Is postsurgical sternal erythema synonymous with reticular telangiectatic erythema?

Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema

“…However, the two conditions differ in the presence of pain over the affected area, which is only seen in the case of impending pacemaker extrusion. Similarities between RTE and pathologies such as sternal erythema prompted Bowers et al to suggest that many of these skin findings represent ‘a larger and incompletely understood phenomena’(35, 36). The clinicopathological features of our case 1 were consistent with a diagnosis of RTE.…”

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“…1 In essence, he compellingly asserts that sternal erythema may not be an entity sui generis, but represent a forme fruste of reticular telangiectatic erythema. 2 Reticular telangiectatic erythema has been reported in conjuction with cardiac devices and an implanted intrathecal infusion pump. [3][4][5] 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).…”

“…In fact, psoriasis patients with risk factors for NASH display liver fibrosis at a lower cumulative methotrexate dose than those patients without risk factors, and methotrexate likely aggravates pre-existing NASH, implying that the patients with psoriasis at greatest risk while receiving methotrexate are those with diabetes, obese patients, and people who drink alcohol. 2 Verily, obesity and alcoholism may represent inherent phenotypes of psoriatic patients that increase hepatotoxic risk.…”

“…If these studies were controlled for these confounding factors, then the methotrexate-related liver injury rate in patients with psoriasis would closely resemble that of RA patients. 2,3 Therefore, in our opinion, when evaluating a patient for methotrexate treatment, risk factors such as alcohol consumption, obesity, diabetes, previous exposure to liver toxins, and viral hepatitis should be considered. In short, the clinical scenario of each patient must dictate the necessity of the liver biopsy.…”

“…4 Furthermore, more recent data suggest that 3.5 to 4.0g, instead of 1.0 to 1.5 g, of cumulative methotrexate dose should prompt the first liver biopsy in patients without preexisting risk factors for hepatotoxicity. 2,5 Only those patients with one or more risk factors for hepatic fibrosis should be followed using the current AAD guidelines. All…”