1
|
Caldito EG, Kaul S, Caldito NG, Piette W, Mehta S. Erythromelalgia. Part I: Pathogenesis, clinical features, evaluation, and complications. J Am Acad Dermatol 2024; 90:453-462. [PMID: 37364617 DOI: 10.1016/j.jaad.2023.02.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 06/28/2023]
Abstract
Erythromelalgia is a rare pain disorder that is underrecognized and difficult-to-treat. It is characterized by episodes of extremity erythema and pain that can be disabling; it may be genetic, related to an underlying systemic disease, or idiopathic. Considering the prominent cutaneous features characteristic of the condition, dermatologists can play an important role in early recognition and limitation of morbidity. The first article in this 2-part continuing medical education series reviews the epidemiology, pathogenesis, clinical manifestations, evaluation, and complications.
Collapse
Affiliation(s)
| | - Subuhi Kaul
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Warren Piette
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois; Department of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| |
Collapse
|
2
|
Caldito EG, Caldito NG, Kaul S, Piette W, Mehta S. Erythromelalgia. Part II: Differential diagnoses and management. J Am Acad Dermatol 2024; 90:465-474. [PMID: 37364616 DOI: 10.1016/j.jaad.2023.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/28/2023]
Abstract
The management of erythromelalgia is challenging and requires multidisciplinary effort. Patient education is crucial as unsafe self-administered cooling techniques can lead to significant morbidity, including acral necrosis, infection, and amputation. The goal of management is pain control, reduction of flare frequency, and prevention of complications. This text is focused on the management of erythromelalgia and several other incompletely understood and under-recognized neurovascular disorders such as red scrotum syndrome, red ear syndrome, facial flushing, and complex regional pain syndrome.
Collapse
Affiliation(s)
| | | | - Subuhi Kaul
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois
| | - Warren Piette
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois; Department of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| |
Collapse
|
3
|
Rodrigues LM, Caetano J, Andrade SF, Rocha C, Alves JD, Ferreira HA. Studying Erythromelalgia Using Doppler Flowmetry Perfusion Signals and Wavelet Analysis-An Exploratory Study. Biomedicines 2023; 11:3327. [PMID: 38137548 PMCID: PMC10741181 DOI: 10.3390/biomedicines11123327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Erythromelalgia (EM) is a rare disease, which is still poorly characterized. In the present paper, we compared the hand perfusion of one female EM patient, under challenges, with a healthy control group. Using a laser Doppler flowmeter (LDF) with an integrated thermal probe, measurements were taken in both hands at rest (Phase I) and after two separate challenges-post-occlusive hyperemia (PORH) in one arm (A) and reduction of skin temperature (cooling) with ice in one hand (B) (Phase II). The final measurement periods corresponded to recovery (Phases III and IV). The control group involved ten healthy women (27.3 ± 7.9 years old). A second set of measurements was taken in the EM patient one month after beginning a new therapeutic approach with beta-blockers (6.25 mg carvedilol twice daily). Z-scores of the patient's LDF and temperature fluctuations compared to the control group were assessed using the Wavelet transform (WT) analysis. Here, fluctuations with |Z| > 1.96 were considered significantly different from healthy values, whereas positive or negative Z values indicated higher or lower deviations from the control mean values. Cooling elicited more measurable changes in LDF and temperature fluctuations, especially in higher frequency components (cardiac, respiratory, and myogenic), whereas PORH notably evoked changes in lower frequency components (myogenic, autonomic, and endothelial). No significant Z-score deviations were observed in the second measurement, which might signify a stabilization of the patient's distal perfusion following the new therapeutic approach. This analysis involving one EM patient, while clearly exploratory, has shown significant deviations in WT-derived physiological components' values in comparison with the healthy group, confirming the interest in using cold temperature as a challenger. The apparent agreement achieved with the clinical evaluation opens the possibility of expanding this approach to other patients and pathologies in vascular medicine.
