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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 3731
Experience:  30 years practice in general and cosmetic dermatology
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cure for erythema ab igne skiin rash

Customer Question

cure for erythema ab igne skiin rash
Submitted: 2 years ago.
Category: Dermatology
Expert:  dermdoc19 replied 2 years ago.

dermdoc19 :

Hello

dermdoc19 :

Obviously removing the heat source which caused it. Beyond that Retin A may help as may Am-Lactin Cream. Use the Retin A at night and Am-Lactin twice a day.

dermdoc19 :

There is some evidence that 5 FU might help.

Customer :

do you need prescription for that

dermdoc19 :

Kind of a strange rash to get at this time of the year. I saw a case in March.

Customer :

there is no heat source though

dermdoc19 :

Not for the Am Lactin cream.

dermdoc19 :

Are you sure of the diagnosis then. I was thinking hot water bottle, in front of a fire that sort of thing.

Customer :

also tried vaseline, lotrisone, hyrdocortisone

Customer :

aloe vera

dermdoc19 :

You need a prescription for Retin A but ROC Retinol and Hyaluronic will help too.

dermdoc19 :

Not sure if any of those would help ertyema ab igne and hydrocortisone might make it worse since you already have a dilated blood vessel problem

Customer :

had it for two years, seems strange that biopsy showed that...can it be a virus where antibiotics cure

dermdoc19 :

Interesting. Did the biopsy suggest that or was it fairly conclusive. ? Livedo Reticujlaris maybe instead?

Customer :

topicaltretinoin what about that for treatment

Customer :

clinical data and history results erythema abe igne r/o other vasculitis is what the biopsy results were

dermdoc19 :

tht is the generic name for retin a...you might try Atralin...they have a card that makes the cost $25-50.

Customer :

is this a form of ringworm?

dermdoc19 :

Not at all.

Customer :

microscopic description - the features seen are a punch biopsy specimen showing mild spongiosis in the epidermis, in tact basal layer, and a mild superficial perivascular infiltraate of lymph ocytes and histiocytes. there is some edema in the dermis that was biopsy description

Customer :

and elastic tissue stain was also performed and showed focal fragrmentation of elastic fibers in the dermis and possibly some clumping of elastic fibers in the dermis that was the total test results

Customer :

??

Customer :

so any other suggestions, been to two dermatologists already

dermdoc19 :

Happy to look at a photograph.

Customer :

how do we e-mail the photo for this? new to this service and process

Customer :

ok I can do this in a few minutes if you hang on will send you as an attachment ok?

Customer :

ok thanks for waiting here is the photo attached for your review

Full Size Image

Customer :

so you think the am lactin cream will work on this rash have you seen anything similar

Customer :

sidenote...when I sweat on my arm it appears the redness decreases is there a reason why?

dermdoc19 :

It looks like a variant of livedo Reticularis but erythema ab igne would certainly fit. I would order an ANA and cryogolbulins.

Customer :

what is that and how do you get this

dermdoc19 :

I am going to an informal dinner meeting with a few of the more astute local dermatologists, I would be happy to share the picture with them and garner any thoughts they might have.

dermdoc19 :

Did you have a laptop overlying the area

dermdoc19 :

This looks like a picture I saw of that.

Customer :

ok great thank you!!! my e-mail address is XXXXX@XXXXXX.XXX

Customer :

no laptop directly on that area but yes I do use my laptop frequently

Customer :

it is very frustrating

Customer :

what is ANA??

dermdoc19 :

ANA measures any actilvity where the body is producing antibodies to its own tissue.

Customer :

so what can I use in the meantime for this

Customer :

how do you order an ANA? what exactly is it? tests? lotion? biopsy?

dermdoc19 :

To me this also looks most like parapsoriasis variegata. Have they considered this? Let me review the pathology findings in this condition and get back to you.

Customer :

no they have not

dermdoc19 :

The physician would order it. It is blood work. PV would be the zebra not the horse! ( When you hear hoofbeats think of horses not zebras).

Customer :

ok any other suggestions in the meantime like Am Lactin cream still a good suggestion for the meantime.

dermdoc19 :

Am Lactin is a good suggestion as would plenty of sunlight.

