Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Observation Letter
2018:84:3;334-336
doi: 10.4103/ijdvl.IJDVL_933_16
PMID: 29451140

Reticular telangiectatic erythema associated with implantable automatic cardioverter defibrillator

Ximena Calderón-Castrat, Javier Cañueto, Concepción Román-Curto, Ángel Santos-Briz, Emilia Fernández-López
 Department of Dermatology, University Hospital of Salamanca, Salamanca, Spain

Correspondence Address:
Ximena Calderón-Castrat
Paseo San Vicente 58-182, 37007 Salamanca
Spain
Published: 14-Feb-2018
How to cite this article:
Calderón-Castrat X, Cañueto J, Román-Curto C, Santos-Briz &, Fernández-López E. Reticular telangiectatic erythema associated with implantable automatic cardioverter defibrillator. Indian J Dermatol Venereol Leprol 2018;84:334-336
Copyright: (C)2018 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Reticular telangiectatic erythema associated with the implantation of a medical device is a rare entity, which must be considered as one of the differential diagnoses of a local infection or allergic contact dermatitis to prevent future extractions and/or replacement of the devices.[1]

A 64-year-old woman with a medical history of idiopathic dilated cardiomyopathy and cardiac insufficiency developed an erythematous plaque on the chest, 1 week after the subcutaneous placement of an implantable automatic cardioverter defibrillator [BIOTRONIK LUMAX 340 HFT], overlying the site of implantation. Infection of the implanted device was suspected and the patient received wide spectrum antibiotic therapy with amoxicillin and clavulanate without much improvement. Subsequently, the patient underwent a second surgical procedure where the implantable automatic cardioverter defibrillator was relocated at the same site but in a submuscular placement; however, the lesion persisted.

Routine blood examination findings were within normal limits and both blood cultures and intra-operative cultures were negative. The patient was referred to the dermatologist after an interval of 1 month, with a possible diagnosis of refractory cellulitis. Physical examination revealed a slightly warm, non-indurated, erythematous plaque with ill-defined margins and a reticulate appearance (more evident with dermoscopy), located on the left side of the chest [Figure - 1]. The device could be felt on palpation, which had been previously deeply implanted and there was no loco-regional lymph node enlargement. No systemic or local symptoms were observed. In view of the absence of clear signs of infection, a skin biopsy was performed. The histopathological study revealed spongiotic dermatitis with telangiectatic vessels in the papillary dermis and a mixed inflammatory infiltrate. These findings suggested reticular telangiectatic erythema [Figure - 2]. The concomitant antibiotics were discontinued and therapy was initiated with methylprednisolone aceponate cream once a day. The erythematous plaque showed clinical improvement progressively and after 1-week, complete resolution was observed [Figure - 3]. Corticosteroid treatment was suspended after 2 weeks and no immediate recurrence was observed. A 6-month follow-up revealed complete remission.

Figure 1: Reticular telangiectatic erythema: Erythematous plaque located on the left side of the chest, showing the scar at the insertion site and the superior border of the subcutaneous implantable cardioverter defibrillator
Figure 2
Figure 3: Resolution of reticular telangiectatic erythema after treatment with topical corticosteroid cream

In 1981, the first case of reticular telangiectatic erythema was described by Gensch and Schmitt.[1] This rare entity is characterized by painless erythema with slightly prominent telangiectasia, associated with the placement of a medical device.[1],[2] Most of the cases found in medical literature appear after placement of an implantable automatic cardioverter defibrillator or a pacemaker, however, some cases have also been described with prostheses and infusion pumps.[2] Reticular telangiectatic erythema may develop weeks or even months after the intervention.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] Although its pathophysiology is not completely clear, some authors suggest that it is likely due to the development of changes in the microcirculation secondary to the healing process, generating an obstruction of blood flow caused by the device or by the anatomical characteristics of the implanted sites.[2],[7],[15] Allergic contact dermatitis to some of the components of the devices is one of the entities which must be taken into account as a differential diagnosis, besides local infection.[3],[4],[5] According to the literature, however, it is not necessary to perform skin tests in all patients for confirmation of diagnosis.[6],[7],[8],[9] The clinical course of reticular telangiectatic erythema consists of spontaneous resolution,[9],[12],[14] with or without treatment, as observed in our patient; whereas in other cases, disappearance or partial improvement is seen after device removal.[2],[4],[6],[8],[11] In any case, therapeutic management should always include reassurance to the patient and observation.

