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Abstract

To the Editor: We would like to respond to the letter submitted by Dr Chiu regarding our recent article.1Morgan M.B. Scalf L.A. Hanno R. Sternal erythema: a distinctive postsurgical eruption.J Am Acad Dermatol. 2005; 53: 893-896Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar In essence, he compellingly asserts that sternal erythema may not be an entity sui generis, but represent a forme fruste of reticular telangiectatic erythema.2Chiu M. Is postsurgical sternal erythema synonymous with reticular telangiectatic erythema?.J Am Acad Dermatol. 2006; 55: 180Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Reticular telangiectatic erythema has been reported in conjuction with cardiac devices and an implanted intrathecal infusion pump.3Gensch E.F. Schmitt C.G. Circumscribed reticular telangiectatic erythema following implantation of a heart pacemaker.Hautarzt. 1981; 32: 651-654PubMed Google Scholar, 4Dinulos J.G. Vath B. Beckmann C. Welch M.P. Piepkorn M. Reticular telangiectatic erythema associated with an implantable cardioverter defibrillator.Arch Dermatol. 2001; 137: 1259-1261Crossref PubMed Scopus (17) Google Scholar, 5Mercader-Garcia P. Torrijos-Aguilar A. de La Cuadra-Oyanguren J. Vilata-Corell J.J. Fortea-Baixauli J.M. Telangiectatic reticular erythema unrelated to cardiac devices.Arch Dermatol. 2005; 141: 106-107Crossref PubMed Scopus (20) Google Scholar The histopathologic features in these cases showed similar changes to what we observed with epidermal atrophy (ie, papillary dermal telangiectases and a sparse perivascular lymphohistiocytic infiltrate). Common to all referenced cases was the presence of metal either in the form of cardiac devices, pumps, or sternal wires, engendering consideration that the metal itself may have pathogenically contributed to the eruptions. Of note, metal-induced hypersensitivity to common allergens and infectious etiologies were similarly excluded. More difficult to reconcile is the paucity of reported association between the aforementioned scenarios, especially given the ubiquity of implanted metallic devices in proximity to the skin. A more tenable possibility remains that unique anatomic relationships apropos of the thorax and/or antecedent trauma related to the surgery or postoperative healing relate to its development, inclusive of a possible physical mechanism, including electromagnetic induction. We hypothesize that both of these described conditions represent a larger and incompletely understood phenomenon. Increased awareness and reporting of the association may lead to elucidation of its pathogenesis and actual incidence.