What is the treatment for erythema ab igne in older adults or patients with a history of chronic pain?

Treatment of Erythema Ab Igne

The primary and most critical treatment for erythema ab igne is immediate and complete cessation of heat exposure, which often results in spontaneous resolution over weeks to months. 1, 2

Immediate Management

Remove the heat source completely and permanently. This is the cornerstone of treatment and the only intervention proven to prevent progression to permanent pigmentation or malignant transformation. 1, 2

• Counsel patients extensively on the importance of discontinuing use of heating pads, space heaters, laptops, or any other heat-producing devices that caused the condition 1
• In older adults with chronic pain (the most common scenario), this requires addressing the underlying pain condition with alternative pain management strategies rather than topical heat 2
• Document the heat source and duration of exposure, as prolonged exposure increases risk of permanent changes 2

Prognosis and Expected Course

• Early-stage lesions typically resolve completely within weeks to months after heat source removal, though hyperpigmentation may persist 2
• Chronic cases with prolonged exposure may result in permanent pigmentation or require additional interventions 2, 3
• The excellent prognosis depends entirely on early recognition and heat source elimination 2

Treatment for Persistent Hyperpigmentation

If hyperpigmentation persists after several months of heat source avoidance:

• Topical retinoids can be considered for persistent pigmentation in chronic cases 3
• 5-fluorouracil cream may be used for premalignant cutaneous dysplasia that has developed 3
• Laser treatments are an option for refractory pigmentation 3

Note: There are currently no FDA-approved therapies specifically for erythema ab igne hyperpigmentation 2

Critical Monitoring Requirements

Biopsy is indicated when malignancy is suspected, particularly in longstanding cases with hyperkeratotic lesions or atypical features. 1, 4

• Monitor for malignant transformation in chronic cases, as erythema ab igne can rarely progress to squamous cell carcinoma, Merkel cell carcinoma, basal cell carcinoma, or cutaneous marginal zone lymphoma 1, 2, 3
• Hyperkeratotic lesions emerging within longstanding erythema ab igne warrant biopsy to exclude premalignant or malignant transformation 4
• Delays in diagnosis and ongoing heat exposure significantly increase risk of permanent pigmentation and malignancy 1

Special Considerations for Chronic Pain Patients

When erythema ab igne occurs over the abdomen or lower back, investigate for underlying disorders including malignancy, as localized heat application to these areas often indicates chronic pain from an undiagnosed condition. 3

• Collaborate with pain management specialists to provide alternative pain control strategies 2
• Address the root cause of pain rather than relying on symptomatic heat application 2
• Consider physical therapy, oral analgesics, or other non-heat-based modalities 2

Common Pitfalls to Avoid

• Failing to identify and eliminate the heat source leads to progression and permanent changes 1, 2
• Not investigating underlying causes of chronic pain in patients using heat for symptom relief, particularly when lesions are on the abdomen or back 3
• Delaying biopsy in chronic cases with hyperkeratotic changes or atypical features, missing early malignant transformation 4, 3
• Assuming all cases will resolve completely—chronic exposure may cause permanent pigmentation despite heat source removal 2