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Rapid Onset of Bullous Erythema Ab Igne E-IJD CORRESPONDENCE Rapid Onset of Bullous Erythema treated with topical 5‑FU daily. Over a period of 2 months her lesions started to clear [Figure 3]. In the case of our Ab Igne: A Case Report of Atypical Presentation Ali Asilian, Bahareh Abtahi‑Naeini, Mohsen Pourazizi1, Mehrdad Rakhshanpour Departments of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, 1Semnan University of Medical Sciences, Student research committee, Semnan, Iran. E-mail: [email protected] Indian J Dermatol 2015:6(3):325 Sir, Erythema ab igne (EAI) was first described in the UK by German dermatologist Abraham Buschke in the early 1900s a b as a result of proximity to stoves burning with peat.[1] It Figure 1: (a) Bullous erythema ab igne‑ Bullae within a localized area of reticular, is caused by repeated and prolonged exposure to infrared brown, macular pigmentation on calve (b) Reticulate erythematous patch lesion on the [2,3] radiation insufficient to produce burns. Heat radiation left calve after use of topical burrow's solution and the disappearance of bullous lesion may be due to repeated body – warming techniques like the use of Kangri — an indigenous fire pot used to generate warmth during winter months‑ by the people of northern India,[4,5] frequent hot bathing, hot water bottles, heating pads, and cooking.[2,3] The initial manifestation of EAI is the presence of red macules at the site of exposure. These macules are most often found on the back or the lower leg parts of women. With continued episodes of heat exposure, the skin reaction evolves into a hyperpigmented reticulated macular eruption with dusky erythema, telangiectasia, and epidermal atrophy. Symptoms of burning or itching may be described by patients,[3,6] although bullae are rarely seen.[7,8] Arriving at the diagnosis of bullous EAI may be easy if it be supported by the patient’s history. However, if this history is vague or if the patient denies heat injury, confirming such a diagnosis can be difficult. A combination of history, physical findings, and histology Figure 2: Bullous erythema ab igne. Histologic feature. Subepidermal blister and the dilated blood vessels in superficial dermis with mild perivascular lymphocytic [7] should confirm the diagnosis. infiltrations was seen (H and E, × 100) In our case, a 22‑year‑old woman is presented with pruritic lesions over the legs since 2 weeks ago. She recalled a history of newly onset exposure to an electrical heater due to painfully cold toes. On physical examination, a bilateral reticulate hyperpigmented net‑like pattern associated with tens bulla was observed on both lateral aspects of her calves. Lesions were absent over the thighs [Figure 1a and b]. The review of her systems showed only chilblains on both feet brought on by cold exposures. Laboratory findings include blood and urine testing, ESR, ANA, and SLE‑specific autoantibodies; serum cryoglobulin levels, complement level was normal. Histopathological examination of her skin showed sub epidermal blisters, dermal pigmentation; vasodilation of blood vessels within the superficial dermis was seen no evidence of true vasculitis [Figure 2]. DIF was negative for IgG, IgM, and C3 deposition. We consider our Figure 3: Bullous erythema ab igne ‑ Clearance of reticulate erythema after 2 month case to be the bullous variant of EAI. She was successfully OF topical 5‑FU Correspondence patient skin damage initially showed itself as bullous and pattern in squamous cell carcinoma of skin of lower the main manifestation of the disease, i.e. the bilateral extremities and abdominal wall (Kangri cancer) in Kashmir reticulate hyperpigmented net‑like pattern revealed itself valley of Indian subcontinent: Impact of various treatment modalities. Indian J Dermatol 2009;54:342‑6. after a few days. Bullous variant of erythema ab igne 5. Hassan I, Sajad P, Reshi R. Histopathological analysis of the should be considered a well‑defined variant of erythema cutaneous changes due to kangri use in kashmiri population: ab igne and kept in mind in the differential diagnosis of A hospital based study. Indian J Dermatol 2013;58:188‑90. any Bullous lesion with unknown aetiology and should 6. Shahrad P, Marks R. The wages of warmth: Changes in be treated and sores eliminated due to the potentially erythema ab igne. Br J Dermatol 1977;97:179‑86. malignant condition. 7. Kokturk A, Kaya TI, Baz K, Yazici AC, Apa DD, Ikizoglu G. Bullous erythema ab igne. Dermatol Online J 2003;9:18. References 8. Flanagan N, Watson R, Sweeney E, Barnes L. Bullous erythema ab igne. Br J Dermatol 1996;134:1159‑60. 1. Arnold AW, Itin PH. Laptop computer‑induced erythema ab igne in a child and review of the literature. Pediatrics 2010;126:e1227‑30. Access this article online 2. Riahi RR, Cohen PR, Robinson FW, Gray JM. Erythema Quick Response Code: ab igne mimicking livedo reticularis. Indian J Dermatol Website: www.e‑ijd.org 2010;49:1314‑7. 3. Kennedy CT, Burd DA, Creamer D. Mechanical and Thermal Injury. Rook’s Textbook of Dermatology. WileyBlackwell; 2010. p. 1‑94. DOI: 10.4103/0019‑5154.156488 4. Teli MA, Khan NA, Darzi MA, Gupta M, Tufail A. Recurrence .
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