|Year : 2014 | Volume
| Issue : 4 | Page : 529-530
Erythema ab igne (Unilateral) due to "Chulla"
Sumit Kar, Ajay Krishanan, Krishanan Preetha, Atul Mohankar, Neha Singh
Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
|Date of Web Publication||25-Jun-2014|
Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha - 442 102, Maharashtra,
Source of Support: None, Conflict of Interest: None
Erythema ab igne (EAI) is characterized by localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Taking a good history plays an important role in coming to the diagnosis of the disease condition; and at the same time, the particular cultural practices of a place determine its occurrence in the local masses. Herein we report the case of a young lady in her early thirties who presented to us with a dusky hyperpigmentation over her right arm and leg. Her detailed history and cutaneous examination led to the diagnosis of erythema ab igne.
Keywords: Erythema ab igne, fire stains, laptop thigh
|How to cite this article:|
Kar S, Krishanan A, Preetha K, Mohankar A, Singh N. Erythema ab igne (Unilateral) due to "Chulla". Med J DY Patil Univ 2014;7:529-30
| Introduction|| |
Erythema ab igne is also known as hot water bottle rash,  fire stains,  laptop thigh, and toasted skin syndrome.  The term is derived from Latin and means "redness from fire".  The skin condition is caused by long-term chronic exposure to heat particularly the infrared radiation. People may complain of mild itching and burning sensation, but, unless a change in pigmentation is seen, it can be unnoticed. It is once commonly seen in the elderly who stand or sit closely to open fires or electric heaters in cold countries to warm themselves. Erythema ab igne reportedly affects the face and/or palms of cooks who work over an open fire.
The initial presentation is a transient macular erythema in a broad, reticulated pattern that blanches easily. Initially mild elevation of the skin temperature results in slight, transient, often reticulated erythema. With prolonged and repeated exposure, areas of reticular erythema persist and, in time, become livid and hyperpigmented. The entire size and shape of the lesion often depends on the heat source.
As the heat exposure continues over time, the erythema evolves into a dusky hyperpigmentation, with lesions fixed and no longer blanchable. Epidermal atrophy may overlie the reticulated pigmentation. Later-stage lesions may become somewhat keratotic, and bullae may appear. Lesions are characteristically asymptomatic although a slight burning sensation is sometimes reported.
| Case Report|| |
A middle aged lady came to us with complaints of macular reticulate pattern of erythema of right upper limb and lower limb. On detailed history, we found that the lady, while cooking, sat on a low stool sideways to the chulha (Low, open, earthen, Indian oven, [Figure 1]). This type of sitting on a low-leveled stool sideways to the chulla predisposes the ladies to develop erythema peculiar of the so-called fire stains. The danger of the saree (dress worn by Indian ladies) catching the fire forces the ladies to raise it above the knee thus exposing that side leg with that side of forearm. Due to a rural practice of making chapattis or cutting vegetables at the same time as cooking makes the ladies sit in a sideways posture there by exposing half/unilateral part of body more to the fire.
Due to unilateral exposure to heat it leads to retiform patterning of the skin over the right upper limb and right lower limb causing erythema ab igne [Figure 2].
|Figure 1: Showing a rural Indian woman besides a chulla showing her sideways posture|
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|Figure 2: Showing erythema ab igne in patients right forearm and right leg only|
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| Discussion|| |
Erythema ab igne is characterized by localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Patients with erythema ab igne have a history of repeated exposures to heat at a lower level than that which causes a thermal burn.  Initially, the skin in erythema ab igne patients is often mildly erythematous; however, after repeated heat exposures, the classic blue, purple, or brown reticulated hyperpigmentation develops. Pathophysiologically, erythema ab igne is a reticulate hypermelanosis with erythema resulting from repeated heat exposure that induces injury to the epidermis and superficial vascular plexus. The exposure, which need not be of long duration, results in cutaneous hyperthermia in the range of 43°-47°C.
The histopathologic changes are however similar to those seen in solar-damaged skin. Although the pathogenic mechanisms in erythema ab igne are poorly understood, studies have shown that moderate heat acts synergistically with ultraviolet radiation to denature DNA in squamous cells in vitro.  Chronic exposure to ultraviolet rays leads to photoimmunosuppression as an adaptive response.  Thermal keratosis, squamous cell carcinoma in situ, and squamous cell carcinoma have been reported in patients after chronic exposure to infrared radiation.  There has been a case report of a 90-year-old woman with erythema ab igne on the records, who developed Merkel cell carcinoma adjacent to squamous cell carcinoma. Occasionally, the first sign of splenomegaly, pancreatitis, pancreatic cancer, and other cancers is erythema ab igne resulting when patients applying external heat to relieve the underlying pain.  The condition is also likened to Khagri Cancer, common in Kashmir, where people use Khagri (hot earthen pot with coal) close to their abdomen to keep themselves warm.
Besides the housewives, more so in rural areas who are exposed to chronic infra red radiation while cooking, men may also develop the disease through occupational exposure to heat as in for bakers, silversmiths, and boiler operators.  Additionally, erythema ab igne has been reported to appear on the legs following prolonged, daily exposure to a car heater!
Thus, in our case one side of the body, particularly, the right hand and right leg (as the sari; the cloth worn by adult females in India, is raised a little) was exposed to heat while cooking leading to erythema ab igne. This case is presented to highlight the importance of cultural practices to identify different mode of presentation of a simple condition.
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[Figure 1], [Figure 2]