Bilateral lesions on the legs
Treatment: Eliminate heat source
The first goal of treatment is to identify the source of heat radiation to avoid further exposure. For mild lesions, no intervention is needed after the heat source is removed; the probability of full resolution is good. In this case, the patient was advised to stop using the hot water bottle on her skin. Over 4 months her lesions started to clear with no further intervention.
Topical meds help with cosmesis
Topical retinoids, vitamin A derivatives, hydroquinone, and 5-fluorouracil can be prescribed to treat abnormal skin pigmentation.13 Laser therapy has been used to even out the skin color.
TABLE
Differential diagnosis for erythema ab igne
| DISEASE | CLINICAL FEATURES |
|---|---|
| Acanthosis nigricans | Velvety, light-brown-to-black markings usually on the neck, under the arms, or in the groin |
| Most often associated with being overweight | |
| More common in people with darker skin pigmentation | |
| May begin at any age | |
| May be inherited as a primary condition or associated with various underlying syndromes | |
| Livedo reticularis | Reticular cyanotic cutaneous discoloration surrounding pale central areas due to dilation of capillary blood vessels and stagnation of blood |
| Occurs mostly on the legs, arms, and trunk | |
| More pronounced in cold weather | |
| Idiopathic condition that may be associated with systemic diseases | |
| Poikiloderma atrophicans vasculare | Circumscribed violaceous erythema |
| Occurs mostly in posterior shoulders, back, buttocks, V-shaped area of anterior neck, and chest | |
| May be asymptomatic or mildly pruritic | |
| May remain stable in size or gradually increase | |
| Numerous atypical lymphocytes are observed around dermal blood vessels and someepidermotropism is observed | |
| A variant of mycosis fungoides |
CORRESPONDENCE
Amor Khachemoune, MD, CWS, Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 530 First Avenue, Suite 7R, New York, NY 10016. E-mail: amorkh@pol.net
