Indian Journal of Dermatology
CORRESPONDENCE
Year
: 2011  |  Volume : 56  |  Issue : 2  |  Page : 233-

Erythema AB igne of chest in a patient with pulmonary tuberculosis


K Chandramohan, PV Bhagwat, T Arun, SE Mohan 
 Department of Skin & STD, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

Correspondence Address:
K Chandramohan
Department of Skin & STD, Karnataka Institute of Medical Sciences, Hubli, Karnataka
India




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;56:233-233


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 Nov 28 ];56:233-233
Available from: https://www.e-ijd.org/text.asp?2011/56/2/233/80435


Full Text

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}

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

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