Toasted Skin of Pregnancy
Prashant Kaushik, Aadya Kaushik,
Craig Zelig, Vivek R Mehta and Jennifer
Correspondence Address :
Albany VA Medical Center
Associate Professor, Albany Medical College
Albany, United States
Received on: , Accepted on: , Published on:
Citation: Kaushik P, Aadya Kaushik A, Craig Zelig, Vivek R Mehta and Jennifer Walia (2019). Toasted Skin of Pregnancy
Copyright: 2019 Kaushik P, et all. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Tables & Figures
Rheumatology was consulted on a 27 year old primigravida hospitalized to the Obstetric floor at 37 weeks of gestation for a possible 'vasculitic' rash. The history was not suggestive of any systemic vasculitic process. On examination, there was a mottled lacy purplish rash on the lower back [Figure 1].
On more attentive listening, the patient admitted using a 'hot pack' for several hours a day to relieve chronic low back pain (mechanical) aggravated by the abdominal growth of pregnancy.
Q: Based on history and physical exam findings, which is the most likely diagnosis?
A. Livedo reticularis
B. Erythema ab igne
C. Livedo racemosa
D. Caput medusa
The answer is B: Erythema ab igne.
Erythema ab igne (also known as 'toasted skin syndrome') is a hyperpigmented reticulated erythema seen in association with long term exposure to the heat. Etiology is thought to be repetitive exposure to infrared radiation causing erythematous reticulated bands to darken (1). It has been seen after prolonged use of heat pads, laptop computers, car heaters etc. It tends to be self-limiting and resolves after cessation of heat application. If heat application has persisted for a long time, the rash can become permanent. In case of persistent lump or sore, biopsy should be considered to rule out malignancy.
Livedo reticularis is a red-purple violaceous reticulated rash. It is often associated with exposure to cold; patients can have concomitant Raynaudís phenomenon as well. Often it is benign but can be pathologic. Benign variant is most commonly seen in neonates and fair skinned individuals (2). If livedo reticularis is persistent, underlying etiologies like systemic lupus erythematosus, vasculitis, cryoglobulinemia etc. should be ruled in appropriate clinical setting (3).
Livedo racemosa is characterized by "broken" rings, which helps to differentiate it from livedo reticularis. Identifying clinical picture is vital as it is often pathologic and requires active intervention (4). Sneddonís syndrome is an example of a disease state that can present with livedo racemosa; these patients are typically young female presenting with cerebrovascular accidents (5).
Caput medusa is a distention of superficial veins radiating from umbilicus across the abdomen. It is most commonly associated with portal hypertension but can be seen in superior or inferior vena cava syndrome (6,7). Management of underlying cause is the mainstay of treatment.
Our patient sacrificed the attachment to the heating pack and the skin rash started abating.
Dr. Kaushik would like to express gratitude to Albany VA Medical Center and Albany Research Institute for the kind support.
1. Riahi RR, Cohen PR, Robinson FW, Gray JM. Erythema ab igne mimicking livedo reticularis. Int J Dermatol.. 2010;49(11):1314-1317.
2. Gibbs MB, English JC, Zirwas MJ. Livedo reticularis: an update. Journal of the American Academy of Dermatology. 2005;52(6):1009-1019.
3. Toubi E, Krause I, Fraser A, Lev S, Stojanovich L, et al. Livedo reticularis is a marker for predicting multi-system thrombosis in antiphospholipid syndrome. Clin Exp Rheumatol. 2005;23(4):499-504.
4. Kawakami T, Yamazaki M, Mizoguchi M, Soma Y. Differences in antiphosphatidylserine- prothrombin complex antibodies and cutaneous vasculitis between regular livedo reticularis and livedo racemosa. Rheumatology (Oxford). 2009;48(5):508-512.
5. Dean SM. Livedo reticularis and related disorders. Curr Treat Options Cardiovasc Med. 2011;13(2):179-191.
6. Nieto AF, Doty DB. Superior vena cava obstruction: clinical syndrome, etiology, and treatment. Curr Probl Cancer. 1986;10(9):441-484.
7. Missal ME, Robinson JA, Tatum RW. Inferior vena cava obstruction: clinical manifestations, diagnostic methods, and related problems. Ann Intern Med. 1965;62:133-161.
Tables & Figures