A case of erythema ab igne with histopathological features resembling keratosis lichenoides chronica.

This case describes a pediatric patient with a history of ichthyosis vulgaris and global anhidrosis who was diagnosed with erythema ab igne (EAI), a rare dermatosis resulting from chronic heat exposure. After developing progressive, reticulated brown patches on his extremities and abdomen, extensive diagnostic investigations were conducted to rule out autoimmune, vascular, and genetic etiologies. Bloodwork was unrevealing and biopsies showed histologic features closely resembling keratosis lichenoides chronica. Ultimately, after discovering the patient had prolonged exposure to a space heater, the diagnosis of EAI was made. This case underscores the diagnostic challenges in pediatric EAI cases and emphasizes the importance of careful history taking as part of a comprehensive evaluation.

Pediatric erythema ab igne: clinical aspects and diagnostic issues.

Erythema ab igne is a dermatological condition resulting from repeated low-grade heat exposure (below the burning point), which can variably manifest with reticulated erythema and skin hyperpigmentation. Not infrequently, the cause of such a skin disorder is not immediately evident or reported by patients, especially if these are children. Compared to adults, erythema ab igne is rare in children and, if the general practitioners and pediatricians are not aware of this disorder, pediatric patients are often addressed to rheumatologists and/or undergo useless immunological investigations. Here, we performed a systematic case-based review, which finally included 32 cases of pediatric erythema ab igne (in addition to our new clinical report), and discussed the main clinical aspects and issues of this clinical entity in children. In detail, similarities of erythema ab igne with livedo reticularis and/or vasculitis-related rashes sometimes can lead to perform a panel of immunological investigations, which could be avoided. Indeed, our analysis emphasizes the importance of a careful and complete patient's anamnesis, including active questioning about the potential exposure to any physical agents (including heat sources) that may cause dermatological lesions. We also highlight some peculiarities in terms of location and heat injury in children developing erythema ab igne, based on the presence or absence of comorbidities. CONCLUSION: The occurrence of erythema ab igne in children (and especially in adolescents) is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. Physicians should be aware of this condition in order to prevent patients from useless investigations, especially in the differential diagnosis of rheumatic disorders. A careful and complete patient's history with active questioning about the potential exposure to heating source is often decisive to diagnose erythema ab igne. WHAT IS KNOWN: • Erythema ab igne is a dermatological condition which is mainly described in adults exposed to heating source at the workplace. WHAT IS NEW: • The occurrence of erythema ab igne in children is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. • Erythema ab igne in children can be classified in two main categories, based on the presence or absence of comorbidity. • A careful and complete anamnesis (including the active questioning about potential exposure to any heating source) is the mainstay for diagnosing erythema ab igne in children.

Erythema Ab Igne with Histological Features of Keratosis Lichenoides Chronica.

Erythema ab igne (EAI) is a localized, hyperpigmented and reticulated dermatosis at sites of chronic heat exposure. Within longstanding skin lesions of EAI, hyperkeratotic lesions may emerge and can potentially transform into pre-malignant or malignant skin lesions. A 55-year-old woman presented for the evaluation of multiple hyperkeratotic lesions along with a reticular patterned hyperpigmentation on her right knee, an area that had repeated and prolonged exposure to a heat source over a period of several months. Based on her clinical history and the physical examination of her lesions, she was diagnosed as having a hyperkeratotic form of EAI. A skin biopsy was performed to rule out malignant alteration, but the histopathological findings were supportive of keratosis lichenoides chronica.

Rare mimic of angiosarcoma: Erythema ab igne with reactive angiomatosis.

Erythema ab igne is an uncommon physical dermatosis that presents with localized patches of reticulated erythema and hyperpigmentation corresponding with the underlying dermal venous plexus. The rash occurs in response to chronic heat exposure that does not meet the threshold for thermal burn of the skin. The histopathologic findings are characterized by atrophy and thinning of the epidermis, focal hyperkeratosis, and keratinocyte atypia. The dermis displays dilated capillaries, evidence of pigment incontinence, and prominent elastotic material. We report a case of a 65-year-old male who presented to his primary care physician with a 1-year history of reticular erythema and hyperpigmentation with focal ulceration on his right lateral leg. Histopathology on biopsy revealed mild hyperkeratosis and focal epidermal atrophy; however, the most striking finding was a proliferation of dermal vascular spaces lined by pleomorphic endothelial cells and numerous mitotic figures, which was morphologically compatible with angiosarcoma. However, clinicopathologic correlation and immunostaining revealed an actual diagnosis of erythema ab igne with reactive angiomatosis. Reactive angiomatosis-morphologically mimicking angiosarcoma-is a rarely reported feature of severe erythema ab igne, and dermatopathologists should be aware of this possibility to avoid misdiagnosis of erythema ab igne as angiosarcoma.

Erythema ab igne masking cutaneous metastasis of colorectal adenocarcinoma.

Skin metastasis commonly manifest as subcutaneous or intradermal violaceous nodules that coalesce with a firm rubbery appearance. Few cases reported an erythema ab igne-like appearance in the presence of internal malignancy. We report a case of metastatic colorectal adenocarcinoma with erythema ab igne-like presentation. We also review cases of erythema ab igne in association with internal malignancy.

