VDE_304.

fm Page 283 Friday, September 20, 2002 4:32 PM

Veterinary Dermatology 2002, 13, 283292

Case
Report
Blackwell
Science,heat
Ltd dermatitis
Chronic
moderate

Case report

Chronic moderate heat dermatitis (erythema ab igne) in five dogs,

three cats and one silvered langur
EMILY J. WALDER* and ANN M. HARGIS
*An independent Biopsy Service, Venice, CA 90291, USA; DermatoDiagnostics, Edmonds, WA 98026, USA;
Phoenix Central Laboratory, Everett, WA 98204, USA; Department of Comparative Medicine, University of
Washington, Seattle, WA 98195, USA
(Received 27 November 2001; accepted 22 May 2002)

Abstract Erythema ab igne, an old and rare disease in the human literature, is an erythematous, often pigmented, reticular, macular dermatosis that occurs at the site of repeated exposure to moderate heat. We identified
lesions consistent with erythema ab igne in five dogs, three cats and one silvered langur (Trachypithecus cristatus
{Raffles, 1821}). In dogs and cats, the cutaneous lesion distribution typically reflected chronic exposure to
moderate heat during lateral or sternal recumbency. The silvered langur developed cutaneous lesions on the
dorsal neck from exposure to a heat lamp. Principal clinical lesions consisted of irregular areas of alopecia
(7/9) and erythema (7/9), sometimes with hyperpigmentation (3/9). Principal histological features consisted of
karyomegaly (9/9) and keratinocyte atypia (4/9), scattered apoptotic or vacuolated basal cells and/or apoptotic
keratinocytes (6/9), mild mixed mononuclear interstitial or interface dermatitis (9/9) with adnexal atrophy (8/9),
and a variable number of wavy eosinophilic elastic fibres (9/9). The presence of these cutaneous lesions in an
animal indicates that the environment should be evaluated for exposure to chronic moderate heat, and the heat
source should be eliminated or modified to prevent further exposure and progression of lesions.
Keywords: cat, dog, erythema ab igne, moderate heat dermatitis, silvered langur, skin

INTRODUCTION
Erythema ab igne, an old disease in the human literature, is an erythematous, often pigmented, reticular,
macular dermatosis that occurs at the site of repeated
exposure to moderate heat. The name is derived from
Greek (erythema) and Latin (ab ignis), and essentially
means redness from fire.1 Synonyms include ephelis
ignealis (1835), ephelis ab igne (1902), erythema a
calore (1963), erythema ab igne elastosis (1971) and
reticular erythema of the lower back (1991).26
The most common sources of chronic moderate
heat dermatosis in humans are open fires (coal, peat,
fireplaces), heating pads, hot water bottles and steam
radiators. 5,710 Cutaneous lesions have developed
from repeated exposure to moderate heat over periods
varying between 2 months and 30 years.10 Clinical
lesions occur in cutaneous sites chronically exposed
to the heat source, classically the shins, lower back or
buttocks.5,9,10 In contrast, occupational exposure (e.g.
bakers, foundry workers, glass blowers, welders) often
results in lesions on the face, hands and forearms.1113
Erythema ab igne occurring on the abdomen or lower

Correspondence: Ann M. Hargis, DermatoDiagnostics, Edmonds,

WA 98026, USA.
2002 Blackwell Science Ltd

back, secondary to heat application for pain, is considered

to be a marker for serious internal disease, including
pancreatitis and carcinoma of abdominal viscera.14,15
Lesions may be transient or permanent depending upon
exposure frequency and duration.16 Thermal keratoses
(heat-induced epidermal carcinoma in situ ) have
progressed to invasive squamous cell carcinoma in a
few people.1719 Histological features in humans include
scattered atypical keratinocytes, occasional giant keratinocyte nuclei (karyomegaly), and mild to moderate
basal cell apoptosis and vacuolar degeneration.10,16,17
There is attenuation of superficial dermal collagen and
variable deposition of acid mucosaccharides.5 A pathognomonic feature of erythema ab igne is the abnormal and
often numerous elastic fibres with brightly eosinophilic
staining.5,10,16,17 There is usually a mild, interface to
interstitial mixed inflammatory cell infiltrate with
melanophages and haemosiderophages.10 16
Erythema ab igne in one dog was originally presented
by one of the authors (EW) in 1994.20 It has recently
been described in two dogs.21 Erythema ab igne in animals also has been the subject of a recent workshop.22
Here we describe the clinical and histological features
of erythema ab igne in five dogs, three cats and one
silvered langur (Trachypithecus cristatus {Raffles,
1821}),23 and describe the circumstances leading to the
development of the lesions.
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2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 283 292

