An Old, New Diagnosis

The middle aged woman started to pull down her jeans as she explained:

“I want you to look at this rash on my leg. I’ve had it for a month now.”

What I saw got my mind churning. On top of her left thigh was a brown discoloration about the size of the palm of my hand. It had a reticular pattern, like a coarse lace doily or irregular fish net. It was light brown, smooth to the touch and didn’t blanch when I pressed on it.

I knew I had read something about rashes that looked like that, but I couldn’t remember any details. So I did what I often do, I googled the description:

(Images) Brown reticular erythema.

Almost instantly I saw a perfect picture of the woman’s rash. The caption read “Erythema ab igne”.

Yes, that was it, but what was it again?

My trusted Wikipedia had a tidy little entry that echoed with memories in the recesses of my mind. I printed it out for her. It described the rash as often occurring in older patients who used hot water bottles or, in the old days, stood too close to the fire to keep warm.

I didn’t think my patient slept with a hot water bottle only on her left thigh.

“Is anything warm often touching that spot?” I asked.

“Yeah, my laptop”, she answered instantly.

“Try putting a folded towel or something between your leg and your laptop”, I said as we wrapped up her visit.

What an odd symmetry, I thought to myself: A diagnosis of historical interest, brought back by the use of modern technology and identified by the very device that causes it.

4 Responses to “An Old, New Diagnosis”

  1. 1 Robyn E Newell October 13, 2017 at 1:11 pm

    Very cool! I love reading your posts!

  2. 2 sam October 13, 2017 at 2:38 pm

    Reminds me of my friends slowly developing black thumb. Turns out it was the leather dye slowly leeching from his motorcycle glove onto his hand. Duh.

  3. 4 Will June 14, 2021 at 11:59 am

    I might just move to where you are to have you as my doctor!!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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