Collapse
Affiliation(s)
- Luis Monteiro Rodrigues
- CBIOS—Research Center for Biosciences and Health Technologies, Universidade Lusófona Lisboa, 1700-097 Lisbon, Portugal; (J.C.); (S.F.A.); (C.R.)
| | - Joana Caetano
- CBIOS—Research Center for Biosciences and Health Technologies, Universidade Lusófona Lisboa, 1700-097 Lisbon, Portugal; (J.C.); (S.F.A.); (C.R.)
- Immuno-Mediated Systemic Diseases, Medicina IV, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal;
- Nova Medical School, Nova University of Lisboa, 1169-056 Lisboa, Portugal
| | - Sergio Faloni Andrade
- CBIOS—Research Center for Biosciences and Health Technologies, Universidade Lusófona Lisboa, 1700-097 Lisbon, Portugal; (J.C.); (S.F.A.); (C.R.)
| | - Clemente Rocha
- CBIOS—Research Center for Biosciences and Health Technologies, Universidade Lusófona Lisboa, 1700-097 Lisbon, Portugal; (J.C.); (S.F.A.); (C.R.)
| | - José Delgado Alves
- Immuno-Mediated Systemic Diseases, Medicina IV, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal;
- Nova Medical School, Nova University of Lisboa, 1169-056 Lisboa, Portugal
| | - Hugo Alexandre Ferreira
- Faculty of Sciences, Institute of Biophysics and Biomedical Engineering, University of Lisbon, Campo Grande, 1749-019 Lisboa, Portugal;
| |
Collapse
|
4
|
Bourkas AN, Geng R, Sibbald M, Sibbald RG. A case of erythromelalgia with gastrointestinal dysautonomia treated with immunoglobulin: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231213137. [PMID: 38022850 PMCID: PMC10658769 DOI: 10.1177/2050313x231213137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
An 18-year-old female with a history of atopic march, hyperhidrosis, and eosinophilic esophagitis was diagnosed with erythromelalgia and gastrointestinal dysautonomia secondary to presumed autoimmune small fiber neuropathy. The patient experienced significant clinical improvements after the initiation of intravenous immunoglobulin therapy, supporting an underlying autoimmune disorder.
Collapse
Affiliation(s)
| | - Ryan Geng
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Sibbald
- Department of Medicine, McMaster Education Research Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - R Gary Sibbald
- Dalla Lana School of Public Health & Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Watabe D, Tominaga M, Toyama S, Takamori K, Nakano H, Amano H. A severe case of primary erythromelalgia presenting as small fiber neuropathy with a novel SCN9A mutation. J Dermatol 2023. [PMID: 36815391 DOI: 10.1111/1346-8138.16754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
Primary erythromelalgia (PEM) is a rare condition characterized by severe burning pain, erythema, and increased temperature in the extremeties. Mutations in the Nav1.7 sodium channel encoded by the SCN9A are responsible for PEM. The pathophysiology of PEM is unclear, but the involvement of neurogenic and vasogenic mechanisms has been suggested. Here we report a case of severe PEM in a 9-year-old child with a novel SCN9A mutation and examine the distribution of nerve fibers and expression of neuropeptides in the affected skin. Gene mutation analysis revealed a novel mutation p.L951I (c.2851C>A) in the heterozygous form of the SCN9A. An immunofluorescence study showed that intraepidermal nerve fibers were decreased in the affected leg, suggesting small fiber neuropathy. There was no increase in the expression of substance P (SP) or calcitonin gene-related peptide (CGRP) in the lesional skin tissue. These findings suggest SP and CGRP do not play a major role in the pathophysiology of primary erythromelalgia.
