A Reticulate Hyperpigmented Abdominal Patch Associated with Chronic Abdominal Pain

Julie Man, MD,1 Joseph M. Lam, MD, FRCPC,2

1Department of Family Medicine, University of Alberta, Edmonton, AB.
2Assistant Clinical Professor, Department of Paediatrics, Associate Member, Department of Dermatology, University of British Columbia, BC.

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Abstract: A 13-year-old girl presented with a 3-month history of a reticulate hyperpigmented patch over the lower abdomen. Her past medical history was significant for recurrent abdominal pain, Ehlers-Danlos syndrome, a mild learning disability, and multiple allergies. On physical examination, she had a reticulate, hyperpigmented patch distributed diffusely over the lower abdomen (Figure 1). The remainder of her exam was unremarkable. Upon questioning, it was revealed that the patient had been applying a hot water bottle to the lower abdomen for the last 4 months to help relieve the discomfort associated with the abdominal pain. This history led to the diagnosis.
Key Words: Erythema ab igne, hyperpigmentation, reticulate, thermal injury.
Erythema ab igne may present as a transient erythematous eruption, or as a reticulate hyperpigmentation.
Erythema ab igne is a clinical diagnosis which rarely requires biopsy confirmation.
Direct questioning about heat sources, such as prolonged laptop computer use, aids the diagnosis.
Treatment consists of patient education and removal of the heat source.
1. Erythema ab igne is a recognizable condition associated with chronic exposure to heat sources such as heating pads, hot water bottles, electric blankets, space heaters and laptop computers.
2. The differential diagnosis for erythema ab igne includes livedo reticularis, livedoid vasculitis, cutis marmorata telangiectatica congenita, a reticulate port-wine stain and poikiloderma.
3. The most important treatment for erythema ab igne is recognition and removal of the source of infrared radiation.
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