Customer :

ok thanks I appreciate any other suggestions as well...

Customer :

one last question if PV how do you get this, virus? or what?

dermdoc19 :

It would not be know. The thing against this is that the histology description does not fit this, unless it is very early.

Customer :

ok thanks I appreciate this

Customer :

the redness on my arms appears to be thin and wrinkled and scally

Customer :

I have also been taking Fish oil 3000 miligrams is that a good idea or should I discontinue

Customer :

also my Mom just ordered Triderma lotion and also thought of use Emu Oil are these good options or overkill

Customer :

i also have dryness of my skin such as my hands and elbows and other parts of my body that i have to use lotion for everyday could this be a sign of anything....????

dermdoc19 :

The fish oil is a good idea. I did look up the histology and it would actually be very compatible with that diagnosis,the small plaque type of parapsoriasis ( which is the better type to have ( I had it once). It does respond to light therapy ( PUVA). My recommendation would be to make an appt. later in the week..after I show the photo to my colleagues and see if they agree. I think it is early, which makes the diagnosis a little...a LOT harder to make. I strongly doubt it is erythema ab igne ( though it looks a bit like it)...I just cannot make that diagnosis is the Spring/Summer months...Plus, the patients I have seen are elderly females.

dermdoc19 :

I will look up Triderma lotion. From what I read Emu oil is more of a marketing ploy...but I will check.

dermdoc19 :

Triderma doesn't seem like a bad product, but I don't think it will help you much.

Customer :

i have had this rash for a while now ... not like i just got this... but when i did first get this was during the spring/summer time..... almost 2 years i believe but it didnt start out like it is now... just a few red dots and lines alomst 85 percent less of what is in the picture.. i also had gotten jock itch the same time i had gotten this red markings on my inner elbows but the jock itch went away in a little over a week with the use of antifungal cream that you can buy at a local drug store...

Customer :

if i go in the sunlight do i need to put that lotion on before i go in the sunlight or any type of precautionary things i need to know or use on it before i go in the sun??? or can i just get some sun on the area just how it is???

dermdoc19 :

I would just get some sun..but not a burn. Psoralen is generally a pill and a prescription product and has to be used very carefully.

Customer :

would salt water help the area if i ever went into the ocean... or how bout a pool with the chlourine... last summer when i stayed in a pool for almost 30 -40 mins the redness was greatly reduced and almost look liked it was gone til i got out of the pool and dried off... dont knpw if this means anything or was it just because the water was cold??? or something along those lines

Customer :

i can buy that am lactin cream at a local drug store???

Customer :

and when i get this lotion you said use it only twice a day??? morning and night or when should i apply?? sorry to bug you but i have been using so much stuff and trying a lot of different things i just want to get the correct advice on usage infoprmation... and what about retin a ?? just get the am Lactin??

Customer :

????.....

dermdoc19 :

Retin A at night and Am Lactin in themorning and maybe about 5 00PM

Customer :

how do i go about getting retin a.... isnt that a prescription drug??

dermdoc19 :

Salt water as you mentioned can be used and would help. It was probably the sun and salt. Retin A is a RX product but you can try ROC Retinol.

Customer :

ok thanks... i greatly appreciate the info you gave me ass i have been to see 4 doctors already and one dermatologist...

Customer :

last ? i have for you is can i use table salt or a certain salt with water and soak my elbows in it in a bath or something like that for like 15 minutes or would that be a bad idea and i should just stick with the sun...?

Customer :

as*

dermdoc19 :

I would stick with the sun.

dermdoc19 :

If this is parapsoriasis variegata, it is very important to treat this early

dermdoc19 :

You should also have your dermatologist ask the pathologist to review the slide with that diagnosis in mind.

Customer :

ok thanks .. if you would like to reach me with any other info about this after showing that picture to your colleagues or need any other info you can either email me at XXXXX@XXXXXX.XXX or you can contact me on my cell phone @ XXX XXX XXXX

Customer :

but i can buy both am lactin and roc retinol at local drug stores or would i need to order one or the other on the internet???

