A 45-Year-Old Woman with Suddenly Discolored Skin

Differential Diagnosis

• Livedo reticularis
• Cholesterol emboli
• Erythema ab igne
• Systemic lupus erythematosus

Diagnosis

This patient was diagnosed with erythema ab igne (literally, in Latin, redness from fire), a hyperpigmentation disorder caused by long-term exposure to heat. The most common sources include hot water bottles, electric blankets, and even laptop computers.

Learnings

• Although actual burns do not occur from the heat source in erythema ab igne, the skin develops a course pigmentation that appears as patches that are pink, purple, and eventually brown
• Pruritus or mild burning paresthesias may occur
• Resultant pigmentation changes can be permanent; there is no effective treatment

 

Pearls for Urgent Care Management and Considerations for Transfer

• Caution the patient to avoid prolonged exposure to the heat source
• Follow-up with a dermatologist is warranted to establish a new “baseline” against which future changes in pigmentation can be measured, in the interest of vigilance for cutaneous malignancies

 

Acknowledgment: Images courtesy of VisualDx.