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

Erythema ab igne, also known as toasted skin syndrome, is an acquired asymmetric hyperpigmented dermatosis that is caused by repeated exposure to moderate heat or infrared radiation. Hyperpigmentation is caused by the degeneration of elastic fibers and basal cells resulting in the release of melanin. Historically found in bakers and industrial workers, this condition has recently resurfaced in medical literature with the use of novel heat sources such as laptops and heated car seats. While this condition can resolve spontaneously after removal of heat exposure, delay in diagnosis and persistent exposure can lead to permanent pigmentation or progression to Merkel cell carcinoma, basal cell carcinoma, and squamous cell carcinoma.

Erythema ab igne: Toasted Skin Syndrome.

Introduction: Erythema ab igne is a benign skin condition caused by long-term exposure to infrared radiation and/or heat. Erythema ab igne begins as a mild erythema over the previously exposed areas and develops into an erythematous reticulated hyperpigmentation with scaling and telangiectasias. Clinical Findings: A 55-year-old female presented to the primary care clinic with concerns due to the development of a rash on her lower back in the previous 1 to 2 weeks. She had a history of chronic back pain and was using conservative treatment for pain management, including daily use of a heating pad for 15 minutes every hour. Interventions: There is no definitive therapy for erythema ab igne. Elimination of the heat source may reverse the erythema and hyperpigmentation. Outcome: The patient was counseled regarding the importance of limiting and/or discontinuing the use of the heating pad to facilitate resolution of the rash. The patient did not return to the clinic and resolution of the rash was not confirmed.

Erythema ab igne with features resembling keratosis lichenoides chronica.

Erythema ab igne (EAI) is an asymptomatic dermatosis that develops in response to chronic exposure to low-grade heat. Characteristic findings on histopathology include epidermal atrophy, dermal elastosis, atypical histiocytes, and melanin and hemosiderin deposition. Reactive endothelial changes and prominent vascular proliferation are variable. Keratosis lichenoides chronica (KLC) is a rare lichenoid hyperkeratotic dermatosis. Acanthosis with parakeratosis and a lichenoid interface dermatitis with lymphocytes, histiocytes, and plasma cells are characteristic findings of KLC. Although its etiology remains unclear, KLC has been reported to occur in response to heat. Herein, we report a case of EAI with features resembling KLC.

Abdominal erythema ab igne-An "old" finding revisited.

Abdominal erythema ab igne may be the result of insufficient pain medication in chronic pancreatitis. Stenting therapy is to be considered, and the patient should be informed about the risk of developing cutaneous squamous or Merkel cell carcinoma.

Erythema ab igne in patients with sickle cell disease.

Erythema ab igne (EAI) is an asymptomatic dermatosis caused by prolonged exposure to localized heat. Affected areas have net-like hyperpigmentation that may resemble more serious conditions such as livedo racemosa or vasculitis. We report three cases of EAI in pediatric sickle cell disease (SCD) patients who were initially suspected of having a more severe, life-threatening disorder before Dermatology was consulted. Clinicians caring for pediatric SCD patients who regularly use heating pads/devices for pain relief should consider EAI in the differential diagnosis of large areas of net-like hyperpigmentation. This paper aims to increase recognition of EAI and patient education on safe practices while using heating pads.

Erythema Ab Igne Successfully Treated With Mesoglycan and Bioflavonoids: A Case-Report.

Erythema ab igne is a localised, cutaneous condition consisting of reticulate hyperpigmentation, epidermal atrophy, and telangiectasias. It is caused by repetitive and prolonged exposure to moderate heat that is insufficient for producing burns. Currently, erythema ab igne is most commonly observed following repeated use of hot water bottles, infrared lamps and heating pads. If not properly treated, erythema ab igne can become chronic and even malignant. We report a case of erythema ab igne, successfully treated with systemic mesoglycan-based therapy, and local therapy with bioflavonoids.

Erythema Ab Igne Caused By Laptop Computer.

Erythema ab igne (EAI) represents the stereotype of a modern technology induced disease. Originally produced by repeated exposure of the skin to a heat source, more often because of habits related to the job or personal activities, this condition now tends to occur more frequently, being associated with a variety of modern instruments. The aim of our report is to discuss this strange medical condition with a focus on clinical features, possible confounding differential diagnoses and recommendations for prevention.

A Hyperpigmented Reticular Rash in a Patient on Peritoneal Dialysis.

Chronically ill patients often develop uncommon exam findings. A 16-year-old female with end-stage renal disease secondary to immune complex-mediated glomerulonephritis on peritoneal dialysis (PD) developed a pruritic, hyperpigmented reticular rash on her abdomen, sparing the PD catheter insertion site. The rash appeared approximately 6 weeks after initiating PD. She used a heating pad nightly during PD for dialysis drain pain. Testing for systemic and autoimmune disease was negative. She was referred to dermatology, where the diagnosis of erythema ab igne (EAI), a well-described but less well-known hyperpigmented reticular cutaneous eruption caused by chronic exposure to low levels of infrared heat, was confirmed. The eruption is typically painless but is often pruritic. Common sources of heat include fires, stoves, portable heaters, heating pads, and laptop computers. The association between EAI and PD is unknown. Our patient discontinued the heating pad and her rash resolved.

