Erythema Ab Igne 

  • Author: Laila I Alotaibi, MD, MSc; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 23, 2010
 

Background

Erythema ab igne (EAI) is characterized as localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Patients with erythema ab igne have a history of repeated exposures to heat at a lower level than that which causes a thermal burn.[1] Other terms used to describe erythema ab igne include toasted skin syndrome and fire stains.[2]

Initially, the skin in erythema ab igne patients is often mildly erythematous; however, after repeated heat exposures, the classic blue, purple, or brown reticulated hyperpigmentation develops.[1]

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Pathophysiology

Erythema ab igne (EAI) is a reticulate hypermelanosis with erythema resulting from repeated heat exposure that induces injury to the epidermis and superficial vascular plexus. The exposure, which need not be of long duration, results in cutaneous hyperthermia in the range of 43-47°C. Erythema ab igne 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.[3]

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Epidemiology

Frequency

United States

Erythema ab igne is rare. Because of the general availability of central heating, erythema ab igne is less common in the United States than in countries where open fires are commonly used for heating.

Historically, erythema ab igne was often seen on the inner thighs and legs of women who sat in front of a stove or open fire.[1, 4] Now erythema ab igne is more commonly related to heating pads or laptop computer use.

International

Currently, erythema ab igne is most commonly seen internationally following repeated use of hot water bottles, infrared lamps, and heating pads. Additionally, chronic pain in the lumbosacral region and consequent repeated and prolonged use of localized heat to relieve those symptoms has led to an increased incidence of erythema ab igne in this area.[5, 6, 7]

Studies have shown that physiotherapeutic treatments use ultrasound and short-wave diathermy to promote (via high-frequency mechanical waves) an extremely rapid vibration in the tissues in order to generate heat and consequent dilation of the local veins to provide pain relief.[8]

Mortality/Morbidity

Chronic repeated exposure to infrared radiation may result in changes similar to those seen with chronic repeated ultraviolet radiation. Carcinoma can develop from dysplastic keratinocytes harbored within the reticulated hyperpigmentation. Thermal keratosis, squamous cell carcinoma in situ, and squamous cell carcinoma have been reported in patients after chronic exposure to infrared radiation.[9] In one 90-year-old woman with erythema ab igne, Merkel cell carcinoma developed adjacent to squamous cell carcinoma. Occasionally, the first sign of splenomegaly, pancreatitis, pancreatic cancer, and other cancers is erythema ab igne resulting when patients apply external heat to relieve the underlying pain.[4]

Work exposure to heat (eg, for bakers, silversmiths, and boiler operators) may cause erythema ab igne.[1] Additionally, erythema ab igne has been reported to appear on the legs following prolonged, daily exposure to a car heater.

Race

Erythema ab igne has no overt racial predisposition.

Sex

Women, in particular those who are overweight, are affected by erythema ab igne more often than men.[1]

Age

Erythema ab igne primarily occurs in adults, usually of middle age (40-70 y).

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Contributor Information and Disclosures
Author

Laila I Alotaibi, MD, MSc  Dermatologist, Rashid Hospital, Dubai Health Authority, United Arab Emirates

Disclosure: Nothing to disclose.

Coauthor(s)

Anwar Al Hammadi, MD, FRCPC  Consultant and Head of Dermatology, Rashid Hospital, Dubai Health Authority; Clinical Assistant Professor of Dermatology, University of Sharjah, United Arab Emirates

Anwar Al Hammadi, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Canadian Dermatology Association, Royal College of Physicians and Surgeons of Canada, and Skin Cancer Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

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.

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.

References

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  2. Rapini, Ronald P; Bolognia, Jean L; Jorizzo, Joseph L. Dermatology. 2-Volume Set. Mosby. pp ISBN 1-4160-2999-0: St. Louis; 2008:Chapter 87.

  3. 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].

  4. Meffert JL, Davis BM. Furniture-induced erythema ab igne. J Am Acad Dermatol. 2000;34:516-517.

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  8. Imamura MT, Imamura ST, Hsing WT. Agentes físicos em reabilitacao. In: Lianza S, editores. Medicina de reabilitacao. 2a ed. Sao Paulo: Guanabara-Koogan; 1995:103-7.

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  21. 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].

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

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

  32. 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].

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

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

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

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

 
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