Erythema Ab Igne due to Heating Pad Use: A Case Report and Review of Clinical Presentation, Prevention, and Complications

Abstract

Erythema ab igne is an asymptomatic cutaneous condition caused by exposure to heat. Cases of erythema ab igne may prove to be diagnostically challenging due to lack of familiarity with the condition. While this dermatosis carries a favorable prognosis, nonmelanoma skin cancers have been reported to arise within lesions of erythema ab igne. Erythema ab igne is preventable, and, thus, clinicians should provide education regarding safe use of heating devices to patients using these products in both outpatient and inpatient settings.

Erythema ab igne: new technology rebounding upon its users?

“…In longstanding EAI, follow‐up screening is recommended for signs of malignant change. A more aggressive approach is indicated if premalignant features are present, such as hyperkeratosis or ulceration . The infrared radiation‐induced malignant progression of EAI seems to mirror that of ultraviolet radiation as demonstrated by similar features both histopathologically and clinically .…”

“…Exposure can lead to a transient, blanchable, reticulated erythema. With chronic exposure, EAI appears as a brownish reticulated, erythematous, hyperpigmented and hypopigmented eruption, and can be also characterized by cutaneous atrophy, telangiectasia, and subepidermal bullae (Fig. ).…”

“…Historically, it was observed on the legs and shins of elderly people who sat near coal and wood fires or steam radiators, on the arms and faces of cooks and bakers who worked by hot stoves, and workers who shoveled hot coals . More modern and novel associations include heating pads, electric blankets, space heaters, kerosene heaters, heated car seats and recliners, laptop computers, and cellphones . Laptop computer‐induced EAI has been of particular interest, as the use of these devices has increased, and in younger populations.…”

“…The prognosis for EAI is good, with removal of the offending heat source typically resulting in a gradual regression of the hyperpigmentation. Educating patients to avoid close, prolonged exposure to the offending heat source is a desirable, preventative method . In chronic cases, additional treatment options include topical retinoids, 5‐fluorouracil cream, and laser treatment employing an Nd:YAG, ruby, or alexandrite laser .…”

“…Ironically, new technology is creating a rebound of EAI, while low‐technology infrared heat sources like radiators and water bottles still persist. Still unusual, EAI may be diagnostically challenging due to its infrequency …”