eMedicine Specialties > Dermatology > Environmental

Erythema Ab Igne

Author: Robert S Bader, MD, Assistant Clinical Professor, Department of Dermatology, Drexel University College of Medicine; Dermatologist, Section of Dermatology, Department of Medicine, North Broward Medical Center
Contributor Information and Disclosures

Updated: Dec 2, 2009

Introduction

Background

Erythema ab igne (EAI) occurs in skin that is chronically and repeatedly exposed to infrared radiation. Erythema ab igne results in persistent, reticulate, erythematous patches; telangiectasia; and hyperpigmentation.

Pathophysiology

Erythema ab igne is caused by chronic repeated exposure to moderate heat from an external heat source. The exposure, which need not be of long duration, results in cutaneous hyperthermia in the range of 43-47°C, which, in turn, results in histopathologic changes similar to those seen in solar-damaged skin. Although the pathogenic mechanisms in erythema ab igne are poorly understood, one study has shown that moderate heat acts synergistically with ultraviolet radiation to denature DNA in squamous cells in vitro.1

Frequency

United States

Erythema ab igne is rare.

Mortality/Morbidity

Chronic repeated exposure to infrared radiation may result in changes similar to those seen with chronic repeated ultraviolet radiation. Thermal keratosis, squamous cell carcinoma in situ, and squamous cell carcinoma have been reported in patients after chronic exposure to infrared radiation.2 In one 90-year-old woman with erythema ab igne, Merkel cell carcinoma developed adjacent to squamous cell carcinoma.

Sex

Women, in particular those who are overweight, are affected by erythema ab igne more often than men.

Clinical

History

Commonly, patients with erythema ab igne report mild pruritus and burning.

Physical

Mild elevation of skin temperature initially results in mild, transient, often reticulated erythema. With prolonged and repeated exposure, areas of reticular erythema persist and, in time, become livid and hyperpigmented. Rarely, areas affected by erythema ab igne may become bullous or hyperkeratotic3 ; in patients with severe long-standing erythema ab igne, poikilodermatous changes may result. Some believe that a bullous variant of erythema ab igne exists, in which bullae and crusts are present on a base of reticulated erythema.

Causes

The following have been reported as heat sources that resulted in the development of erythema ab igne:

  • Open fires reportedly result in erythema ab igne.
    • Typically, erythema ab igne affects the legs of women aged 40-70 years who use indoor fire as a heat source.
    • Erythema ab igne reportedly affects the face and/or palms of cooks who work over an open fire.
  • Some patients use a heat source (eg, heating pad, hot water bottle, heated recliner, heated blanket) to relieve chronic pain.4 In these patients, determine the etiology of the pain.
    • Heating pads and/or hot water bottles: Erythema ab igne occurs in patients with pain associated with either primary or metastatic malignancy, as well as with pain associated with chronic pancreatitis.5,6,7
    • Heated recliners (reclining chairs): Erythema ab igne has been reported in patients with chronic lower back pain.8
    • A car heater reportedly caused erythema ab igne in one patient.9
    • The application of heated popcorn kernels applied to the skin to reduce arthritic pain caused erythema ab igne in one patient.10
  • More recently, using laptop computers while they are propped on the legs has resulted in the development of erythema ab igne. Some laptop computers can generate significant heat that can result in erythema ab igne when placed on the lap for prolonged periods.11,12,13,14,15
  • One case report describes erythema ab igne in a patient with diabetic neuropathy.16
  • Erythema ab igne has also been described subsequent to sauna belt usage for abdominal obesity.17

More on Erythema Ab Igne

Overview: Erythema Ab Igne
Differential Diagnoses & Workup: Erythema Ab Igne
Treatment & Medication: Erythema Ab Igne
Follow-up: Erythema Ab Igne
References
[ CLOSE WINDOW ]

References

  1. Roth D, London M. Acridine probe study into synergistic DNA-denaturing action of heat and ultraviolet light in squamous cells. J Invest Dermatol. Oct 1977;69(4):368-72. [Medline].

  2. Arrington JH 3rd, Lockman DS. Thermal keratoses and squamous cell carcinoma in situ associated with erythema ab igne. Arch Dermatol. Oct 1979;115(10):1226-8. [Medline].