Duration not provided

90% regrowth of hair by

removing heat source
Lost to follow up
Plant warmer covered with
blankets placed in the cats bed
Heating pad covered by blankets
6 years

18 years

Case 7: Feline,
Domestic Long-haired
Case 8: Feline, Siamese

Case 9: Feline,
Domestic Short-haired

7 years

14 years

Two small erythematous nodules

(abdomen). Dusky erythema
(sternum)
Irregular, linear, alopecia, scaring,
crusting
Erythema, shiny (appeared moist),
alopecia
Erythema, hyperpigmentation,
alopecia, and pruritus

Ventral thorax and

abdomen
Ventral thorax and
abdomen
Ventral chest and leg

Electric blanket

Duration not provided. Outdoor

cat sleeps on electric blanket
9 months

Continued access permitted

Develops transient erythema on
ventral thorax after exposure
Lost to follow up
Duration not provided

Heating pad and sun-heated

driveway (composition of
driveway unknown)
Concrete driveway
Lattice work hyperpigmentation
and light red skin

Ventral sternum, and

ventrolateral thorax
and flank
Ventral abdomen and
sternum

Hot air heat register

Ventral abdomen

9 years

Case 6: Canine,
Staffordshire Bull Terrier

Lost to follow up

Outdoor dog
Winter months
One month total, 30 min
at a time, 3 times per day
Winter months (heating pad)
Warm months (heated driveway)
Heated kennel pad
8 years

Case 3: Canine, German

Short Hair Pointer
Case 4: Canine,
Jack Russell Terrier
Case 5: Canine,
Cocker Spaniel

Sternum and over each hip

Outcome
Duration of exposure

Winter months
Duration not provided
Dog sleeps on the heating pad
13 years
7 years
Case 1: Primate, Langur
Case 2: Canine, Basenji

Figure 1. Abdominal skin; Basenji (case 2) with chronic moderate

heat dermatitis (erythema ab igne). Irregular, linear, partially
interconnecting areas of alopecia, erythema and variable pigmentation are present. Photograph was taken after biopsy samples were
collected and diagnosis of chronic moderate heat dermatitis was
made, thus four biopsy sites are present.

Table 1. Clinical findings

Gross lesions

Crusty alopecia with focal exudation

Irregular branching areas of
alopecia, erythema, and
hyperpigmentation
Erythematous plaques
(12 cm) with alopecia
Alopecia, scales, erythema, crust

Age
Animal

Location

Heat source

Clinical data
Clinical data are listed in Table 1. The mean age of
affected animals was 9.4 years (range 318 years).
Heat sources included heating pad or heated kennel
mat (three animals), electric blanket (one animal), plant
warmer (one animal), heat register (one animal), heat
lamp (one animal), concrete driveway (one animal),
and a combination of heating pad and driveway
(composition unknown) (one animal). Exact duration
of exposure, when known, varied from 1 month (one
animal) to 9 months (one animal). Duration of exposure
was recorded only as winter months (three animals) or
was unknown (four animals). Lesions occurred in sites
exposed to the heat source. The typical sites were
ventral thorax or abdomen associated with ventral
recumbency and exposure to heated bedding or surface
materials (e.g. concrete driveway). The silvered langur
developed lesions on the skin of the dorsal neck from
exposure to a heat lamp. Clinical lesions consisted of
irregular, linear, macular or plaque-like areas of alopecia,
erythema and occasional hyperpigmentation (Fig. 1).

Heat lamp in cage

Heating pad

RESULTS

Dorsal neck
Lateral thorax and flank

The animals in this report (five dogs, three cats and

one silvered langur) had skin biopsy samples submitted
to the biopsy services of the authors or to colleagues
of the authors. Biopsy samples of lesional skin were
submitted in 10% neutral buffered formalin. The fixed
samples were dehydrated in graded ethanols, cleared in
xylene and embedded in paraffin. Tissue sections were
stained with haematoxylin and eosin (H&E). In four
animals, tissue sections also were stained with Verhoeffvan Gieson technique for elastin24 and Gomoris method
for iron.25 For the Verhoeff-van Gieson elastin stain,
skin sections from two cats and four dogs were used
as species- and age-matched controls. A section of liver
served as a control for the Gomoris iron stain.

