Home » Erythema ab igne, what is it, how it manifests itself and what are the therapies

Erythema ab igne, what is it, how it manifests itself and what are the therapies

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Erythema ab igne, what is it, how it manifests itself and what are the therapies

With the record prices reached by gas, many are considering cheaper alternatives to traditional heating. There are those who are preparing to reactivate the wood-burning fireplaces of the house and those who are equipping themselves with thermal clothing, hot water bottles and electric heaters to postpone the lighting of the radiators. Even in some factories it is being envisaged to equip workers with small electric radiators to avoid heating entire warehouses. But you have to be careful with prolonged exposure to all these heat sources, especially if they are near the legs or arms.

What is heat rash

Reporting the course of a serious clinical case of a 24-year-old woman who sat for many hours a day near an electric heater, the New England Journal of Medicine turns the spotlight onerythema from the firea rather widespread and underestimated skin condition until a few decades ago, greatly reduced by the use of modern heating systems.

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How erythema manifests itself from the fire

It is in fact a skin rash that most of the time can go unnoticed, due to prolonged and repeated exposure to heat. This is because thermal radiation develops a reticulated erythema on the skin, chronic dilation of the capillaries and hyperpigmentation, all not necessarily associated with itching and burning. And although in most cases it can remain a cosmetic problem that leaves its mark for years, unfortunately it can lead to cancerous lesions and cause squamous cell carcinoma.

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Credit: New England Journal of Medicine

Credit: New England Journal of Medicine

The long-term consequences

“Without alarming, it is certainly something that we must pay attention to especially in this period in which alternative forms of heating are sought”, explains the doctor. Norma Cameli, Head of Corrective Dermatology at the San Gallicano Institute in Rome. “Erythema ab igne can affect anyone, no particular predisposition is required. And to all intents and purposes it is an inflammation that manifests itself with an asymptomatic red spot that can become, and remain for a long time, brown. In more rare and serious cases, it can also degenerate into burn ulcerations that can favor the onset of cancer. “

The underlying mechanism of this dermatitis is currently unknown. Warmer rash – ab igne in Latin means “caused by fire” – was first described by the dermatologist Horatio George Adamson in 1909 and was widespread among all those who at that time used embers to heat their beds.

Women more affected than men

Today we know that it affects women more than men and that unlike what has been thought it is not due to exposure to infrared radiation. In fact, it can be caused by any source of heat, even moderate, such as electric blankets, hot water bottles or electronic devices, on all laptops resting on their legs.

A testimony comes from the young Indian woman who last winter went to a dermatological clinic for a consultation two months after the onset of erythema on the shins. The rash was asymptomatic and was most prominent on the left leg.

According to what the patient reported, the woman habitually used an electric heater that she held closer to the left leg, just where more hyperpigmentation was visible and several atrophic scars had developed. There were no subcutaneous nodules but a biopsy showed skin lymphocyte infiltration, with hemosiderin – an iron-binding protein – deposited in the upper dermis.

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“Based on these results, she was diagnosed with heat exposure dermatosis for the first time”, explains Dr. Rhea Ahuja who visited it. “Erythema ab igne manifests itself as an erythematous or hyperpigmented reticulation that can occur anywhere in the body and can be distributed asymmetrically, depending on the location of the external heat source.”

The difficulty of the diagnosis

Diagnosing it is not easy because “it can be confused with vasculitis, an inflammation that occurs when the immune system attacks blood vessels,” and there is no definitive treatment. “The first step is to cut off the source of heat. In this case the patient was advised to avoid further direct exposure to heat. And at a follow-up visit after three weeks the hyperpigmentation had already diminished without the need for more. therapies while the scars persisted “.

The precautions

The heat “can give relief and offer a feeling of pleasure, of course, but you must always be careful: never expose your bare skin to a source of heat or, even worse, lean on a warmer when wearing a synthetic fabric”, advises Dr. Cameli .

In case of skin rash, with or without itching or burning, it is good to stop the exposure and contact a dermatologist who will be able to give the right indications, evaluate the problem and, if necessary, recommend a biopsy to exclude the possibility of evolution towards a cancer.

How to cure

Among the recommended therapies, “if the inflammation is ongoing, cortisone or non-steroidal anti-inflammatory drugs can be used. But most patients come to the dermatologist when the acute phase has passed, leaving a brown patch on the exposed area – he concludes -. People are surprised, they do not think that even a simple hot water bottle can cause hyperpigmentation. To solve the aesthetic problem, the most effective solution is lightening creams. In the case of scars, on the other hand, the Co2 laser is used “.

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