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Endgames Picture Quiz

A reticulated eruption on the lower abdomen in a 17 year old girl

BMJ 2012; 344 doi: (Published 13 January 2012) Cite this as: BMJ 2012;344:e359
  1. A C Seghers, clinical fellow,
  2. S Breathnach, consultant dermatologist
  1. 1St John’s Institute of Dermatology, Guy’s and St Thomas’ Foundation Trust, London SE1 7EH, UK
  1. Correspondence to: A C Seghers aseghers{at}

A 17 year old girl presented with a net-like brownish eruption on her lower abdomen that had appeared nine months previously (figure). It was asymptomatic and showed no tendency to spread. She was otherwise healthy, apart from having had an appendicectomy three years earlier. On further questioning, she admitted that she often applied hot water bottles to her abdomen for pain relief because she had been experiencing recurrent abdominal cramps since the operation. The time between the use of the hot water bottles and the onset of the eruption was unclear.


  • 1 How would you describe this rash?

  • 2 What is the probable diagnosis?

  • 3 Why is it important not to miss the diagnosis?

  • 4 How should this condition be managed?


1 How would you describe this rash?

Short answer

A localised area of reddish brown reticulate discoloration affecting the lower abdomen.

Long answer

Examination showed a diffuse reticulate erythematous to brown, macular, non-blanching discoloration around her umbilicus. No evidence of telangiectasia, atrophy, bullae, or superficial erosions was seen. She had two symmetrical scars from laparoscopic appendicectomy on the lateral sides of her abdomen.

2 What is the probable diagnosis?

Short answer

The most likely diagnosis is erythema ab igne.

Long answer

This typical clinical presentation, together with the history of repeated exposure …

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