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July 2009

Reticulated Erythematous Plaque on the Back—Diagnosis

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Arch Dermatol. 2009;145(7):829-834. doi:10.1001/archdermatol.2009.141-b

Low-power histologic examination revealed a “squared-off” biopsy specimen. The epidermis demonstrated overlying compact hyperkeratosis. The dermis was remarkable for hyalinized, swollen eosinophilic collagen bundles with loss of hair follicles and eccrine glands but persistent arrector pili muscle. Telangiectasias were prominent in the superficial dermis with surrounding enlarged pleomorphic fibroblasts consistent with “radiation fibroblasts.”

On further questioning, the patient had undergone a transjugular intrahepatic portosystemic shunt (TIPS) placement several weeks prior to the onset of the cutaneous eruption. Fluoroscopic procedures have become more commonplace in modern medical practice with the increasing popularity of minimally invasive techniques. They include diagnostic studies as well as interventional coronary procedures (eg, angioplasty, stent placement, radiofrequency ablation) and TIPS placement.1 These procedures involve a relatively high amount of radiation exposure and have been associated with radiation-induced skin injury.2 This risk has increased as the procedures have become longer, more frequent, and more complex.3

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