Lightning Flowers

(A topic I found interesting in my physical diagnosis course during my 4th year of medical school…and subsequently wrote a little summary of…at this point many of the image links are broken, but they were all found using google images.  I also apologize for the formatting, when I imported this post from my old blog some of the formatting got messed up. If  you have an interest in emergency medicine related topics and stores, please check out the main page)

Licthenberg figures, also know as Lichtenberg flowers, lightning flowers or Keraunographic markings (Keraunos is Greek for thunderbolt) are strange, non blanching, erythematous marks on the skin appearing after a person has been struck by lightning.  The mark has a feathered, arborescent, or dendritic pattern and this injury is pathognomic of a lightning strike

The mark is named for Georg Christoph Lichtenberg (1742-1799), a German scientist and professor of experimental physics.  At Gottingen University, Lichtenberg did research in a wide variety of fields, including geophysics, volcanology, meterology, chemistry, astronomy, and mathematics. As a physicist,  he is most remembered for his investigations in electricity, especially for discovering the branching patterns of electricty upon discharge. At one point he built a gigantic electrophorus and by discharging a high voltage near an insulator, he was able to record strange tree like patterns in dust, figures which would later become known as Lichtenberg figures.  

Of note, with this priciple he also discovered the most basic form of modern xerography now seen in today’s modern copy machines. He also proposed the standardized paper system used all over the world today, with A4 is the most commonly used size.

When Lichtenberg’s figures were first discovered, it was thought that the characteristic shapes might help to reveal the nature of positive and negative electric “fluids”.   Although Lichtenberg only studied 2 dimensional figures, modern high voltage researchers study both 2D and 3D figures. Through subsequent study,  Lichtenberg figures are now know to be examples of fractals, a geometric figure that repeats itself under several levels of magnification.

( 3D Lichtenberg figure)
 Human skin and in the laboratory are not the only place that this figures appear. A lightning strike can also create a large lichtenberg figure in grass surrounding the impact point. These large scale figures are commonly found on golf courses or in meadows. When they occur in sand or soil, they are commonly referred to as fulgarites as the sand is fused into glassy tubes by the intense heat of the strike.
However, it is not the heat that is thought to cause these marks on humans.  Lighting flowers that appear on human skin following a lightning strike were initally thought to be causes by the rupture of small capillaries under the skin due to the passage of the lightning current, or the shock wave from the lightning discharge as it flashes over the skin. However, because the arborescent or feathering pattern of a lichtenberg figure resembles the dendritic marks often seen on x-ray film due to static electricty, it has been hypothesized that the cutaneous markings are due to showers of electrons tracking or showering on the skin during the lightning strike. They are not considered to be thermal burns and usually disappear within 24 hours. Histological examination of Lichtenberg flowers reveals normal epidermis and dermis with focally extravasated red blood cells in the subcutaneous fat. This subcutaneous vascular congestion may explain the brown or erythematous coloration, but the rapid, non scarring resolution of the coloration remains a mystery.

But how important is the Lichtenberg flower in today’s modern medicine? How often does it occur and is it a reliable indicator of the offending trauma? Lightning causes approximately 1000 injuries each year in the U.S. and is the second leading cause of weather related death, with approximately 100 reported deaths each year. Reported mortality rates vary from approximately 0.5 per million in the general U.S. population to as high as 8.8 per million in the rural African populations. Here in the U.S., rates are highest in the southeastern states with Florida reporting lightning fatalities at nearly 5 times the national average.

Approximately 70-90% of individuals struck by lightning survive, but as many of three quarters of these survivors may have permanent sequela. The injuries associated with lightning can invole the cardiorespiratory, neurologic, cutaneous, opthalmologic and otologic systems. Interestingly, lightning injury associated with indoor telephone use during lightning storms has been reported. One Australian study identified up to 80 such injuries yearly.

Most of the hard data surrounding Lichtenberg’s flower  is of the observation or case report variety. Given the obviously uncontrollable nature of a lightning strike, a controlled study of this clinical finding is unrealistic. One study observed these figures in 13 of the 40 cases of lightning strikes, while another case report noted it occurring in 7 out of 7 victims.. Regardless of its frequency of occurance, Lichtenberg’s figure remains an important clinical finding to know for several reasons. Keraunographic marking is pathognomic of lightning strike. No other electrical injury produces this clinical finding. Thus, if observed on the body of someone found unresponsive, it indicates the person was a victim of lightning and might benefit from aggressive resuscitation, even if onset is delayed, as strike victims are particularly responsive to resuscitation.
Most individuals have had a basic interest in the phenomena of thunder and lightning at some point in their lives, or have at least been warned about the dangers of playing golf in a storm. As such, this is a valuable clinical finding to teach to medical students, perhaps as early as the first year, as its is a simple, straightforward finding with a high “cool” factor that can have significant impact on patient care.

References: (I can’t figure out how to remove the highlighting from some of these, sorry. )

Wetli CV. Keraunopathology: an analysis of 45 fatalities. Am J Forens Med Pathol. 1996; 17:89–98.
Centers for Disease Control and Prevention: Lightning-associated injuries and deaths among military personnel—United States 1998–2001. MMWR Morb Mortal Wkly Rep 51: 859, 2002.

Lightning Safety Facts. U.S. National Oceanic and Atmospheric Administration. Available at:

Bartholome CW, Jacoby WD, Ramchand SC. Cutaneous manifestations of lightning injury. Arch Dermatol 1975;111:1466-8.

Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med1980;9:134-8.Muehlberger T, Vogt PM, Munster AM: The long-term consequences of lightning injuries. Burns27: 829, 2001.

Edlich R, Drake D. Burns, Lightning Injuries.

Andrews CJ: Telephone-related lightning injury. Med J Aust 157: 823, 1992.
Resnik, Barry I. M.D.; Wetli, Charles V. M.D. Lichtenberg Figures The American Journal of Forensic Medicine and Pathology Issue: Volume 17(2), June 1996, pp 99-102

Ghezzi KT. Lightning injuries: a unique treatment challenge. Postgrad Med 1989;85:197-208.

Ohashi M, Kitagawa N, Ishikawa T. Lightning injury caused by discharges accompanying flashovers: a clinical and experimental study of death and survival.Burns 1986;12:496

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 22, 2011, in Emergency Medicine. Bookmark the permalink. 6 Comments.

  1. >i have heard of this before. What amazing pictures and story. Thank you!

  2. >"What treatment, in an emergency, is administered by ear?"

  3. >Great post! I went to an Expedition Med conference a few years ago and one of the presenters was a clinical nurse specialist who is a lightening strike expert–her job is to travel around the US and document/guide care of patients who have been struck. Hers was by FAR one of the most interesting presentations (aside from the docs who live/conduct research from a basecamp on Denali). She had some CRAZY photos of lightening strike scenes plus all the wild patient photos. The 'ferning pattern' as she called it was totally fascinating to me, as was some of the burn patterns from pieces of metal (jewelery, underwires in bras, etc.). Really amazing/interesting area of medicine. All I could think was "no one ever told me THAT job existed when I was in high school!" hahah

  4. >thankyou for the pictures! they really helped me remember my theory!

  5. Thank you for the story. But I can’t see most of the pictures above. I don’t
    Know why. Maybe just because I’m in China and behind the GFW, what a shame… I believe them will be very helpful for my forensic lesson. So would you please to send those pictures through email? Thank you again.

  1. Pingback: Can you pick the cause of this injury? »

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