Lichtenberg figure and lightning.

Sir,

Lightning is a very powerful and spectacular natural phenomenon, earlier interpreted as divine punishment. It was only in 1752 that Benjamin Franklin discovered that lightning is electricity. It can be a potentially devastating cause of injury and death in humans, affecting mostly the cardio-respiratory, nervous, and integumentary systems.

A 28-year-old female patient residing in a nearby village was struck by lightning in the month of July 2014, inside her house early morning, as she was standing by the side of her bed. A flash of lightning penetrated through their thatched house and hit her suddenly from the left side, making her to lose consciousness for about an hour. On recovering, she experienced only pain and burning over the affected sites, which persisted, and she presented to our outpatient department a week later.

General examination showed anemia. There was neither any cardiological abnormality nor any neurological deficit. Cutaneous examination showed hyperpigmented, slightly, scaly lesions and erosions in an almost continuous pattern, over the entire left side of her body, suggestive of a linear pattern of lightning injury to the skin [Figure 1]. The striking feature was the presence of a horizontally placed linear hyperpigmented macule over her back, with the branches fanning out to the periphery. This corresponded to the pathognomonic integumentary change produced by lightning; the Lichtenberg figure [Figure 2]. Lichtenberg figures disappeared after a week without a sequel.

Figure 1

Photograph showing the linear pattern of cutaneous change extending from the submammary region (L) to the popliteal fossa (L)

Figure 2

Photograph showing the characteristic of “Lichtenberg figure.”

Lichtenberg figures are specific to individuals struck by lightning, either by a direct strike, a side flash, or ground voltage. They appear within an hour and disappear by 48 hrs. Our patient was probably hit by a side flash; her lesions persisted much longer. Four types of superficial burns or skin changes may occur: linear, punctate, feathering, or thermal burns. Linear burns are partial thickness burns that occur over the moisture rich areas of the body. Punctate burns appear as multiple, small cigarette-like burns in a rosette-like pattern. Thermal burns occur when the lightning ignites or melts the clothing. Feathering burns are not true burns; they produce the pathognomonic ferning pattern on the skin known as Lichtenberg figures.[12]

Named after the discoverer, Georg Christopher Lichtenberg, Lichtenberg figures occur due to high voltage discharge on or within the insulating material. A lightning strike produces around 30 million volts/50,000 amperes of electric current to flow through the victim's body. Skin being a relatively good insulator, a similar pattern is seen in lightning strike victims. The intensive electron flow is estimated to cause dielectric degradation of the skin and red blood cell leakage to the superficial skin layers from the capillaries.[3]

Unlike skin, the nervous tissue has very low electrical resistance, and the nervous system suffers most from a lightning injury, ranging from transient benign symptoms to permanent disability. Injuries of the cardiovascular system are common in lightning strike victims; patients mostly go into asystole, following the impressive shock. The most common cause of death in the lightning strike victims is a cardiopulmonary arrest.[456]

Our patient suffered from the lightning strike indoors, developed the characteristic skin changes, lost consciousness for an hour, and recovered without a sequel. This is quite in contrast to report of patients, who mostly suffer from injuries outdoors and are brought for medical assistance either with a retrograde amnesia, or unconsciousness. Lichtenberg figures are extremely helpful not only in the diagnosis and the proper management of these patients but prove to be a vital evidence for testifying the autopsy reports in patients brought dead.

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