There are only a few described cases of reticular telangiectatic erythema associated with medical devices.[2],[15] However, it is believed that this low incidence rates may be attributed to missed diagnosis due to lack of awareness.[7]

We performed a review of all the cases reported in medical literature after implantation of a cardiac device and found a total of 26 cases. Twenty (77%) cases of reticular telangiectatic erythema occurred in male patients and 2 (7,6%) in women (sex was not available in 4 patients). Time of onset for the development of reticular telangiectatic erythema was available for 17/26 cases; it was observed in 9 (53%) within the first 3 months after implantation and in 15 (88.2%) within the first 2 years. Only in 2 cases, reticular telangiectatic erythema was observed after 4 or 5 years.[3],[6] Histopathological assessment was performed in 21 (80.7%) patients, which was consistent with telangiectatic blood vessels in the papillary dermis and superficial perivascular lymphohistiocytic infiltrate. Patch testing was carried out in 18 (69.2%), showing negative results in all cases. Nine (35%) patients received treatment. In patients receiving topical corticosteroids and/or oral antibiotics, no changes were observed in the reticular telangiectatic erythema, except in our case. On the other hand, with replacement or removal of the device performed in 5 (19.2%) patients, 3 (60%) experienced resolution, 1 (20%) partial improvement, and 1 (20%) showed no changes.[2],[6],[10],[11]

Furthermore, the general course of reticular telangiectatic erythema without treatment in 12 (46.1%) patients revealed no changes in 6 (50%),[1],[7],[15],[16] spontaneous resolution in 3 (25%),[9],[12],[14] and partial improvement in 3 (25%).[2],[4],[8]

In summary, we present a new case of reticular telangiectatic erythema with a successful outcome. Dermatologists and specialists in medical device placement, such as cardiologists and traumatologists, should be familiar with this benign clinical entity as it may prevent aggressive procedures involving unnecessary replacement or extraction, as in our case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Gensch EG, Schmitt CG. Circumscribed reticular telangiectatic erythema following implantation of a heart pacemaker. Hautarzt 1981;32:651-4.
[Google Scholar]
2.
Aneja S, Taylor JS, Billings SD, Honari G, Sood A. Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema. Contact Dermatitis 2011;64:280-8.
[Google Scholar]
3.
Kopera D, Auer-Grumbach P, Cerroni L, Smolle J. Pacemaker erythema with telangiectasis. Hautarzt 1994;45:716-8.
[Google Scholar]
4.
Krasagakis K, Vogt R, Tebbe B, Goerdt S. Persistent telangiectatic erythema associated with an automatic implantable cardioverter defibrillator. Br J Dermatol 1997;136:633.
[Google Scholar]
5.
Wimmershoff MB, Landthaler M, Stolz W. The artificial pace- maker erythema. Dtsch Med Wochenschr 1998;123:441.
[Google Scholar]
6.
Dinulos JG, Vath B, Beckmann C, Welch MP, Piepkorn M. Reticular telangiectatic erythema associated with an implantable cardioverter defibrillator. Arch Dermatol 2001;137:1259-61.
[Google Scholar]
7.
Herbst RA, Weiss J. Reticular telangiectatic erythema associated with an implantable cardioverter defibrillator: an underpublished entity? Arch Dermatol 2003;139:100-1.
[Google Scholar]
8.
Lin YC, Chiu HC, Chu CY, Sun CC. Telangiectatic pacemaker erythema. Clin Exp Dermatol 2003;28:447-8.
[Google Scholar]
9.
Pitarch G, Mercader P, Torrijos A, Martínez-Menchón T, Fortea JM. Reticular telangiectatic erythema associated with an implantable cardioverter defibrillator. Cutis 2006;78:329-31.
[Google Scholar]
10.
García SM, González IR, Sambucety PS, Rodríguez Prieto MA. Reticulated telangiectatic erythema associated with automatic implanted defibrillator. J Eur Acad Dermatol Venereol 2008;22:115-6.
[Google Scholar]
11.
Martin LK, Wendschuh P, Wendschuh P. Reticulated telangiectatic erythema of the pacemaker. Pacing Clin Electrophysiol 2008;31:624-6.
[Google Scholar]
12.
Rodríguez-Lojo R, Verea MM, Godoy J, Barja JM. Reticular telangiectatic erythema in a patient with a cardioverter defibrillator. Actas Dermosifiliogr 2010;101:183-4.
[Google Scholar]
13.
Hinterberger L, Müller CS, Vogt T, Pföhler C. Reticulated teleangiectatic erythema after implantation of medical devices. An increasingly occurring phenomenon? Hautarzt 2011;62:770-3.
[Google Scholar]
14.
Ringrose JS, Banerjee T, Hull PR. Angiosarcoma-like presentation of pacemaker-related vascular proliferation. Clin Exp Dermatol 2012;37:143-5.
[Google Scholar]
15.
Ocampo OV, Marín VM, Idarraga JC. Reticulated telangiectatic erythema related to an implantable carioverter defibrillator: Case report and review of the literature. Dermatol Argent 2012;18:49-52.
[Google Scholar]
16.
Beutler BD, Cohen PR. Reticular telangiectatic erythema: Case report and literature review. Dermatol Pract Concept 2015;5:71-5.
[Google Scholar]

Fulltext Views
1,676

PDF downloads
1,771
Show Sections