders seen in the migrant farmworker health care clinic setting.

BACKGROUND: Skin diseases are common occupational illnesses for farmworkers. Migrant farmworkers commonly access rural health clinics for diagnosis and treatment of skin disease. PURPOSE: To assess common skin conditions of migrant farmworkers treated in rural clinics and to describe effective and economic management of these conditions. METHODS: Seventy-nine farmworkers with a skin condition were seen as patients at 4 clinics in eastern North Carolina. A list of the most common conditions encountered was compiled and treatment methods were found in the literature. RESULTS: Twenty-three common conditions were identified. The most common conditions were contact dermatitis, melasma, tinea, seborrheic keratoses, and impetigo. A table of treatment recommendations was composed that can be used by clinicians in this setting. CONCLUSIONS: Generally, the most common skin conditions seen in the migrant farmworker population in eastern North Carolina are similar to conditions found in the general population.

Blistering eruption in a Latino migrant farmworker.

Skin rashes are among the most common problems seen by those providing health care to agricultural workers. We present a case report of a migrant farmworker patient with a painful, blistering eruption of the axilla and adjacent skin developing after an insect bite. The possibility of infection was not initially considered, and teledermatology was helpful in making the diagnosis of bullous impetigo. This was important because initial culture confirmation was not obtained and antibiotic treatment had not been initiated. After the consultation, the impetigo was treated by empiric antibiotic coverage. The environmental conditions of migrant farmworkers raise special issues for infectious skin diseases like bullous impetigo. Crowded living conditions, lack of proper sanitary facilities, and poor accessibility to health care increase the risk of occurrence and spread of this disease. With the recent emergence of multi-drug-resistant organisms such as methicillin-resistant Staphylococcus aureus in community settings, this case report should serve to reinforce the need to recognize the possibility of infection and to obtain culture specimens at the initial visit to better treat and control this infectious skin condition.