This is reticulated hyperpigmentation with multiple erosions and superficial ulceration on the back of a woman in her 50s (fig 1). She had been using a transcutaneous electrical nerve stimulation (TENS) machine for several months to relieve back pain from multiple spinal compression fractures and regularly left the device in place overnight. Erythema ab igne was diagnosed as well as acute thermal burns from the device. This condition is a complication of direct and prolonged exposure to heat that can occur anywhere on the skin. Patients with longstanding erythema ab igne are at risk of developing squamous cell and Merkel cell carcinoma.1 During review of their pain management, patients should be counselled about the appropriate use of TENS machines.bmj;381/jun29_5/e074804/F1F1f1Fig 1
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