Hot water bottles, burns and toasted skin syndrome: staying warm safely

Snuggling up with a hot water bottle is a winter comfort for many. They’re a fast, simple and inexpensive way to take the chill off - yet they can also lead to serious harm.

Across the UK, there were 5,944 burn injuries linked to hot water bottles between 2014 and 2023.

The risk isn’t theoretical. In 2022, Sharon Portingale suffered third degree burns after taking a hot water bottle to bed. In 2021, Helen Powell was scalded when a hot water bottle she was using for back pain burst.

Hot water bottles: burns and scalds aren’t the only hazard

While burns and scalds are the best-known dangers, they’re not the only injuries associated with hot water bottles.

Toasted skin syndrome (erythema ab igne)

Toasted skin syndrome is also called erythema ab igne (redness from fire).

Repeated exposure to heat sources - including hot water bottles, heat pads, space heaters and even laptops - can leave the skin with a red, net-like (fishnet) pattern. This happens as tiny blood vessels in the skin widen in an attempt to manage the heat.

In many cases, the changes settle soon after the heat source is removed. But if heat exposure is frequent and ongoing, the skin can thin and develop hyperpigmentation - where some areas become darker than others.

This hyperpigmentation occurs because the skin’s elastic fibres are damaged and melanin is released from skin cells.

The damage may be permanent, although treatments such as laser therapy or topical creams containing 5-fluouracil can help.

If toasted skin syndrome is diagnosed late and heat exposure continues, the condition can also be associated with cancers, including basal cell carcinoma, neuroendocrine carcinoma and low-grade lymphoma.

Who is most at risk?

Some groups are more vulnerable to heat-related skin damage. For instance, people living with sickle cell disease and those with chronic pain are more likely to develop erythema ab igne or to experience significant burn injuries.

People with diabetes who have circulatory complications that affect temperature regulation may feel colder and, as a result, rely on heating aids more often. But diabetes-related circulation problems can also reduce sensation, meaning the skin may overheat without being noticed until a burn has already occurred.

Hot water bottles should not be used to keep babies warm or to pre-heat an infant’s sleeping area. Newborns have brown fat that helps them maintain a healthy body temperature and protects against hypothermia.

At birth, brown fat makes up about 5% of a baby’s body weight, and it is stored around vital organs to generate heat.

Staying warm

So, how can you keep warm without reaching for a hot water bottle?

In bed, weighted blankets can help by reducing how much warm air is pushed out whenever you shift position. When sitting, try keeping your feet raised and off the floor - which is often the coldest part of the room.

Instead of relying on one thick coat or jumper, remember that multiple layers are much better at trapping air and retaining heat.

Your fingertips contain around twice as many nerve fibres as your palms, which makes them especially sensitive to low temperatures.

That’s why wearing gloves - even indoors - can reduce how much heat your body needs to send to your hands, while also helping to keep body heat close to the skin.

Getting up and moving from time to time generates warmth and supports circulation, helping warmer blood travel from your core out to extremities such as your fingers and toes.

If you do choose to use a hot water bottle, avoid filling it with boiling water and make sure you add cold water to the bottle. Ideally, the temperature should be around 50°C-60°C.

Finally, you can lower the chance of tissue damage from hot water bottles or heat pads by spreading the heat more evenly - reposition them so warmth isn’t concentrated on one spot.

Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University

This article is republished from The Conversation under a Creative Commons licence. Read the original article.