Erythema ab igne in an individual with diabetes and gastroparesis.

Ravindran R. BMJ Case Rep 2017. doi:10.1136/bcr-2014-203856 Description Prolonged abdominal heat application in an individual with diabetes and gastroparesis leads to the development of erythema ab igne. Practitioners should be aware of the various ways that erythema ab igne can present. Erythema ab igne is due to prolonged heat exposure (43–47°C) which causes damage to superficial vascular plexus leading to vasodilation, erythema and haemosiderin deposition which clinically appears as hyperpigmentation. A 28-year-old man with type 1 diabetes and gastroparesis had presented with vomiting and abdominal pain. Abdominal examination revealed a erythematous, reticulated, macular and non blanchable pigmentation, (figure 1). The patient used to apply hot water bottles for abdominal pain relief. Erythema ab igne can be associated with epidermal atrophy and scaling. The lesions may become keratotic and bullous (rare) with a slightly burning sensation. 3 Important differentials include other reticulated conditions such as livedo reticularis and livedoid vasculitis, cutis marmorata, poikiloderma atrophicans vasculare and cutaneous T-cell lymphoma. Management is mainly removing the heat source. 5-fluorouracil is recommended if the lesion shows precancerous changes and can help clear epithelial atypia. Topical tretinoin or laser is advocated for improving skin pigmentation. 5 Biopsy of the lesion was not performed in the patient as it was clear that the lesion was due to application of heat source as the lesion started to fade during the patient’s hospital stay. Biopsy is usually recommended to rule out cancer if lesions are not fading after the removal of heat source.