Erythema ab igne

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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165 Erythema ab igne

Instruction

Examine this patient’s legs.

Examine this patient’s abdomen.

Salient features

History

• Ask the patient whether she exposed the affected area to heat.

Examination

• Reticular erythematous or pigmented rash, usually on the forelegs (or abdomen), known as ‘Granny’s tartan’

Proceed as follows:

• Look for features of hypothyroidism (pulse, ankle jerks).

• Tell the examiner that you would like to proceed as follows:

• measure serum thyroxine and thyroid-stimulating hormone
• investigate for chronic pancreatitis and intra-abdominal malignancy.

Note: If the rash is present over the anterior abdominal wall or lumbar region, it is very likely that there is an intra-abdominal malignancy or chronic pancreatitis.

Diagnosis

This patient has a reticular pigmented rash (lesion) on the abdomen caused by local heat from a hot-water bag (aetiology); I would like to exclude an underlying intra-abdominal malignancy.

Advanced-level questions

What do you know about erythema ab igne?

It is dusky discolouration of the skin that is associated with repeated exposure to heat. Typically the heat is not painful (<45°C) and does not burn the skin but produces a net-like reticulated pigmentation. It is usually found on the front of the lower legs of the elderly who sit in front of open fireplaces (Fig. 165.1) or and on the abdomen or back of patients with chronic conditions who seek relief of pain by the long-term application of hot-water bottles or heating pads (Fig. 165.2).

image

Fig. 165.1 Erythema ab igne.

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Fig. 165.2 Erythema ab igne produced by applying a heating pad to a painful back.

(With permission from Townsend et al. 2007.)

How may erythema ab igne be complicated?

Epitheliomas may develop in keratoses, which form in later stages of this condition.

What other reticulated rashes do you know?

• Livedo reticularis (Fig. 165.3), seen in the following conditions:

• Polyarteritis nodosa
• SLE
• Occult malignant neoplasm
• Atherosclerotic microemboli to the skin
• Physiological in young women (it is most apparent on the thighs of young females playing outdoor sports on a cold day).

• Cutaneous marmota seen in children.

image

Fig. 165.3 Livedo reticularis.

Mention some skin abnormalities related to heat or cold

• Erythema ab igne

• Livedo reticularis (as a result of cold in young women)

• Raynaud’s phenomenon

• Chilblains.

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