Lost to follow up
Lost to follow up

MATERIALS AND METHODS

Lesions resolved by preventing

access to heat register
Lost to follow up

E.J. Walder and A.M. Hargis

3 years

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Chronic moderate heat dermatitis

Figure 2. Skin; case 7. Karyomegaly of the epidermis is present

(H&E, 372).

Erosion and exudation were uncommon and, if present,

were considered to be associated with more severe
thermal injury (e.g. thermal burn).
The silvered langur had a cagemate with similar
clinical lesions in the skin of the dorsal neck, but no
skin samples were collected for histopathology so the
cagemate was not included in this study. Similarly, two
of the cats, each living in separate households, had a
feline housemate with similar clinical lesions involving
the skin of the ventral abdomen or ventral chest. The
cats either had heating pads covered by blankets or
plant warmers in their beds. No skin samples were
collected for histopathology from the two feline housemates so they were not included in this study.
In two animals (one cat and one dog) for which
follow up information was available, the lesions resolved
with removal of the heat source. In one animal allowed
continued access to the heat source, transient erythema
developed after heat exposure. No follow up was available for six animals.
Histopathological changes
Histopathological data are listed in Table 2. Epidermal
changes typically consisted of mild to moderate hyperkeratosis and acanthosis (8/9) with keratinocyte atypia
(4/9) and karyomegaly (9/9) (Fig. 2). Keratinocyte
atypia consisted of irregular nuclear size, shape, contour, staining and stratification, and enlarged nucleoli.
There was focal vacuolar and apoptotic degeneration
of basal cells (Fig. 3) and apoptosis of keratinocytes
in the stratum spinosum (6/9). Uncommonly, the basal
cell degeneration led to clefting between the epidermis
and dermis (3/9). Uncommonly, epidermal thinning
(2/9) was observed. In three of the nine animals, crusts
were present overlying the epidermis. Two of these
animals also had foci of necrosis of the epidermis (Fig. 4),
and one also had focal necrosis of sebaceous glands.
The lesions in these three animals were suggestive of
subacute to resolving thermal burns.
Dermal changes consisted of rarefaction of dermal
collagen with amphophilic, mucinous or oedematous
fluid (6/9) in the superficial one third of the dermis, and

285

Figure 3. Skin; case 4. Basal cell vacuolization and apoptosis are

present (H&E, 372).

Figure 4. Skin; case 7. Coagulation necrosis of epidermis, sparing a

few basal cells, is evident in a cat with thermal burn coexisting with
chronic moderate heat dermatitis (erythema ab igne) (H&E, 372).

Figure 5. Skin; case 2. Elastic fibres (arrows) are fine, irregular and
eosinophilic (H&E, 372). Elastic fibres in chronic moderate heat
dermatitis (erythema ab igne) are eosinophilic, whereas the elastic
fibres in solar elastosis are basophilic.

with a variable number of wavy, eosinophilic fibres

in the superficial dermis (9/9) (Fig. 5). In four of the
nine animals, sections were stained with Verhoeffvan Gieson method for elastin. The eosinophilic fibres
observed in the H&E sections stained greyish-black
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 283292

Moderate to
extensive
hyperkeratosis
and acanthosis
Focal-serocellular
crust

Mild to moderate
hyperkeratosis
and acanthosis

Mild to moderate
hyperkeratosis
and acanthosis

Mild to moderate
hyperkeratosis
and acanthosis

Moderate
acanthosis and
mild hyperkeratosis

Case 1: Primate,
Langur

Case 2: Canine,
Basenji

Case 3: Canine,
German Shorthaired Pointer*

Case 4: Canine,
Jack Russell
Terrier*

Case 5: Canine,
Cocker Spaniel*

Animal

Acanthosis
Ulceration
Crusting

Table 2. Histological findings

2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 283 292

None

None

Mild karyomegaly
and focal increase
in epidermal melanin
pigment

Karyomegaly
Apoptotic
basal cells

Karyomegaly
Occasional
apoptotic
keratinocyte

Karyomegaly
Atypical
keratinocyte
nuclei

Karyomegaly
Basal cell
apoptosis and
vacuolation
Atypical
keratinocyte
nuclei

Keratinocyte
dysplasia
degeneration
karyomegaly

Eosinophilic
and basophilic
fibrils. Some
areas fibrils are
prominent.
Elastin stain,
numerous fibrils
(some related to
solar injury and
some related to
heat injury)

Curvy
eosinophilic
fibres. Elastic
stain, mild increase
in fine wavy fibrils

Scattered curved
eosinophilic fibrils,
few prominent
Elastic stain,
numerous positive
fibrils, thinner and
more irregular than
normal

Curvy
eosinophilic
fibres

Wavy,
curvilinear
eosinophilic
fibrils

Dermal elastin
fibres, superficial
dermis

Mild cell poor

interface dermatitis,
mixed, with
ischaemic dermatitis
Macrophages with
pigment
Moderate interface
and interstitial
lymphocytic,
neutrophilic,
and histiocytic
inflammation
Mild haemorrhage
Hemosiderophages
Melanophages
Mild interface
and interstitial
lymphocytes,
macrophages,
mast cells, and
occasional
neutrophil
Hemosiderophages
Mild interstitial
and subtle focal
interface,
lymphocytic and
histiocytic dermatitis
Hemosiderophages
and melanophages

Mild lymphocytic
to mixed interface
dermatitis
Macrophages
with pigment

Dermal
inflammation

Moderate
dermal scarring
and oedema

Pale dermal
collagen
Mucinous fluid

Pale dermal
collagen
Scarring
Occasional large
nucleus spindle
cell
Oedema
Mucinous fluid
Superficial
dermal scarring

Pale dermis
with attenuated
collagen
Mucinous
fluid

Collagen
rarefaction,
scarring

Congestion

Mild congestion
and occasional
endothelial cell
degeneration
(Ischaemic
dermatitis)

Congestion, focal
haemorrhage
Mild endothelial
degeneration
(Ischaemic
dermatitis)
Mild endothelial
degeneration
and congestion
(Ischaemic
dermatitis)

Mild congestion
Endothelial
degeneration
(Ischaemic
dermatitis)

Vessels

Follicular
atrophy

Follicular and
sebaceous
gland atrophy

Follicular
atrophy

Follicular and
sebaceous
gland atrophy

Follicular
atrophy

Adnexa

None

None

None

Probable focal
resolving burn.
Epidermal protein
exudation and
neutrophilic
inflammation
with subepidermal
clefting
None

Thermal burn

286

None

None

Focal
subepidermal
clefting

Necrosis
Subepidermal
clefting

VDE_304.fm Page 286 Friday, September 20, 2002 4:32 PM

E.J. Walder and A.M. Hargis

Focal
subepidermal
clefting

Karyomegaly
Focal apoptotic
keratinocytes

Karyomegaly,
keratinocyte atypia,
occasional apoptotic
basal cell and
keratinocyte

Karyomegaly
Occasional apoptotic
and atypical
keratinocytes
(epidermis and
superficial adnexa)

Subtle karyomegaly

Keratinocyte
dysplasia
degeneration
karyomegaly

*Cases evaluated with Gomoris iron and Verhoeffs elastin stains.

Hyperkeratosis.
Acanthosis.
Focal old
detached crust

Case 9: Feline,
Domestic
Short-haired

None

Focal
subepidermal
clefting

Hyperkeratosis.
Acanthosis.
Atrophy
Focal crust

Mild hyperkeratosis
and acanthosis

None

Necrosis
Subepidermal
clefting

Thin epidermis

Case 8: Feline,
Siamese

Case 6: Canine,
Staffordshire
Bull Terrier
Case 7: Feline,
Domestic
Long-haired*

Animal

Acanthosis
Ulceration
Crusting

Table 2. (continued)

Few focal
eosinophilic
fibrils

Few focal
eosinophilic
fibrils

Few prominent
eosinophilic
fibrils. Elastic
stain, numerous
positive fibrils,
thinner and more
irregular than
normal

Eosinophilic fibres

Dermal elastin
fibres, superficial
dermis

Interface and
interstitial
neutrophils,
macrophages,
lymphocytes,
mast cells
No significant
haemosiderin,
scant melanin
Equivocal interface
and few scattered
mast cells,
lymphocytes,
and eosinophils
No major pigments
Subtle interface
and periadnexal
mast cells,
lymphocytes,
macrophages with
pigment, and
occasional neutrophils

Mild superficial
interstitial dermatitis

Dermal
inflammation

Minor superficial
scarring

Mild oedema and

mild superficial
dermal scarring

Mucinous fluid
Moderate
scarring

Dermal scarring

Collagen
rarefaction,
scarring

Congestion and
focal
haemorrhage

Mild congestion

Congestion
Mild endothelial
degeneration
(ischaemic
in some sections)

Moderate
congestion

Vessels

Follicular
atrophy

Follicular and
sebaceous gland
atrophy

Follicular and
sebaceous
gland atrophy

No lesion

Adnexa

Probable focal burn

Focal necrosis of
epidermis with
proteinaceous
fluid and
erythrocyte
exudation

None

Focal burn
Focal necrosis
of epidermis,
sebaceous glands,
plus karyorrhectic
debris in dermis.

None

Thermal burn

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Chronic moderate heat dermatitis

287

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E.J. Walder and A.M. Hargis

DISCUSSION

Figure 6. Skin; case 4. Elastic fibres (arrows) are fine, irregular and
greyish-black (Verhoeff-van Gieson, 372).

Figure 7. Skin; control case, dog. Normal elastic fibres are evident.
There are thinner fibres immediately subjacent to the epidermis
(smaller arrows), and thicker, course fibres (larger arrows) deeper in
dermis (Verhoeff-van Gieson, 372).

with the Verhoeff-van Gieson method confirming

that these were elastic fibres (Fig. 6). Compared with
sections from normal controls (Fig. 7), the elastic fibres
were more numerous, more irregular, and finer. In one
dog in this study, both eosinophilic and basophilic
elastic fibres were present in the dermis. This dog lived
in an environment with abundant sun exposure, and the
dog was known to sunbathe in addition to sleeping on
a heating pad and resting with the abdomen in contact
with the sun-heated driveway.
There was a mild, interstitial or interface, mixed
inflammatory response (9/9) consisting of lymphocytes,
macrophages, mast cells and, occasionally, neutrophils
or eosinophils. Brown granular pigment was often
seen in macrophages. Sections from four animals were
stained using Gomoris method for iron. In three of the
four animals, variable amounts of the brown pigment
stained positively (blue) for iron. Other brown granular
pigments did not stain for iron and were considered to
represent melanin. Subtle vascular degeneration (5/9),
such as loss of capillary endothelium, was seen. There
was follicular and adnexal atrophy (9/9), and dermal
scarring (7/9).
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 283 292

Erythema ab igne occurs in human skin at sites of

chronic exposure to moderate heat. Duration of
exposure to moderate heat sources reported to produce
lesions varied from 2 months to 30 years.10 Moderate
heat implies that the skin surface temperature is not
so high as to result in a thermal burn. An objective
definition of moderate heat was not found in the human
literature on erythema ab igne. However, an experimental
study on rats utilized a range of 3560 C (95140 F)
to determine doseresponse curves for moderate
temperature burns.26 In Suzukis study, first-degree
burns did not occur at 35 C even after 7 days of constant exposure of ventral abdominal skin to heated
water, and 5 days of constant exposure to 36 C water
was required to induce first-degree burns. Only 3 min
of exposure to 60 C water caused deep third-degree
burns.26 A veterinary study demonstrated that surgical
heating pads at a low setting achieve a surface temperature of 3644 C (97112 F); at a medium setting,
the temperature range was 4256 C (108133 F).27 For
purposes of comparison, 6 h of constant exposure to
hot water at 44 C (112 F) was the lowest temperature
resulting in second-degree burn in pigs and humans.28
In the authors experience, both pigs and humans
have considerably thicker epidermis and dermis than
rodents, cats and dogs.
In order to speculate on the pathogenesis of erythema
ab igne, a brief discussion of basic thermodynamics
is requisite. Heat is a result of random kinetic energy
of the molecules within any substance. This thermal
energy can be transferred within the same substance
or to another substance by means of conduction (direct
collision with neighbouring atoms), convection (the
motion of a liquid or gas due to changes in density
as thermal energy is absorbed) or radiation (infrared
electromagnetic energy that is released into space as
atomic particles decelerate). Radiant heat is infrared
radiation that originates from one solid object, passes
through space or air, and is absorbed by another
solid object.29 Infrared radiation is that portion of the
electromagnetic spectrum lying between visible light
and microwaves and having wavelengths of 750
14 000 nm. Erythema ab igne is generally considered
to represent chronic radiant heat dermatitis, based on
the original descriptions of lesions caused by open fires.
Radiant heating would also be the primary thermodynamic mechanism affecting workers in foundries and
bakeries, as well as the silvered langur in this study with
the heat lamp in its cage. Infrared radiation penetrates
the skin and can cause damage to basal keratinocytes,
melanocytes and blood vessels as demonstrated in studies
on infrared lasers.30 Single- and double-stranded DNA
breakage has resulted from exposure to various wavelengths of infrared radiation.31
In people, chronic DNA damage in erythema ab
igne has resulted in development of carcinoma in situ,
termed thermal keratosis.17 Thermal keratoses, just
like actinic keratoses, can in turn progress to invasive

VDE_304.fm Page 289 Friday, September 20, 2002 4:32 PM

Chronic moderate heat dermatitis

squamous cell carcinoma in humans.8,18,19 Progression
of erythema ab igne to thermal keratoses and squamous cell carcinoma has not yet been described in the
veterinary literature.
Interaction of infrared radiation and ultraviolet
radiation is controversial. Some reports indicate a
protective effect by infrared radiation against ultraviolet
associated damage,3234 whereas other reports describe
exacerbation of epidermal and dermal damage with
combined exposure.35 However, in the cases where the
heat source is in direct contact with the skin (heating
pads, hot water bottles, electric blankets, etc.), which
comprise the majority of examples in this article as
well as the more current cases in the human literature,
it is more likely that conduction plays a far greater
role than radiation. This would appear to be true in
part because of the obvious physical contact, but also
because the temperature of such a heat source would
be too low to generate significant amounts of infrared
radiation. Abundant infrared radiation is typically
accompanied by visible wavelengths,36,37 e.g. the glow
of a fire. The pathomechanism at the cellular level by
which conductive heating causes erythema ab igne has
not been investigated.
The clinical features of erythema ab igne in humans
and animals are similar.10,38 There is an irregular pattern of erythema, sometimes with hyperpigmentation.
In animals, alopecia is also a feature and is likely more
apparent due in part to their denser hair coat. In this
study, three house or cagemate animals developed
similar clinical lesions in similar cutaneous sites, but
biopsy samples were not collected. It is probable that
the lesions in the contact animals also represented
erythema ab igne, although this was not proven histologically. Even so, in animals sharing an environment,
the development of similar clinical lesions in cutaneous
sites of lateral or sternal recumbency suggests that
evaluation for exposure to moderate heat sources may
be useful.
The salient histological features of erythema ab igne
in the epidermis, mild to moderate acanthosis, spotty
karyomegaly, scattered atypical keratinocytes, mild to
moderate basal cell apoptosis and vacuolar degeneration, are similar in humans and animals.5,10,16,17 In the
dermis in H&E sections, abnormal and often increased
numbers of elastic fibres with eosinophilic staining are
considered a pathognomonic lesion in humans10 and
are also a feature of the disease in animals.
In humans, elastic tissue changes are also seen in
solar dermatitis. The elastic tissue changes in erythema
ab igne are differentiated from solar elastosis by the
lack of homogenization and loss of fibrous structure,
and the eosinophilic rather than basophilic character
of the fibres in H&E preparations.10 The basophilic
elastic fibres associated with solar damage have been
described picturesquely as blue spaghetti.39 In animal
skin, solar elastosis is often poorly developed in contrast to human skin, but when present, the elastic fibres
associated with solar dermatitis stain basophilic in
H&E preparations.40 Therefore, it appears that the

289

differential staining properties of elastic fibres in H&E

preparations can be used to help differentiate between
solar dermatitis and erythema ab igne in animals as
well. The term red spaghetti to describe heat-induced
elastosis has been suggested by one of the authors
(EW) as a comparison with the mental image of
blue spaghetti. In one dog (case 5) in this study, both
eosinophilic and basophilic elastic fibres were present
in the dermis. This dog lived in an environment with
abundant sun exposure, and the dog was known to
sunbathe in addition to sleeping on a heating pad and
resting with the abdomen exposed to a sun-heated
driveway. In this dog, the elastic tissue changes may
have been multifactorial, due both sun exposure and
chronic moderate heat exposure (blue and red spaghetti, respectively).
In animals, erythema ab igne has several histological
features in common with ischaemic dermatopathies, e.g.
pale dermal collagen with mild endothelial degeneration, and follicular and sebaceous gland atrophy.41,42
Vascular lesions in erythema ab igne in humans are
controversial with some reports suggesting the presence of primary vascular damage and others refuting
the presence of primary vascular lesions.5,9,10 The
ischaemic lesions in animals may be due to infrared
radiation-induced vascular damage and may be a
mechanism of injury contributing to the alopecia
recognized clinically.
The chronological sequence of histological lesion development in erythema ab igne in animals is speculative
due to the fact that the exact pathogenesis of lesion
development for different heat sources is unknown, this
study was retrospective, the animals were exposed to a
variety of heat sources, and biopsy samples were collected
only once, during active disease, from each animal.
Because erythema ab igne develops with repeated exposure to moderate heat, early lesions are undoubtedly
superimposed upon later developing lesions. The
authors believe that early lesions consist of congestion
and oedema due to vascular injury. Early lesions also
include basal cell vacuolization and basal cell and
keratinocyte apoptosis due either to direct injury to
epidermal cells or secondary to ischaemia associated
with vascular injury (basal cell degeneration). Subsequently, pigmentary changes develop from damage
to melanin-containing basal cells and melanocytes, and
from vascular damage. Melanin pigment from damaged
epidermal cells is released into the dermis and is
phagocytized by dermal macrophages. Also, erythrocytes released from damaged vessels are phagocytized
by dermal macrophages and processed into haemosiderin. The inflammation likely develops concurrent to
the cellular injury, from release of pro-inflammatory
cytokines from injured basal cells, melanocytes and
vascular endothelial cells. Adnexal atrophy and scarring are considered late changes, both secondary to
vascular injury similar to that seen in the ischaemic
dermatopathies. Also likely to be a late change, possibly
due to DNA damage to basal cells, is keratinocyte atypia
and karyomegaly. The cause of the elastic tissue change
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E.J. Walder and A.M. Hargis

remains undetermined, as does the time the elastic

tissue change is first evident in lesions. Clearly, by the
time the animals in this report had biopsy samples
collected, the elastic tissue change was present.
The previous report of erythema ab igne in dogs
described, among other lesions, ulceration and crusting
leading to scarring.21 The other clinical lesions (alopecia,
erythema and pigmentary changes), and the histological
lesions (enlarged irregular keratinocytes, dyskeratosis,
vacuolar degeneration of basal cells and mixed dermal
inflammation) are consistent with erythema ab igne.21
The ulceration and crusting described in the dogs of
the previous report are more severe lesions than those
expected with erythema ab igne. It is likely that ulceration and crusting were due to first- or second-degree
thermal burns associated with a greater degree of
heat and/or longer exposure times. Foci suggestive of
thermal burn (necrosis, protein exudation, crusting) were
observed in three animals in our study as well. Thermal
burn might coexist with erythema ab igne in animals
due to the fact that animals tend to sleep on or near
the heat source. Lack of conscious awareness could
predispose to the development of a thermal burn. Also,
compression of body weight associated with resting or
sleeping on the heat source could predispose to thermal
burn by reducing the ability of heat to dissipate. This
was demonstrated experimentally in Suzukis rat study,
in which dermal temperature increased significantly,
and all threshold exposure times for thermal damage
decreased, when weights of 100400 g were placed on
the temperature applicator device.26 Similarly, when
ischaemia was induced by creating poorly vascularized
skin flaps, the effects of heat exposure were magnified.26
In conclusion, lesions consistent with erythema ab
igne developed in five dogs, three cats and one silvered
langur. The skin of these animals was repeatedly
exposed to moderate conductive or radiant heat
over a period ranging from 1 to 9 months. Heat sources
associated with erythema ab igne included heating pad
and heated kennel mat, electric blanket, heat lamp, heat
register and sun-heated driveways. Alopecia, erythema
and sometimes hyperpigmentation were salient clinical
features. Common epidermal histological lesions were
karyomegaly, mild keratinocyte atypia, and basal cell
vacuolization and apoptosis. The pathognomonic
dermal lesion is wavy eosinophilic elastic fibres in
H&E stained sections. In addition, there is evidence
of ischaemic dermatopathy, especially in dogs. The
ischaemic lesions may reflect direct vascular injury by
infrared radiation or increased dermal temperature.
The lesions of erythema ab igne may be superimposed
upon those of thermal burn, especially when the
animal sleeps on or near the source of heat. We propose
that the term chronic moderate heat dermatitis be
used as the English equivalent of erythema ab igne, as
this would encompass cases due to heating by conduction as well as radiant heating. The authors believe that
the histological lesions of karyomegaly with or without
basal cell vacuolization and apoptosis, in combination
with the wavy eosinophilic dermal elastic fibres as
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 283 292

seen in H&E stained sections are pathognomonic for

chronic moderate heat dermatitis (erythema ab igne) in
animals. Additionally, lesions of ischaemic dermatopathy or thermal burn may be superimposed.

ACKNOWLEDGEMENTS
The authors thank Drs Dimitry M. Danilenko,
Michael M. Garner, Thelma Lee Gross, Sally J. Lester,
L. McKerlich, Linda M. Messinger and David D.
Whitney for contribution of case materials.

