Biopsy of the skin reveals mild hyperkeratosis, atrophy of the epidermis, increased pigmentation in the dermis, and elastosis. The pathophysiology is unclear, although histologic changes are similar to those seen in actinic elastosis.6 In general, biopsy is unnecessary for diagnosis as the history and skin findings are usually characteristic. The main treatment of erythema ab igne is elimination of heat exposure, although fluorouracil cream and laser therapy have been used in treatment.7 Skin pigmentary changes usually take months to resolve and in some cases are permanent. Although rare, epithelia atypia including squamous cell carcinoma and thermal keratoses have been associated with erythema ab igne.8 Therefore, erythema ab igne should be monitored to assure that eventual resolution of the skin changes does occur and that more concerning lesions do not arise. Furthermore, evaluation of the initial discomfort that prompted therapeutic application of heat is essential. Erythema ab igne is a complication of direct heat exposure but is not the source of the initial discomfort.