Collapse
Affiliation(s)
- Daisuke Watabe
- Department of Dermatology, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center, Institute for Environment and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Japan
| | - Sumika Toyama
- Juntendo Itch Research Center, Institute for Environment and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center, Institute for Environment and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroo Amano
- Department of Dermatology, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| |
Collapse
|
6
|
El Khatib K, Gerges Z, Azar N. Erythromelalgia in a patient with feet erythema and cyanosis. BMJ Case Rep 2023; 16:e253786. [PMID: 36669785 PMCID: PMC9872455 DOI: 10.1136/bcr-2022-253786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Erythromelalgia is a rare disease characterised by a triad of a clinical syndrome of redness, warmth and painful extremities. We present the case of a male adolescent with no prior medical history who presents to our family medicine clinic with a 3-month history of bilateral feet erythema followed by episodes of cyanosis in bilateral toes. Given his history, the findings on clinical examination, and the lack of any pathology on the diagnostic testing, the patient is diagnosed with erythromelalgia. He is then counselled on both pharmacological and non-pharmacological treatments for his condition and is discharged on non-pharmacological treatment options such as leg elevation, cooling with a fan and limiting exposure to heat. The patient is also advised to perform an annual complete blood count given the association of erythromelalgia with myeloproliferative disorders.
Collapse
Affiliation(s)
- Khaled El Khatib
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Gerges
- Department of Family Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Nagham Azar
- Department of Family Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| |
Collapse
|
7
|
Loureiro MDP, Novais PM, Paulin JAN, de Almeida DB, de Lemos AN. Endoscopic lumbar sympathectomy as a treatment option for primary erythromelalgia - case report and review. J Vasc Bras 2023; 22:e20220095. [PMID: 36950140 PMCID: PMC10026352 DOI: 10.1590/1677-5449.202200952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 03/24/2023] Open
Abstract
Erythromelalgia is a rare disease, involving pain, edema, redness, and hyperthermia in the limbs. It is extremely refractory to drugs, has no defined treatment, and causes psychological comorbidities in the patient. We describe a case of erythromelalgia involving a 17-year-old boy who had been suffering from the disease for almost 4 years prior to finding an effective treatment. A bilateral endoscopic lumbar sympathectomy was performed, limited to L2 and L3 resections. Four weeks after the procedure, the patient's symptoms were significantly mitigated and at 8 months follow-up he remained almost asymptomatic. Endoscopic lumbar sympathectomy was an effective treatment for primary erythromelalgia in this teenager, with exceptional reduction of his symptoms.
Collapse
Affiliation(s)
- Marcelo de Paula Loureiro
- Universidade Positivo - UP, Curitiba, PR, Brasil.
- Instituto Jacques Perissat de Cirurgia Minimamente Invasiva - IJP, Curitiba, PR, Brasil.
| | | | | | | | | |
Collapse
|
8
|
Lu J, Lu Y. Hormone replacement therapy-induced pain and redness of the feet. Clin Exp Dermatol 2022; 47:2290-2292. [PMID: 35941758 DOI: 10.1111/ced.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jiawei Lu
- Department of Dermatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Dermatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
9
|
SAITO N, ASHIDA A, SHIROTA S, OKUYAMA R. Erythromelalgia Associated with Neuropathy in Sjögren's Syndrome: A Case Report. Acta Derm Venereol 2022; 102:adv00735. [PMID: 35670325 PMCID: PMC9593472 DOI: 10.2340/actadv.v102.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract is missing (Short communication)
Collapse
Affiliation(s)
- Nana SAITO
- Department of Dermatology, Shinshu University School of Medicine
| | - Atsuko ASHIDA
- Department of Dermatology, Shinshu University School of Medicine,Center for Clinical Research, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto 390–8621, Japans
| | - Shiho SHIROTA
- Department of Dermatology, Shinshu University School of Medicine
| | - Ryuhei OKUYAMA
- Department of Dermatology, Shinshu University School of Medicine,Center for Clinical Research, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto 390–8621, Japans
| |
Collapse
|
10
|
