Abstract
Erythema ab igne is a dermatological condition resulting from repeated low-grade heat exposure (below the burning point), which can variably manifest with reticulated erythema and skin hyperpigmentation. Not infrequently, the cause of such a skin disorder is not immediately evident or reported by patients, especially if these are children. Compared to adults, erythema ab igne is rare in children and, if the general practitioners and pediatricians are not aware of this disorder, pediatric patients are often addressed to rheumatologists and/or undergo useless immunological investigations. Here, we performed a systematic case-based review, which finally included 32 cases of pediatric erythema ab igne (in addition to our new clinical report), and discussed the main clinical aspects and issues of this clinical entity in children. In detail, similarities of erythema ab igne with livedo reticularis and/or vasculitis-related rashes sometimes can lead to perform a panel of immunological investigations, which could be avoided. Indeed, our analysis emphasizes the importance of a careful and complete patient's anamnesis, including active questioning about the potential exposure to any physical agents (including heat sources) that may cause dermatological lesions. We also highlight some peculiarities in terms of location and heat injury in children developing erythema ab igne, based on the presence or absence of comorbidities.
Conclusion: The occurrence of erythema ab igne in children (and especially in adolescents) is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. Physicians should be aware of this condition in order to prevent patients from useless investigations, especially in the differential diagnosis of rheumatic disorders. A careful and complete patient's history with active questioning about the potential exposure to heating source is often decisive to diagnose erythema ab igne.
What is Known: |
• Erythema ab igne is a dermatological condition which is mainly described in adults exposed to heating source at the workplace. |
What is New: |
• The occurrence of erythema ab igne in children is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. • Erythema ab igne in children can be classified in two main categories, based on the presence or absence of comorbidity. • A careful and complete anamnesis (including the active questioning about potential exposure to any heating source) is the mainstay for diagnosing erythema ab igne in children. |
Similar content being viewed by others
Data availability
Not applicable.
References
Langlois NI, James C, Byard RW (2016) Erythema ab igne. Forensic Sci Med Pathol 12(1):115–117. https://doi.org/10.1007/s12024-015-9685-5
Salgado F, Handler MZ, Schwartz RA (2018) Erythema ab igne: new technology rebounding upon its users? Int J Dermatol 57(4):393–396. https://doi.org/10.1111/ijd.13609
Jeimy S, Basharat P, Lovegrove F (2019) Dermatomyositis associated with omalizumab therapy for severe asthma: a case report. Allergy Asthma Clin Immunol 15:4. https://doi.org/10.1186/s13223-019-0319-4
Poddighe D, Mukusheva Z, Assylbekova M (2019) Pruritus in patients with amyopathic dermatomyositis. Allergy Asthma Clin Immunol 15:18. https://doi.org/10.1186/s13223-019-0334-5
Milchak M, Smucker J, Chung CG, Seiverling EV (2016) Erythema ab igne due to heating pad use: a case report and review of clinical presentation, prevention, and complications. Case Rep Med 2016:1862480. https://doi.org/10.1155/2016/1862480
Kettelhut EA, Traylor J, Roach JP (2022) Erythema Ab Igne. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL) (PMID: 30855838)
Wharton JB, Sheehan DJ, Lesher JL Jr (2008) Squamous cell carcinoma in situ arising in the setting of erythema ab igne. J Drugs Dermatol 7(5):488–489
