Letters to the Editor body during the span of 10 years and the lesions progressed which caught fire resulting in burns. The burns were managed only in a linear distribution causing only mild pruritus. In conservatively with topical ointment application. Satisfactory addition, histopathology revealed features of psoriasis and the healing was achieved within 2 weeks without residual scarring. lesions responded well to treatment. Fire breathing is a stunning but potentially injurious stunt. The Nidhi Singh, Naseem Noorunnisa1 fire-breathers direct a mouthful of fuel forcefully or creates a Departments of Dermatology and 1Pathology, Sri Venkateshwaraa fine mist by spitting through pursed lips which is ignited over a Medical College Hospital and Research Centre, Ariyur, flame resulting in a stunning visual show of plume, pillar, ball, Puducherry-605102, India volcano, or a cloud of fire [Figure 2]. The important thing in this Address for correspondence: Dr. Nidhi Singh, process is controlling the fuel’s direction and the consistency of Department of Dermatology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry 605102, India. E-mail: [email protected] Access this article online Quick Response Code: Website: www.idoj.in DOI: 10.4103/2229-5178.93489 REFERENCES 1. Chien P Jr, Rosenman K, Cheung W, Wang N, Sanchez M. Linear psoriasis. Dermatol Online J 2009;15:4. 2. Happle R. Somatic recombination may explain linear psoriasis. J Med Figure 1: Fire-breathing burns Genet 1991;28:337. 3. Morag C, Metzker A. Inflammatory linear verrucous epidermal nevus: Report of seven new cases and review of the literature. Pediatr Dermatol 1985;3:15-8. 4. de Jong E, Rulo HF, van de Kerkhof PC. Inflammatory linear verrucous epidermal naevus (ILVEN) versus linear psoriasis: Clinical, histological and immunohistochemical study. Acta Derm Venereol 1991;71:343-6. 5. Bondi EE. Psoriasis overlying an epidermal nevus. Arch Dermatol 1979;115:624-5. Fire-breathing burn Sir, Fire breathing is one of the most skillful and the most dangerous acts of all the fire arts. This stunt is commonly performed by jugglers, magicians, and entertainment performers by spitting out a jet of inflammable liquid over an open flame producing a spectacular “breath of fire.” Since the process involves fire and inflammable fuel, fire-breathing accidents can result in significant burn. A 26-year-old fire-breather presented with a 3% area of superficial partial thickness perioral burns in a typical spilt- fluid pattern [Figure 1]. The patient sustained the injury while exhibiting a fire-breathing act in an entertainment show. The patient used naphtha as the ignition medium and not too forceful blow resulted in spillage of the material around the mouth Figure 2: Fire-breathing show Indian Dermatology Online Journal - January-April 2012 - Volume 3 - Issue 1 73 Letters to the Editor the spray. The choice of fuel also plays an important role in a immediate availability of the medical help, awareness of fire-breather’s technique. The important factors in choosing a local fire safety regulations and permits if required, keeping fuel includes flash point, toxicity, odor, color, visibility of flame, onlookers at a safe distance, and the strict nonperformance of amount and thickness of the smoke produced. The flash point the act under the influence of alcohol or drugs.[1,2,5] The above of a fuel is the temperature at which vapor given off will ignite mentioned recommendations will not only ensure the safety of when an external flame is applied under test conditions. Higher the performer, but will also keep the audience safe. flash point fuels are safer and preferable for the act. Usually, a pure fuel is used; however, a mixture of fuels is often used by Sanjay Saraf the performers to enhance the visual effect. The consideration Department of Plastic Surgery, NMC Specialty Hospital, of angle of the fuel and flame is also important. The lower angle Dubai, UAE can make the flame fall on the body, while the higher angle can Address for correspondence: Dr. Sanjay Saraf, cause unignited fuel to fall back into the face. Department of Plastic Surgery, NMC Specialty Hospital, Dubai, UAE. Various types of fuels used for fire breathing are liquid E-mail: [email protected] hydrocarbons including Naphtha’s (Zippo), gasoline (petrol), diesel; alcohol (methanol, ethanol); liquidified natural gases Access this article online (propane, butane); and various types of oils including mineral, Quick Response Code: kerosene (paraffin), and lamp oils.[1,2] The kerosene and purified Website: www.idoj.in unscented lamp oil are the commonly used fuels as they have a high flash point (~90°C), making them a safer choice. The DOI: naphtha is usually considered as a dangerous fuel choice for fire 10.4103/2229-5178.93491 breathing because of its low flash point and high volatility. The methyl alcohol is extremely toxic and has extremely low flash point; ethyl alcohol in addition allows drunkenness and should REFERENCES be avoided for the fire work. For igniting the fire, flaming juggling torches are the preferred choice, while matches are considered 1. McCleave M, Greenwood J. Burn injuries caused by fire breathing. unsafe as they keep the performer’s hand dangerously close to Burns 2005;31:520-3. the flame. Gas lighters are also not used as they can explode 2. Available from: http://www.homeofpoi.com/lessons_all/teach/Library- in the hand. Fire-Breathing-Introduction-Fire-Breathing-11_52_194. [Last accessed on 2011 May]. There are several immediate and long-term health hazards 3. Aboudara M, Yun J. A case of fire-eater’s pneumonia in an active-duty soldier. Med Gen Med 2006;8:67. associated with fire-breathing act. Burns are the most obvious 4. Karacan O, Yilmaz I, Eyüboglu FO. Fire-eater’s pneumonia after fire-breathing danger; however, there could be facial hair aspiration of liquid paraffin. Turk J Pediatr 2006;48:85-8. loss, ingestional toxicity, cutaneous irritation, peptic ulcers, 5. Available from: http://www.nafaa.org/ppt. [Last accessed on 2011 fire-eater’s pneumonia (hydrocarbon pneumonitis/chemical May 18]. pneumonia),[3,4] inhalational injuries, and Acute Respiratory Distress Syndrome. The post-burn perioral hypopigmentation referred to as leucoderma can cause significant cosmetic concerns in dark-skinned individuals and often leads to adverse Generalized papular psychosocial impact. Naphtha is quite carcinogenic and fuels like gasoline and kerosene often contain carcinogenic additives granuloma annulare or refining byproducts, such as sulfurated compounds or benzenes. Sir, Granuloma annulare (GA) is a benign, inflammatory It is well known among fire manipulators that they will at some dermatosis with no proven etiology. It involves dermis or stage sustain burns.[1] Fire safety should be the number one subcutis in a process characterized by necrobiosis surrounded priority for this art. The recommended fire safety measures by lymphohistiocytes. Various morphological forms are are professional training, awareness of the hazards involved, described, including localized, generalized, perforating and using the right fuel, availability of Manufacturers Safety subcutaneous.[1] Generalized GA (GGA) is a rare variant seen Data Sheet, avoidance of “blow-back,” having an assistant, in 8−15% of cases. Multiple skin colored, pink, or violaceous awareness of the surroundings including power cables and papules coalescing to form annular plaques are the commonest trees with low hanging branches, flame-resistant clothing, use presentation of the GGA, but the distinctive papular morphology of fire-proofing chemicals to coat the mouth, knowledge of the in the absence of the plaques is a rare phenomenon for the first aid, immediate access to fire extinguishing equipments, generalized variety and presents a diagnostic dilemma. 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