Letters to the Editor
Case Report: Erythema Ab Igne in a Patient with Diabetic Neuropathy
Am Fam Physician. 2009 Aug 15;80(4):322.
to the editor: A 51-year-old black woman with diabetic neuropathy presented for evaluation of a pruritic burning rash on her back. Because of inadequate pharmacologic control of chronic back pain over the past several years, she intermittently used a heating pad for pain relief, and occasionally slept with the pad underneath her back.
Examination revealed a diffuse reticular erythematous, macular, non-blanching discoloration of her back, suggestive of erythema ab igne (see accompanying figure); this diagnosis was confirmed on punch biopsy. The hyperpigmentation and lichenification shown suggests chronic permanent skin changes.
Erythema ab igne is a skin condition associated with chronic and repetitive exposure to moderate heat from an external heat source. It is characterized by persistent, pruritic reticulate, erythematous patches, telangiectasia, and hyperpigmentation. Mild cases with little or no pigmentary changes usually resolve within months following cessation of heat exposure. In severe or non-resolving cases, treatment with topical tretinoin (Retin-A) or laser therapy may improve skin appearance. Regular monitoring of permanent skin changes is advised because of the possibility of malignant degeneration (e.g., thermal keratoses, squamous cell carcinoma in situ, squamous cell carcinoma) in the affected areas.1,2 Erythema ab igne is usually diagnosed clinically; however, if the diagnosis is uncertain, a punch biopsy is beneficial.1
Patients who are diabetic are at increased risk of developing chronic thermal injuries because of peripheral neuropathy and poor circulation that results in higher skin temperatures and greater risk of burning. Physicians should be aware of this problem and educate patients with diabetes about the risks associated with the use of contact thermal devices (e.g., heating pads, heating blankets, hot packs).3
Author disclosure: Nothing to disclose.
1. Howe NR, Bader RS. Erythema ab igne. In: Demis DJ. Clinical Dermatology. Philadelphia, Pa.: Lippincott; 1998.
2. Arrington JH III, Lockman DS. Thermal keratoses and squamous cell carcinoma in situ associated with erythema ab igne. Arch Dermatol. 1979;115(10):1226–1228.
3. Shalom A, Friedman T, Wong L. Burns and diabetes. Annals of Burns and Fire Disasters. March 2005; vol. XVIII – n. 1.
Send letters to firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions