Erythema Ab Igne Associated With Cannabinoid Hyperemesis Syndrome

Abstract

A woman in her early 50s presented with a chronic rash and abdominal pain. The patient’s pain was relieved by prolonged hot showers. When the patient’s hot water ran out, she found that using a heating pad provided more sustained relief. She subsequently cut off the cover of heating pads to augment the temperature and used this continuously on her abdomen throughout the day. The patient smoked cannabis for 38 years but noticed stomach pain with the introduction of medicinal marijuana within the past 2 years. Physical examination demonstrated reticulated, hyperpigmented, and erythematous patches with desquamative scaling (Figure). A punch biopsy revealed a subepidermal blister with epidermal atrophy and dermal melanophages. Results of direct immunofluorescence were negative, confirming the diagnosis of bullous erythema ab igne. Erythema ab igne is a cutaneous disorder caused by chronic exposure to heat. Typical sources include space heaters, fireplaces, heating pads, and heating blankets. Rarely, squamous cell carcinoma can result. The treatment of choice is discontinuation of the heat source. Cannabinoid hyperemesis syndrome (CHS) is an increasingly reported disorder manifested by cyclical nausea, vomiting, or abdominal pain that is relieved by prolonged and extreme heat.1Chang Y.H. Windish D.M. Cannabinoid hyperemesis relieved by compulsive bathing.Mayo Clin Proc. 2009; 84: 76-78https://doi.org/10.1016/S0025-6196(11)60811-2Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Abstinence from the use of cannabis is the only known therapy to definitively treat the syndrome.2Simonetto D.A. Oxentenko A.S. Herman M.L. Szostek J.H. Cannabinoid hyperemesis: a case series of 98 patients.Mayo Clin Proc. 2012; 87: 114-119https://doi.org/10.1016/j.mayocp.2011.10.005Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar In addition to heat, capsaicin topical cream has been used to alleviate abdominal pain. Haloperidol and droperidol may be used for nausea and vomiting symptoms.3Razban M. Exadaktylos A.K. Santa V.D. Heymann E.P. Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.Int J Emery Med. 2022; 15: 45https://doi.org/10.1186/s12245-022-00446-0Crossref Scopus (0) Google Scholar Use of cannabis (also referred to as marijuana, weed, or pot) among all age groups is rapidly rising. Duration and quantity of cannabis used are risk factors for CHS. The introduction of high-potency cannabis, with increased levels of tetrahydrocannabinol, might also be responsible for increased addiction and the emergence of CHS. The World Health Organization4World Health Organizationwww.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabisDate accessed: December 10, 2022Google Scholar and the Centers for Disease Control and Prevention5Centers for Disease Control and Preventionwww.cdc.gov/marijuana/health-effects/ index.htmlDate accessed: December 10, 2022Google Scholar do not specifically list CHS as an acute or chronic health effect of cannabis use. Many physicians are also unsuspecting of this syndrome. Physicians should be aware that abdominal erythema ab igne could be a dermatologic clue to CHS. Our patient was referred to an addiction specialist and directed to use capsaicin 0.1% cream to the abdomen 3 to 4 times daily. The authors report no competing interests.