Ye YT, Lu JF, Wu HH, Liu JH, Zhao YK, Luo DQ. Auricular erythermalgia showing excellent response to itraconazole: a case report. Ther Adv Chronic Dis 2022; 13:20406223221099335. [PMID: 35620189 PMCID: PMC9127843 DOI: 10.1177/20406223221099335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Erythermalgia, a rare painful disorder, is characterized by recurrent pain attacking, warmth, and erythema that mainly involves the distal extremities. Red ear syndrome shares similar clinical features of erythermalgia afflicting the external ear with unilateral/bilateral distribution. The treatments of both diseases are still difficult without controlled therapeutics available up to date. A 12-year-old boy was referred because of 3 years of recurrent attacking of painful erythema and warmth that involved the ears alone, the episodes occurred several times daily with duration of dozens of minutes to hours for each flare. The symptoms could be relieved by cold water and triggered by heat stimuli as well as exciting and movement, and showed mild response to gabapentin, celecoxib, and topical lidocaine compounds in combination, but moderate to blocking injection of botulinum toxin to nervus auricularis magnus. However, systemic itraconazole 200 mg daily resulted in an excellent response after 5-week treatment, leading to milder erythema, warmth and burning sensation, shorter duration, and fewer relapses. The treatment continued for 6 months and then itraconazole was decreased to 100 mg daily for another 6 months until it was stopped, with maintenance of good conditions. In 3 months of follow-up after the treatment ceased, the patient had only 7 to 8 attacks over 10 days presenting as tolerable erythema that lasted for less than 10 min and relieved spontaneously, with absence of warmth and no need of treatment. We considered the patient to be a variant of erythermalgia rather than a red ear syndrome. The results showed that erythermalgia might involve the ears alone and itraconazole might be a potential agent for its treatment.
Collapse
Affiliation(s)
- Yan-Ting Ye
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Fa Lu
- Department of Dermatology, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
| | - Hui-Hui Wu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juan-Hua Liu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Kun Zhao
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, 183 Huangpu Road East, Guangzhou 510700, China
| | - Di-Qing Luo
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, 183 Huangpu Road East, Guangzhou 510700, China
| |
Collapse
|
11
|
Li S, Ding M, Wu Y, Xue S, Ji Y, Zhang P, Zhang Z, Cao Z, Zhang F. Histamine Sensitization of the Voltage-Gated Sodium Channel Nav1.7 Contributes to Histaminergic Itch in Mice. ACS Chem Neurosci 2022; 13:700-710. [PMID: 35157443 DOI: 10.1021/acschemneuro.2c00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Itch, a common clinical symptom of many skin diseases, severely impairs the life quality of patients. Nav1.7, a subtype of voltage-gated sodium channels mainly expressed in primary sensory neurons, is responsible for the amplification of threshold currents that trigger action potential (AP) generation. Gain-of-function mutation of Nav1.7 leads to paroxysmal itch, while pharmacological inhibition of Nav1.7 alleviates histamine-dependent itch. However, the crosstalk between histamine and Nav1.7 that leads to itch is unclear. In the present study, we demonstrated that in the dorsal root ganglion (DRG) neurons from histamine-dependent itch model mice induced by compound 48/80, tetrodotoxin-sensitive (TTX-S) but not TTX-resistant Na+ currents were activated at more hyperpolarized membrane potentials compared to those on DRG neurons from vehicle-treated mice. Meanwhile, bath application of histamine shifted the activation voltages of TTX-S Na+ currents to the hyperpolarized direction, increased the AP frequency, and reduced the current threshold required to elicit APs. Further mechanistic studies demonstrated that selective activation of H1 but not H2 and H4 receptors mimicked histamine effect on TTX-S Na+ channels in DRG neurons. The protein kinase C (PKC) inhibitor GO 8963, but not the PKA inhibitor H89, normalized histamine-sensitized TTX-S Na+ channels. We also demonstrated that histamine shifted the activation voltages of Na+ currents to the hyperpolarized direction in Chinese hamster ovary (CHO) cells expressing Nav1.7. Importantly, selective inhibition of Nav1.7 by PF-05089771 significantly relieved the scratching frequency in a histamine-dependent itch model induced by compound 48/80. Taken together, these data suggest that activation of H1 receptors by histamine sensitizes Nav1.7 channels through the PKC pathway in DRG neurons that contributes to histamine-dependent itch.