Customer :

also where are you located??? anywhere near nj?? u have been more helpful to me than anyone ive seen so far.. or is there anyone you can reccommend near the south jersey area that i could see...

dermdoc19 :

You should be able to get them at a drug store. I will get back to you after my colleagues have seen the photo. I practice in Va. I don't know anybody in South Jersey. U of Penn has a very strong dept.

Customer :

and i would need blood work taken for this diagnosis or would they be able to tell just from my skin biopsy???

Customer :

o ok thats fine just thought i would ask...

Customer :

roc retinol correxion deep wrinkle serum is what you are suggesting along with am lactin cream correct?? those are the prroducts i found via the internet

dermdoc19 :

That is the one or Retinol with Hyaluronic

dermdoc19 :

They should be able to tell from the biopsy. You might ask your physician to present you at a medical meeting to get a variety of opinions.

Customer :

o ok thanks for your time and if theres anything else you think of please let me know as it would greatly be appreciated... again email is XXXXX@XXXXXX.XXX and cell is XXXXXXXXXX if you would rather call doesnt bother me if u call but either way your help is greatly appreciated.

Customer :

sorry last question should i clean the area before apllying either of the lotions or will it say on the directions on the bottle

Customer :

do you have an email that i could reach you at if i have any other further questions or would i have to come back through this site???

dermdoc19 :

You don't need to clean the area. However, the advice I gave you is more in regards XX XXXXXXXXX of erythema ab igne ( which I don't think it is after our dialogue) than parapsoriasis variegata. It will not hurt PV though and might be of some benefit. Let me know what happens.

Customer :

ok thanks I also bought Vitamin A 8,000 units and Centrum Performance daily vitamins to add to this treatment

Customer :

keratosis pilaris.....could this be part of this rash because I also have dry skin and some bumps on my upper arms

Customer :

HI again :)

dermdoc19 :

KP would be a separate issue. Although Vitamin A will help somewhat.

Customer :

ok thanks for your help

Customer :

by applying the AM lactin cream would there be signs of improvement if the redness of my skin starts to peel like sunburn does

dermdoc19 :

It probably will not do that but if it does yes.

Customer :

it is starting to slowly peel away not a whole bunch but little pieces here and there expecially when i am in the shower and i wash the area slowly....

Customer :

it also says on the bottle not to get sunlight without using spf15 and u had told me to get some sunlight without apllying anything so this would still be ok if i got a little sunlight on the area just not for a prolonged period of time??

Customer :

i just thought of this ... coould this be some degree of a minor burn from my skin being so dry in that area???? cause when i used bacitracin a while a go for a little bit it got a little better but never went away ???? and when you touch the redness of it it turns white for a second that slowly back to the red just like sunburn would do???

dermdoc19 :

Again, I think it would be very important for you to return to the dermatologist and present him with the idea of parapsoriasis variegata. It is important to treat this so that it does not eventuate into a T cell lympoma as some of them are wont to do.

dermdoc19 :

There are some fairly refined tests the dermatologist can perform to rule this out ( clonal studies).

dermdoc19 :

The problem may wax and wane with some of the medications I mentioned, but those suggestions were made in light of a diagnosis of erythema ab igne which I do not think you have.

dermdoc19 :

Have you seen your dermatologist yet?

Expert:  dermdoc19 replied 2 years ago.
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Expert:  dermdoc19 replied 2 years ago.
Please let me know what is happening. Again, the treatment I proposed would NOT work for parapsoriasis variegata. I gave that when presented with the diagnosis of erythema ab igne. PV needs much stronger treatment. Since this can be serious condition ( if I am correct in my diagnosis), you should see the dermatologist again.
Expert:  dermdoc19 replied 2 years ago.
There is an article in the latest Cutis magazine regarding Erythema ab Igne caused by a laptop computer if you care to read it. The article brings up the fact that nearly all cases are in women, the elderly and those who are hypothyroid. There are some unusual ways to develop erythema ab igne such as a heating blanket in an ICU; therapeutic recliner in an intensive care unit; a car heater; and interestingly a heated bag of popcorn kernels.

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