Cutaneous reactive angiomatosis associated with erythema ab igne.

We present the case of a 49-year-old man with an 18-month history of an intermittently pruritic red-brown reticulate eruption of the medial legs, with occasional blistering. There were areas of scale, crust and superficial erosions. The patient worked long overnight shifts standing in front of hot machinery wearing shorts, and spent time sitting in front of a heater at home. A clinical diagnosis of erythema ab igne (EAI) was made. This settled with heater avoidance and protection of the legs with long trousers, as well as a topical corticosteroid. Histology showed features of cutaneous reactive angiomatosis, a rare condition with various associations but only previously reported once in association with EAI.

Eritema Ab Igne como dermatosis laboral: revisión de la literatura a partir un caso clínico / Erythema ab igne as a dermatosis labor: case report and literature review

El eritema ab igne es una entidad que fue descrita por primera vez por Buschke como “hitze melanosis” (melanosis inducida por calor), en piernas de personas que trabajaban frente a fuegos abiertos o estufas de carbón. Se define como lesiones cutáneas eritematosas o hiperpigmentadas en un patrón reticulado característico, secundario a la exposición crónica de bajos niveles de radiación infrarroja. A pesar que la aparición de calefacción centralha significado una dramática disminución en su incidencia, aún se describen casos de causa cultural, médica o laboral. Una de susconsecuencias más graves es la posibilidad de aparición de un carcinoma espinocelular sobre la lesión. A continuación se presenta un caso clínico de etiología laboral y se realizará una revisión de la literatura.

Erythema ab igne is an entity that was first described by Buschke as “hitze melanosis” (heat-induced melanosis), in the legs of people working in front of open fires or coal stoves. It is defined as erythematous or hyperpigmented skin lesions in a reticulated pattern. The main cause is the chronic exposure tolow levels of infrared radiation. Although the occurrence of central heating has meant a dramatic decrease in incidence, cultural, medical or occupational causes are still described. One of the most serious consequences is the possibility of develoging an squamous cell carcinoma. We present a case of occupational aetiology and a review of the literature.

Histopathological analysis of the cutaneous changes due to kangri use in kashmiri population: a hospital based study.

BACKGROUND: Kangri cancer is peculiar to the valley of Kashmir as people of all age groups are accustomed to warm their bodies by the use of Kangri baskets. The clinical spectrum of skin cancer in the Kashmir valley is entirely different from the rest of the country, which could be attributed to the use of Kangri in this geographical region.[12]. AIMS: Histopathological analysis of the cutaneous changes due to kangri use in Kashmiri population. MATERIALS AND METHODS: This is a prospective hospital based study. All the patients attending the outpatient department of Dermatology, STD and Leprosy at SMHS Hospital, an associated hospital of govt. medical college in Srinagar and presented with suspicious lesions (i.e., erythema ab igne, papular or nodular skin growths) due to Kangri use were taken up for the study. A detailed history including the use of Kangri and a physical examination was done in each patient followed by a histopathological examination in case of suspicious lesions. RESULTS: The cutaneous changes which were observed during the study period of 8 months were erythema ab igne, bowen's disease and squamous cell carcinoma. CONCLUSION: Although this is a preliminary study we will be studying more of such changes caused due to Kangri use in the future.

Recurrence pattern in squamous cell carcinoma of skin of lower extremities and abdominal wall (Kangri cancer) in Kashmir valley of Indian subcontinent: impact of various treatment modalities.

BACKGROUND: The spectrum of skin cancer in Kashmir valley is drastically different from the rest of the country. Maxwell was the first to report skin cancer of lower extremities in Kashmiri population, developing on/over erythema ab igne, and attributed it to the use/or exposure of Kangri. These tumors have an aggressive biological behavior with a substantial risk of loco-regional metastasis in 30-50% cases. Because of unique geographical distribution of Kangri cancer, there is dearth of literature regarding the natural history, loco-regional and distant metastatic pattern and treatment recommendations in these tumors. AIMS: To study the metastatic pattern of these skin tumors and to assess the impact of various treatment modalities and use of prophylactic nodal treatment in this clinical entity. METHODS: The retrospective study (study period 1993-2005) included 266 patients of squamous cell carcinoma of skin of lower extremities and abdominal wall. Two hundred and forty-four cases with a follow-up of 2-7 years were included for final analysis with stress on loco-regional relapse pattern and methods of treatment evolved and used at our institute from time to time. Statistical analysis was done using yates corrected Chi-square test and odds ratio analysis. RESULTS: Our results favor the use of post operative radiotherapy to primary and prophylactic treatment of regional nodes on the lines of head and neck tumors in these cases. CONCLUSION: Post operative radiotherapy significantly decreases the loco-regional recurrences and a trial of prophylactic nodal irradiation is justified in a selected group of such patients.