Lightning strikes are natural phenomena that deliver electrical and thermal trauma to the human body. Survivors often present with a range of cutaneous injuries, which serve as visual evidence of the high-voltage event. These skin marks vary widely, from temporary, feather-like patterns to deep, permanent tissue destruction. Recognizing the characteristics of these markings is fundamental to understanding the severity of the electrical exposure.
The Appearance of Lichtenberg Figures
The most distinctive mark associated with a lightning strike is the Lichtenberg figure, also known as ferning patterns. These marks are characterized by their reddish, fern-like, or branching appearance, exhibiting a fractal geometry on the skin’s surface. The patterns are not true burns but rather a form of temporary skin change.
These figures are typically flat, non-raised, and asymptomatic. They appear quickly, often within the first hour after the strike, and their reddish color results from superficial capillary damage or temporary dilation of small blood vessels just beneath the skin. Lichtenberg figures are considered pathognomonic, meaning their presence is a definitive sign of a lightning injury.
Other Types of Lightning-Related Skin Damage
While the ferning pattern is unique to lightning, other types of skin injuries are commonly observed and represent actual thermal damage. Linear burns appear as lines or streaks, often partial-thickness wounds, found in areas where moisture, such as sweat or rain, collected on the body. The lightning current heats this moisture so rapidly that it instantly vaporizes into steam, causing a superficial scald burn along the path of the vaporized layer.
Punctate burns appear as small, circular, discrete lesions, usually only a few millimeters to a centimeter in diameter. These marks can be partial or full-thickness burns and frequently represent the points where the current entered or exited the body. Contact burns also occur when the lightning current superheats metallic objects worn by the victim, causing localized, deeper burns on the skin underneath.
The Mechanism of Scar Formation
The appearance of the skin marks is directly related to how the high-voltage current interacts with the body’s natural resistance. The formation of the superficial Lichtenberg figures is linked to the “flashover” phenomenon, where the current travels over the surface of the skin rather than passing deeply through the body. This surface discharge is due to the skin’s relatively high resistance, especially when wet, which forces the current to seek the path of least resistance across the body.
Conversely, linear burns and punctate burns involve the actual transfer of thermal energy. Linear burns occur from the flash vaporization of surface moisture, while punctate wounds mark the discrete, high-resistance points where the current concentrates to enter or exit the deep tissues. Although lightning strikes are extremely short in duration, the current and intense heat at these entry or exit points cause localized tissue destruction, resulting in true thermal injury.
Healing and Long-Term Prognosis
The transient nature of the Lichtenberg figures is a defining characteristic, as they typically fade quickly, usually within a few hours or 48 hours after the strike. Because these marks are not true thermal burns and involve no damage to the underlying epidermis, they rarely leave permanent scarring or tissue change. In contrast, the true thermal, linear, and punctate burns carry a higher risk for lasting damage, which may manifest as permanent changes in skin pigmentation, hypertrophic scars, or keloids.
Even when skin wounds heal completely, a significant long-term concern for survivors is neurological damage. Many survivors experience chronic issues such as neuropathy, persistent pain, or paresthesias, indicating the nervous system is often affected by the electrical trauma. The overall prognosis for the skin marks is good, but the systemic effects of the electrical current can lead to lasting morbidity.