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CORRESPONDENCE
Year : 2011  |  Volume : 56  |  Issue : 2  |  Page : 233
Erythema AB igne of chest in a patient with pulmonary tuberculosis


Department of Skin & STD, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

Date of Web Publication5-May-2011

Correspondence Address:
K Chandramohan
Department of Skin & STD, Karnataka Institute of Medical Sciences, Hubli, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.80435

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How to cite this article:
Chandramohan K, Bhagwat P V, Arun T, Mohan S E. Erythema AB igne of chest in a patient with pulmonary tuberculosis. Indian J Dermatol 2011;56:233

How to cite this URL:
Chandramohan K, Bhagwat P V, Arun T, Mohan S E. Erythema AB igne of chest in a patient with pulmonary tuberculosis. Indian J Dermatol [serial online] 2011 [cited 2020 Jul 12];56:233. Available from: http://www.e-ijd.org/text.asp?2011/56/2/233/80435


Sir,

Erythema ab igne is a reticulate hypermelanosis with erythema resulting from repeated mild heat exposures that induces injury to the epidermis. Historically, erythema ab igne was commonly seen on the shins of those who worked in front of open fires or coal stoves. [1] It has also been reported in association with splenomegaly, pancreatitis and pancreatic cancer. In all these reports, patients were attempting to relieve their chronic and recurrent abdominal pain with hot water bottle or heating pads. For the first time, we report a case of erythema ab igne of chest in a patient with pulmonary tuberculosis.

A 45-year-old male, under the treatment of pulmonary tuberculosis, was referred to us with 3 months history of reticulate hyperpigmentation on the chest. It was noticed after the patient started applying hot water bottle to get relief from dyspnea and chest pain. On examination, there was fairly well-defined hyperpigmented reticulate macule measuring 10 cm Χ 10 cm over the chest [Figure 1]. Histopathological examination showed hyperkeratosis, epidermal atrophy, mild pigment incontinence and mild superficial lymphohistiocytic infiltrate. Diagnosis of erythema ab igne was made on the basis of history, characteristic cutaneous presentation and histopathological findings. The patient was instructed to stop applying hot water bottle. His skin lesion started fading after 1 week.
Figure 1: Reticulate hyperpigmentation on chest

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Erythema ab igne is a localized red brown reticular pigmentation resulting from chronic, repetitive exposure to submaximal heat, insufficient to cause burn. [2] Mild elevation of skin temperature initially results in mild, transient, often reticulated erythema. With prolonged and repeated exposure, areas of reticular erythema persist and, in time, become livid and hyperpigmented. Rarely, areas affected by erythema ab igne may become bullous or hyperkeratotic. [3] Although the pathogenic mechanisms in erythema ab igne are poorly understood, one study has shown that moderate heat acts synergistically with ultraviolet radiation to denature DNA in squamous cells in vitro. [4] Erythema ab igne can affect any surface of the body, but is most commonly reported on the lower legs of women. [3] It has also been reported on unusual sites like thigh, pubic area, upper back and arms, especially when it is associated with an underlying malignancy. [5] Our patient developed erythema ab igne on the chest due to his habit of keeping hot water bottle to get relief from chest pain and dyspnea caused by underlying pulmonary tuberculosis. The development of erythema ab igne due to underlying organic disease is not uncommon. It has been reported in association with splenomegaly, [6] pancreatic pseudocyst, pancreatic cancer, [7],[8] gastric carcinoma and renal cell carcinoma. However, it has never been reported in association with pulmonary tuberculosis, and to the best of our knowledge, this is the first case of erythema ab igne affecting the chest and is being reported for its unusual site of involvement.

 
   References Top

1.Bilic M, Adams BB. Erythema ab igne induced by a laptopcomputer [letter]. J Am Acad Dermatol 2004;50:973-4.  Back to cited text no. 1
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2.Raza N, Qadir SN, Ejaz A. Epidemiology of erythema ab igne at a moderately cold weather station. J Pak Med Assoc 2007;57:146-8.  Back to cited text no. 2
[PUBMED]    
3.Kokturk A, Kaya TI, Baz K, Yazici AC, Apa DD, Ikizoglu G. Bullous erythema ab igne. Dermatol Online J 2003;9:18  Back to cited text no. 3
    
4.Roth D, London M. Acridine probe study into synergistic DNA-denaturing action of heat and ultraviolet light in squamous cells. J Invest Dermatol 1977;69:368-72.   Back to cited text no. 4
[PUBMED]    
5.Meffert JJ, Davis BM. Furniture-induced erythema ab igne. J Am Acad Dermatol 1996;34:516-7.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Hurwitz RM, Tisserand ME. Erythema ab igne [Letter]. Arch Dermatol 1987;123:21-3.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Mok DW, Blumgart LH. Erythema ab igne in chronic pancreatic pain: a diagnostic sign. J R Soc Med 1984;77:299-301.   Back to cited text no. 7
    
8.Butler ML. Erythema ab igne: a sign of pancreatic disease. Am J Gastroenterol 1977;67:77-9.  Back to cited text no. 8
[PUBMED]    


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