Erythema e calore - Altmeyers Encyclopedia - Department Vascular medicine

Synonym(s)

caloric erythema; Erythema ab igne; fire stains; toasted skin syndrome

Definition
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Erythema at the point of contact caused by heat or infrared radiation (see below infrared rays), usually reticular erythema at the point of contact, especially in the case of prolonged (usually habitually overheated), regularly or irregularly repeated heat stimuli. The repeated application of heat (e.g. heating cushions, seat and car heaters, but also laptops or mobile phones) initially leads to the red-coloured net-like live image, later to an increasing hyperpigmentation in the given live image pattern (see hyperpigmentation, caloric).

Etiopathogenesis
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The precise cause is unclear. It is assumed to be a paralysis of the deep vascular plexus (located at the corium-subcutaneous border).

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Allergology

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Localization
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Different, depending on the application of the temperature source (heating pads, heating belts, hot-water bottles, open fire, seat heating in cars, infrared lamps)

Clinical features
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Net-like erythema detectable at the heat contact points (no increase in consistency on palpation), each of which forms self-contained circular formations. In the case of long-term damage, brown discolouration increasingly mixes with the red colour. As a late stage only reticulated hyperpigmentations are found.

Histology
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Under largely normal or slightly to distinctly atrophic surface epithelium, dilated capillaries and deposits of melanotic or hemosiderotic pigment are found. Little or no inflammatory symptoms.

Differential diagnosis
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hyperpigmentation, caloric

Complication(s)
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As long-term complications (after 30 years) squamous cell carcinomas and also Merkel cell carcinomas have been described. A higher incidence of carcinoma is found by repeated heat applications using carbon fuel elements, which are in direct contact with the skin as heat sources. Known were the Tibetian or Indian "Kangri ulcer", the Japanese "Cairo cancer" and the Chinese "Kang carcinoma" - Kang = Chinese oven bed).

Therapy
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Avoidance of the damaging temperature influences; otherwise harmless; no therapy necessary

Note(s)
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The overheating caused by regular heat applications is below the pain threshold (<45C°) and does not lead to real burns. The reticular erythema develops after months or even years. Later reticular pigmentation may occur (see below hyperpigmentation, caloric).

Literature
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Beneke J et al (2014) Erythema ab igne in a patient with bulimia nervosa. Nude Dermatol 40:347-349
Bücker H (1961) On the erythema effect of optical radiation. UV erythema, heat erythema. Radiotherapy 115: 136-143