Mucklow ES, Freeman NV (1990) Pancreatic ascites in childhood. Br J Clin Pract 44(6):248–251 (PMID: 2144996)
Wilson NJ, Sharpe GR (1999) Erythema ab igne in a child with atopic eczema. Clin Exp Dermatol 24(4):337–338. https://doi.org/10.1046/j.1365-2230.1999.0496c.x
Maalouf E, Simantov A, Rosenbaum F, Chosidow O (2006) Erythema ab igne as an unexpected computer side-effect. Dermatology 212(4):392–393. https://doi.org/10.1159/000092296
Tighe MP, Morenas RA, Afzal NA, Beattie RM (2008) Erythema ab igne and Crohn’s disease. Arch Dis Child 93(5):389. https://doi.org/10.1136/adc.2008.137968
Arnold AW, Itin PH (2010) Laptop computer-induced erythema ab igne in a child and review of the literature. Pediatrics 126(5):e1227–e1230. https://doi.org/10.1542/peds.2010-1390
Søholm Secher LL, Vind-Kezunovic D, Zachariae CO (2010) Side-effects to the use of laptop computers: erythema ab igne. Dermatol Rep 2(2):e11. https://doi.org/10.4081/dr.2010.e11
Giraldi S, Diettrich F, Abbage KT, Carvalho Vde O, Marinoni LP (2011) Erythema ab igne induced by a laptop computer in an adolescent. An Bras Dermatol 86(1):128–130. https://doi.org/10.1590/s0365-05962011000100018
Fu LW, Vender R (2012) Erythema ab igne caused by laptop computer gaming–a case report. Int J Dermatol 51(6):716–717. https://doi.org/10.1111/j.1365-4632.2011.05033.x
Goldman JL, Nopper AJ, Myers AL (2012) Picture of the month--quiz case. Erythema ab igne. Arch Pediatr Adolesc Med 166(2):185–186. https://doi.org/10.1001/archpediatrics.2011.762a
Docx MK, Simons A, Ramet J, Mertens L (2013) Erythema ab igne in an adolescent with anorexia nervosa. Int J Eat Disord 46(4):381–383. https://doi.org/10.1002/eat.22075
Steadmon MJ, Riley KN (2013) Erythema ab igne: a comeback story. J Pediatr 163(6):1789. https://doi.org/10.1016/j.jpeds.2013.07.040
Turan E, Ye≈üilova Y, U√ßmak D, √áelik √ñƒ∞ (2013) Thermal pillow: an unusual causative agent of erythema ab igne. Turk J Pediatr 55(6):648–650
Brzezinski P, Ismail S, Chiriac A (2014) Radiator-induced erythema ab igne in 8-year-old girl. Rev Chil Pediatr 85(2):239–240. https://doi.org/10.4067/S0370-41062014000200015
Dizdarevic A, Karim OA, Bygum A (2014) A reddish brown reticulated hyperpigmented erythema on the abdomen of a girl. Erythema ab igne, also known as toasted skin syndrome, caused by a heating pad on the abdomen. Acta Derm Venereol 94(3):365–367. https://doi.org/10.2340/00015555-1722
Bassi A, Berti S, Galeone M, Difonzo EM (2014) Erythema ab igne. QJM 107(10):849. https://doi.org/10.1093/qjmed/hcu049
Dessinioti C, Katsambas A, Tzavela E, Karountzos V, Tsitsika AK (2016) Erythema ab igne in three girls with anorexia nervosa. Pediatr Dermatol 33(2):e149–e150. https://doi.org/10.1111/pde.12770
South AM, Crispin MK, Marqueling AL, Sutherland SM (2016) A hyperpigmented reticular rash in a patient on peritoneal dialysis. Perit Dial Int 36(6):699–700. https://doi.org/10.3747/pdi.2016.00042
Gmuca S, Yu J, Weiss PF, Treat JR, Sherry DD (2020) Erythema ab igne in an adolescent with chronic pain: an alarming cutaneous eruption from heat exposure. Pediatr Emerg Care 36(4):e236–e238. https://doi.org/10.1097/PEC.0000000000001460
Samaan CB, Valentin MN, Jamison MO, Ellison K, Marathe KS, Norton SA, Kirkorian AY (2018) Erythema ab igne in patients with sickle cell disease. Pediatr Hematol Oncol 35(3):225–230. https://doi.org/10.1080/08880018.2018.1516838
Knopfel N, Weibel L (2021) Erythema ab igne JAMA Dermatol 157(1):106. https://doi.org/10.1001/jamadermatol.2020.3995
Nield TR, Brunner NE, Zinn Z (2020) Erythema ab igne in a 12-year-old boy diagnosed via telemedicine. Cureus 12(11):e11577. https://doi.org/10.7759/cureus.11577
