Bus Driver With an Erythematous, Reticulated Patch on Her Back

Thomas Stasko, MD


October 21, 2002

Case Presentation

A 50-year-old white woman.

The patient had a history of nonmelanoma skin cancer, and presented to the clinic for her annual skin cancer screening exam. She had been a bus driver for over 20 years, and during that time she admitted to frequently using a heating pad on her lower back while driving to relieve musculoskeletal aches and pains. On the day of the exam, she had no complaints about her skin.

On her lower back, extending laterally from the midline, the patient had a 15 x 18 cm erythematous and slightly hyperpigmented reticulated patch. There were no papules, vesicles, or ulcerations.

Mild epidermal thickening. In the dermis there were many dilated capillaries and venules, a mixed-cell infiltrate, papillary edema, numerous melanophages, and hemosiderin and melanin granules.

What is your diagnosis?

  1. Cutis marmorata

  2. Erythema ab igne

  3. Livedo reticularis

  4. Chilblains

View the correct answer.


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