Heater-Associated Erythema Ab Igne: Case Report and Review of Thermal-Related Skin Conditions

Abstract

Erythema ab igne is a thermal-associated skin condition that can occur secondary to persistent direct or indirect contact with heat. Historically, erythema ab igne has been linked to fireplace and stove exposures; more recently, it has been associated with heaters, hot water bottles, and laptops. A 48-year-old woman presented for the evaluation of hyperpigmented, reticulated macular lesions on her distal legs. Additional history revealed that she had developed erythema ab igne secondary to the use of a space heater underneath her desk at work. Her skin condition stopped progressing with removal of the causative agent. In addition to erythema ab igne, heatrelated skin conditions include basal cell carcinomas and squamous cell carcinomas, burns, erythromelalgia, subtypes of urticaria, and ultraviolet-associated disorders. Awareness of thermal-associated skin conditions enables the clinician to establish the appropriate diagnosis based on the associated history of the condition, the morphology of the skin lesion, and, if necessary, correlation with the skin biopsy findings of the cutaneous condition.

Erythema Ab Igne: A Rare Presentation of Toasted Skin Syndrome With the Use of a Space Heater

“…A rare variant includes crusting bullous lesions overlying the reticular rash. Though it is a benign rash that resolves quickly within a few weeks to months, rare complications decades after exposure include transformation into cutaneous squamous cell carcinoma, Merkel cell carcinoma, and heat-induced basal cell carcinoma in regions of the body without direct sun exposure, such as the perineum [ 5 - 7 ]. Common differential diagnoses include livedo reticularis, autoimmune connective tissue disorders, cutis marmorata, and livedo racemosa [ 8 ].…”

“…Additionally, the release of melanin from heat-induced damage to elastic fibers and basal cells imparts the characteristic reticular rash in a vascular pattern [ 4 ]. While it usually resolves in weeks to months after the removal of the heat source, the rash has a propensity to become permanent, and in some cases, transforms into cutaneous malignancies [ 5 - 7 ]. Both patients and providers must be aware of the association of this rash with repeated heat exposure.…”

Erythema Ab Igne with Histological Features of Keratosis Lichenoides Chronica

“…Skin lesions typically occur on the anterior lower legs or the trunk but may be confined to the face and arms especially in chefs and cooks who work over an open fire [2, 12]. Early lesions commonly present as transient, blanchable erythema; however, over time, and with prolonged heat exposure, the involved area evolves into a nonblanchable reticulated hyperpigmentation that may be associated with superficial atrophy and telangiectasias.…”

“…Erythema ab igne (EAI) is an uncommon cutaneous condition characterized by localized areas of reticulate hyperpigmentation, epidermal atrophy, and at times, telangiectasias and subepidermal bullae [ 1 , 2 ]. Changes in the skin typically occur from repeated exposure to direct heat or infrared radiation and develop over the course of weeks to years at temperatures that are insufficient to cause burns [ 3 ].…”

Erythema Ab Igne in a 12-Year-Old Boy Diagnosed via Telemedicine

“…Livedo racemosa is an irregular violaceous discoloration of the limbs or more widespread on the body of adolescents and adults and is associated with underlying systemic disorders. It is prudent for clinicians also to be aware of other dermatologic disorders that can result from thermal exposure, such as basal cell carcinoma and burns, as described in the review by Forouzan et al [ 12 ].…”