Brazzelli V, Grassi S, Barruscotti S, Croci G, Borroni G (2020) Erythema ab igne induced by laptop computer: an emerging disease among adolescents? G Ital Dermatol Venereol 155(1):99–102. https://doi.org/10.23736/S0392-0488.17.05217-8
Cakan M, Demirsoy EO (2021) Vasculitic rash or something simpler: erythema ab igne. J Clin Rheumatol 27(5):e193. https://doi.org/10.1097/RHU.0000000000001362
Duan GY, Stein SL (2021) Erythema ab igne in pediatric patients remote schooling during the COVID-19 pandemic: a case series. Pediatr Dermatol 38(5):1361–1362. https://doi.org/10.1111/pde.14791
Raza N, Qadir SN, Ejaz A (2007) Epidemiology of erythema ab igne at a moderately cold weather station. J Pak Med Assoc 57(3):146–148 (PMID: 17432021)
Ozturk M, An I (2020) Clinical features and etiology of patients with erythema ab igne: a retrospective multicenter study. J Cosmet Dermatol 19(7):1774–1779. https://doi.org/10.1111/jocd.13210
Daneshvar E, Seraji S, Kamyab-Hesari K, Ehsani AH, Hanifnia AR, Razavi Z (2020) Basal cell carcinoma associated with erythema ab igne. Dermatol Online J 26(4):13030/qt3kz985b4
Johnson NM, Shvygina A, Luyimbazi DT, Grider DJ (2021) Rare mimic of angiosarcoma: erythema ab igne with reactive angiomatosis. J Cutan Pathol 48(10):1298–1302. https://doi.org/10.1111/cup.14072
Wharton J, Roffwarg D, Miller J, Sheehan DJ (2010) Cutaneous marginal zone lymphoma arising in the setting of erythema ab igne. J Am Acad Dermatol 62(6):1080–1081. https://doi.org/10.1016/j.jaad.2009.08.005
Haleem Z, Philip J, Muhammad S (2021) Erythema ab igne: a rare presentation of toasted skin syndrome with the use of a space heater. Cureus 13(2):e13401. https://doi.org/10.7759/cureus.13401
Wick MR (2017) Disorders characterized by predominant or exclusive dermal inflammation. Semin Diagn Pathol 34(3):273–284. https://doi.org/10.1053/j.semdp.2016.12.002
Gusdorf L, Lipsker D (2018) Neutrophilic urticarial dermatosis: a review. Ann Dermatol Venereol 145(12):735–740. https://doi.org/10.1016/j.annder.2018.06.010
Poddighe D, Cavagna L, Brazzelli V, Bruni P, Marseglia GL (2014) A hyper-ferritinemia syndrome evolving in recurrent macrophage activation syndrome, as an onset of amyopathic juvenile dermatomyositis: a challenging clinical case in light of the current diagnostic criteria. Autoimmun Rev 13(11):1142–1148. https://doi.org/10.1016/j.autrev.2014.05.009
Kocoloski AJ, Aggarwal R (2020) Erythema ab igne. J Clin Rheumatol 26(5):e89. https://doi.org/10.1097/RHU.0000000000000875
Chan CC, Chiu HC (2007) Images in clinical medicine. Erythema ab igne. N Engl J Med 356(9):e8. https://doi.org/10.1056/NEJMicm055084
Riahi RR, Cohen PR, Robinson FW, Gray JM (2010) Erythema ab igne mimicking livedo reticularis. Int J Dermatol 49(11):1314–1317. https://doi.org/10.1111/j.1365-4632.2009.04433.x
Lewis P, Wild U, Erren TC (2020) Working from home during and after COVID-19: watch out for erythema ab igne when using laptops. Br J Gen Pract 70(697):404. https://doi.org/10.3399/bjgp20X712037
Author information
Authors and Affiliations
Contributions
D.P. performed the literature search; Z.A. and A.A. managed and described the case presentation; D.P. wrote the manuscript; D.P., M.A., and Z.M. provided intellectual contribution.
Corresponding author
Ethics declarations
Ethical approval
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Communicated by Peter de Winter
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Poddighe, D., Assylbekova, M., Almukhamedova, Z. et al. Pediatric erythema ab igne: clinical aspects and diagnostic issues. Eur J Pediatr 182, 4807–4832 (2023). https://doi.org/10.1007/s00431-023-05155-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-023-05155-1