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Erythralgia
Aka: Erythralgia, Erythromelalgia, Erythremomelalgia
- See Also
- Skin reactions to Temperature
- Pathophysiology
- Episodic bilateral vasodilatation with hyperemia
- Causes
- Primary (Idiopathic) form occurs in Young adult males
- Secondary form due to chronic myeloproliferative disorder (esp. over age 40 years old)
- Polycythemia Rubra Vera
- Primary Thrombocythemia
- Symptoms
- Hand and feet symptoms
- Burning pain
- Prickling pain
- Erythema
- Cyanosis
- Edema or congestion
- Provocative factors
- Heat exposure
- Exercise
- Standing
- Palliative factors
- Elevating or cooling extremities
- Patient walks in snow or cold floors
- Sleeps with feet outside bed covers
- Signs
- Normal peripheral pulses
- Critical to exclude ischemia
- Provocative maneuvers reproduce pain
- Lower the limb
- Expose limb to heat
- Differential Diagnosis
- Peripheral Arterial Disease (Claudication or Critical Limb Ischemia)
- Venous Insufficiency
- Myeloproliferative disorders (Polycythemia Vera, Thrombocythemia)
- Raynaud Phenomenon
- Frostbite
- Immersion Foot (Trench Foot)
- Peripheral neuritis
- Disseminated sclerosis
- Hemiplegia
- Chronic Heavy Metal Poisoning
- HIV Infection
- Diabetes Mellitus
- Rheumatologic Conditions
- Gouty Arthritis
- Systemic Lupus Erythematosus (SLE)
- Rheumatoid Arthritis
- Medications
- Bromocriptine
- Isopropanol
- Calcium Channel Blockers (Nifedipine, felodipine, and Nicardipine)
- Labs: Skin biopsy
- Arteriolar inflammation
- Fibromuscular intima proliferation
- Microvascular thrombi
- Management
- Evaluate for underlying disorder (esp. serious conditions)
- Peripheral Arterial Disease (Claudication or Critical Limb Ischemia)
- Myeloproliferative disorders (Polycythemia Vera, Thrombocythemia)
- Symptomatic measures
- Avoid provocative activities (e.g. heat)
- Aspirin 650 mg per day
- References
- Saliba (2015) Erythromelalgia, Emedicine, accessed 12/15/2015
- http://emedicine.medscape.com/article/200071-overview
- Alarcon-Segovia (1966) Arch Intern Med 117(4): 511-5 [PubMed]