In the current case study we present a patient with type 1 diabetes mellitus and bulimia nervosa who reported intentionally restricting her insulin intake in order to avoid hypoglycaemic episodes. However, she was not concerned about the occurrence of the typical symptoms of hypoglycaemia such as shaking, sweating, drowsiness, nausea, poor motor coordination, mental confusion or unconsciousness. Her fear of hypoglycaemia was solely based on her perception that hypoglycaemia would inevitably lead to binge eating.
With the help of regular food intake, optimised insulin treatment and psychological help, the patient succeeded in reducing the number of binge eating episodes and in achieving a better control of her bulimic symptoms as well as of her diabetes mellitus.
Erythema ab igne (EAI) is a skin lesion, which is characterized by a localized netlike erythema. For the occurrence of the dermatosis a continuous or regular heat exposure and infrared radiation to a skin area is necessary. The reticulated maculae could fade after stopping the heat exposure, persist as hyperpigmentation and in single cases a malignant transformation is possible. We present a patient with bulimia nervosa (BN), who developed an EAI after consequent use of a hot-water bottle. In the context of the eating disorder the patient reported a general feeling of cold. She avoided the contact with the abdomen to prevent a stimulation of the digestion. Therefore the EAI was located predominantly on the medial thighs. After stopping the heat application the EAI faded slightly in the periphery und turned browner.
Zusammenfassung
Das Erythema ab igne (EAI) ist eine Hauterkrankung, die sich durch ein ?rtlich begrenztes, netzf?rmiges Erythem auszeichnet. F?r die Auspr?gung der Hauterscheinung ist eine kontinuierliche oder regelm??ige W?rmeanwendung oder Infrarotbestrahlung auf einem Hautareal notwendig. Die retikul?ren Maculae k?nnen nach Unterlassen der W?rmeanwendung verblassen, jedoch bei chronischer W?rmeanwendung in Form einer Hyperpigmentierung persistieren und in Einzelf?llen die Gefahr einer malignen Entartung in sich tragen. In dem vorgestellten Fall wird eine Patientin mit einer Bulimia nervosa (BN) dargestellt, die aufgrund konsequenter Anwendung einer W?rmflasche ein EAI ausbildete. Durch ein subjektives K?ltegef?hl im Rahmen ihrer Erkrankung hatte die Patientin auf die W?rmeapplikation zur?ckgegriffen. Sie vermied den Kontakt mit dem Bauch, um ?die Verdauung nicht ?berm??ig anzuregen?, sodass sich das EIA ?berwiegend an den Oberschenkelinnenseiten befand. Nach Unterlassen der W?rmeanwendung konnte peripher des EIA ein beginnendes Abblassen beobachtet werden und es nahm einen br?unlicheren Farbton an.
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