  3. Kokturk A, Kaya TI, Baz K, Yazici AC, Apa DD, Ikizoglu G. Bullous erythema ab igne. Dermatol Online J. Aug 2003;9(3):18. [Medline].

  4. Dellavalle RP, Gillum P. Erythema ab igne following heating/cooling blanket use in the intensive care unit. Cutis. Aug 2000;66(2):136-8. [Medline].

  5. Ashby M. Erythema ab igne in cancer patients. J R Soc Med. Nov 1985;78(11):925-7. [Medline].

  6. Mok DW, Blumgart LH. Erythema ab igne in chronic pancreatic pain: a diagnostic sign. J R Soc Med. Apr 1984;77(4):299-301. [Medline].

  7. Mucklow ES, Freeman NV. Pancreatic ascites in childhood. Br J Clin Pract. Jun 1990;44(6):248-51. [Medline].

  8. Meffert JJ, Davis BM. Furniture-induced erythema ab igne. J Am Acad Dermatol. Mar 1996;34(3):516-7. [Medline].

  9. Helm TN, Spigel GT, Helm KF. Erythema ab igne caused by a car heater. Cutis. Feb 1997;59(2):81-2. [Medline].

  10. Donohue KG, Nahm WK, Badiavas E, Li L, Pedvis-Leftick A. Hot pop brown spot: erythema Ab igne induced by heated popcorn. J Dermatol. Mar 2002;29(3):172-3. [Medline].

  11. Bilic M, Adams BB. Erythema ab igne induced by a laptop computer. J Am Acad Dermatol. Jun 2004;50(6):973-4. [Medline].

  12. Jagtman BA. Erythema ab igne due to a laptop computer. Contact Dermatitis. Feb 2004;50(2):105. [Medline].

  13. Mohr MR, Scott KA, Rariser RM. Laptop Computer-Induced Erythema Ab Igne:A Case Report. Cutis. 2007;79:59-60.

  14. Bachmeyer C, Bensaid P, Begon E. Laptop computer as a modern cause of erythema ab igne. J Eur Acad Dermatol Venereol. Jun 2009;23(6):736-7. [Medline].

  15. Fite C, Bouscarat F. [Laptop computer-induced erythema Ab Igne]. Presse Med. Jul-Aug 2009;38(7-8):1164-5. [Medline].

  16. Sesay M, Dhanji S. Case report: erythema ab igne in a patient with diabetic neuropathy. Am Fam Physician. Aug 15 2009;80(4):322. [Medline].

  17. Radmanesh M. Erythema ab igne following Sauna belt use for abdominal obesity and cellulite. Int J Dermatol. Jan 2009;48(1):94-5. [Medline].

  18. Dvoretzky I, Silverman NR. Reticular erythema of the lower back. Erythema ab igne. Arch Dermatol. Mar 1991;127(3):405-6, 408-9. [Medline].

  19. Finlayson GR, Sams WM Jr, Smith JG Jr. Erythema ab igne: a histopathological study. J Invest Dermatol. Jan 1966;46(1):104-8. [Medline].

  20. Hardy JD, Stolwijk JA, Hammel HT, Murgatroyd D. Skin temperature and cutaneous pain during warm water immersion. J Appl Physiol. Sep 1965;20(5):1014-21. [Medline].

  21. Howe NR, Bader RS. Erythema ab igne. Clin Dermatol. 1998;2:7-8.

  22. Peterkin GA. Malignant change in erythema ab igne. Br Med J. Dec 31 1955;2(4956):1599-602. [Medline].

  23. Sahl WJ Jr, Taira JW. Erythema ab igne: treatment with 5-fluorouracil cream. J Am Acad Dermatol. Jul 1992;27(1):109-10. [Medline].

  24. Shahrad P, Marks R. The wages of warmth: changes in erythema ab igne. Br J Dermatol. Aug 1977;97(2):179-86. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

erythema ab igne, erythema ab igne elastosis, EAI, ephelis ab igne, erythema à calore, toasted skin syndrome, erythema a calore

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert S Bader, MD, Assistant Clinical Professor, Department of Dermatology, Drexel University College of Medicine; Dermatologist, Section of Dermatology, Department of Medicine, North Broward Medical Center
Robert S Bader, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and Florida Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Marjan Garmyn, MD, PhD, Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.