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Rsum LErythema ab igne, une dermatose ancienne et rare de la littrature humaine, consiste en une dermatose maculeuse rticuleuse, rythmateuse, souvent pigmente, qui apparat au niveau dune zone expose
rgulirement une chaleur modre. Nous avons identifi une dermatose ressemblant lerythema ab igne chez
5 chiens, 3 chats et un Trachypithecus cristatus {Raffles, 1821}). Chez les chiens et les chats, les lsions cutanes
taient distribues sur une zone expose une chaleur modre, pendant un dcubitus sternal ou lateral. Pour le
Trachypithecus cristatus, la lsion tait localise au niveau de la face dorsale du cou, la suite dune exposition
une lampe chauffante. Les lsions regroupaient des zones irrgulires dalopcie (7/9) et drythme (7/9), parfois
associes une hyperpigmentation (3/9). Les modifications histologiques regroupaient une cariomgalie (9/9) et
une atypie kratinocytaire (4/9), des cellules basales apoptotiques ou vacuolises (6/9), un infiltrat mononucl
dinterface ou interstitiel (9/9) avec une atrophie annexielle (8/9), et un nombre variable de fibres lastiques
osinophiles (9/9). La prsence de ce type de lsions cutanes chez un animal doit faire valuer lenvironnement
la recherch de la prsence dune source rpte de chaleur modre, qui doit tre limine pour viter la
progression des lsions.
Resumen El eritema ab igne, una enfermedad antigua e infrecuente en la literatura humana, es una dermatosis
eritematosa, a menudo pigmentada, reticular y macular que aparece en reas cutneas expuestas repetidamente
a calor moderado. Identificamos lesiones compatibles con eritema ab igne en cinco perros, tres gatos, y un langur
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E.J. Walder and A.M. Hargis

plateado (Trachypithecus cristatus {Raffles, 1821}). En perros y gatos, la distribucin de la lesin cutnea se
corresponda claramente con una exposicin crnica a calor moderado durante un decbito esternal o lateral.
El langur plateado desarroll lesiones cutneas en el cuello dorsal por exposicin a una lmpara de calor. Las
lesiones clnicas principales consistan en reas irregulares de alopecia (7/9) y eritema (7/9), a veces con
hiperpigmentacin (3/9). Las caractersticas histolgicas principales fueron la cariomegalia (9/9) y la atipia de
queratinocitos (4/9), clulas basales aisladas apoptticas o vacuolizadas y/o queratinocitos apoptticos (6/9),
dermatitis mononuclear o mixta intersticial o de la unin, de baja intensidad (9/9) con atrofia de anejos (8/9), y
un nmero variable de fibras elsticas eosinoflicas ondeantes (9/9). La presencia de estas lesiones cutneas en
un animal indica que debera evaluarse su exposicin a calor moderada de forma crnica, y eliminarse o modificar
la fuente de calor para evitar nuevas exposiciones y la progresin de las lesiones.
Zusammenfassung Erythema ab igne, eine alte und seltene Erkrankung in der menschlichen Literatur, stellt eine
erythematse, oft pigmentierte, retikulre, makulre Dermatose dar, die an Stellen wiederholter mittlerer
Hitzeexposition auftritt. Wir identifizierten Lsionen, die mit Erythema ab igne vereinbar waren, in 5 Hunden,
drei Katzen und einem Haubenlangur (Trachypithecus cristatus {Raffles, 1821}). Bei den Hunden und Katzen
war die Verteilung der Hautlsionen typisch fr eine chronische, mittlere Hitzeexposition in sternaler oder Seitenlage.
Der Haubenlangur entwickelte Lsionen am dorsalen Hals infolge der Exposition zu einer Wrmelampe. Die
klinischen Lsionen bestanden hauptschlich aus unregelmigen Bereichen mit Alopezie (7/9) und Erythem
(7/9), teilweise mit Hyperpigmentierung (3/9). Die histologischen Hauptmerkmale waren: Karyomegalie (9/9),
atypische Keratinozyten (4/9), vereinzelt apoptotische oder vakuolierte Basalzellen und/oder apoptotische
Keratinozyten (6/9), geringgradige monuklere interstitielle oder Grenzflchendermatitis (Interface Dermatitis)
(9/9) mit Atrophie der Adnexa (8/9), sowie eine unterschiedliche Anzahl welliger, eosinophiler elastischer Fasern
(9/9). Derartige Hautlsionen bei einem Tier deuten darauf hin, dass die Umgebung des Tieres auf eine mgliche
Exposition zu mittlerer Hitze untersucht werden und die Hitzequelle entfernt oder derart verndert werden sollte,
soda eine weitere Exposition und ein Fortschreiten der Lsionen verhindert wird.

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