Intended for healthcare professionals


Skin reaction in a patient with chronic abdominal pain

BMJ 2018; 361 doi: (Published 18 April 2018) Cite this as: BMJ 2018;361:k1322
  1. Katrina Watson, GPST1 in dermatology,
  2. Allan Matthews, consultant dermatologist
  1. Department of Dermatology, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife, Scotland
  1. Correspondence to K Watson katrina.watson1{at}

A 26 year old pregnant woman with chronic abdominal pain of unclear cause was seen at 25 weeks’ gestation with longstanding marked skin discoloration (fig 1) and fragility over her abdomen and thighs. She had used hot water bottles over many years for relief of the abdominal pain. A severe case of erythema ab igne was diagnosed. Livedo reticularis would be the main differential diagnosis for such an appearance.

Erythema ab igne is characterised by reticulated erythema, hyper- and hypopigmentation, and telangiectasia resulting from chronic exposure to heat, which causes epidermal damage, vasodilation, and haemosiderin deposition. Skin atrophy and blisters or erosions can develop. The mainstay of management is cessation of heat exposure, and mild cases usually self resolve over several months. Squamous cell carcinoma is anecdotally reported to be a rare complication in untreated and chronic cases.1 The underlying cause of hypothermia or pain should be appropriately investigated.


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