Collapse
Affiliation(s)
- Shaoheng Li
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Meihuizi Ding
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Ying Wu
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Shuwen Xue
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Yunyun Ji
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Pinhui Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zhuang Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zhengyu Cao
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Fan Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| |
Collapse
|
12
|
Altemir A, Iglesias-Sancho M, Barrabés-Torrella C, Sanchez-Regaña M, Salleras-Redonnet M. Successful treatment of knee erythromelalgia with topical oxymetazoline. Clin Exp Dermatol 2021; 47:778-780. [PMID: 34905256 DOI: 10.1111/ced.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Arcadi Altemir
- Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quironsalud, Barcelona, Spain
| | - Maribel Iglesias-Sancho
- Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quironsalud, Barcelona, Spain
| | - Cristina Barrabés-Torrella
- Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quironsalud, Barcelona, Spain
| | | | - Montse Salleras-Redonnet
- Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quironsalud, Barcelona, Spain
| |
Collapse
|
13
|
Moehle J, Fuller L, Hardin A. Fish Oil and BCQ™ as a Novel Treatment Approach to Primary Erythromelalgia: A Case Study. Integr Med (Encinitas) 2021; 20:40-45. [PMID: 34602876 PMCID: PMC8483253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Erythromelalgia (EM) is a rare disorder, of which the pathophysiology is poorly understood. Though primary EM is thought to be an autosomal-dominant inherited disorder or of idiopathic origin, secondary EM is associated, most often, with myeloproliferative diseases. Pain management is the primary therapeutic target, however, individual patient responses vary widely, and no single treatment has been determined to be effective. As such, EM is often associated with reduced quality of life and higher morbidity and mortality. This case study examines an 81-year-old Caucasian female patient with a diagnosis of primary EM, for which previous pharmaceutical therapies had proven ineffective. Therapeutic intervention included a novel, daily supplement regimen of fish oil and BCQ™.
Collapse
|
14
|
A reappraisal of the presence of small or large fiber neuropathy in patients with erythromelalgia. Neurophysiol Clin 2021; 51:349-355. [PMID: 33888389 DOI: 10.1016/j.neucli.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the contribution of large and small nerve fiber alteration in erythromelalgia (EM). METHODS Thirty-three EM patients were included and underwent clinical evaluation based on EM severity score, DN4, and Utah Early Neuropathy Scale (UENS) score. Neurophysiological evaluation consisted in nerve conduction studies (NCS) for large nerve fibers and specific tests for small nerve fibers: electrochemical skin conductance, cold and warm detection thresholds, and laser evoked potentials. Finally, the evaluation of vascular changes was based on the presence of clinical feature of microvascular disorders and the measurement of the Toe Pressure Index (TPI). RESULTS While 28 patients (85%) had vascular alteration on TPI or clinical features, 23 patients (70%) had small-fiber neuropathy on neurophysiological tests, and only 10 patients (30%) had large fiber neuropathy on NCS. Regarding clinical scores, there was no difference between groups (presence or absence of large- or small-fiber neuropathy or microvascular disorder) except for a higher UENS score in patients with large fiber neuropathy. CONCLUSION Peripheral neuropathy, mostly involving small nerve fibers, is almost as common as microvascular changes in EM, but remains inconstant and not related to a specific neuropathic pattern or higher clinical severity. SIGNIFICANCE The association of neuropathic and vascular factors is not systematic in EM, this syndrome being characterized by different pathophysiological mechanisms leading to a common clinical phenotype.
Collapse
|
15
|
Schafer AI. Thrombotic, Vascular, and Bleeding Complications of the Myeloproliferative Neoplasms. Hematol Oncol Clin North Am 2021; 35:305-324. [PMID: 33641871 DOI: 10.1016/j.hoc.2020.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thrombotic, vascular, and bleeding complications are the most frequent causes of morbidity and mortality in myeloproliferative neoplasms (MPNs). The interplay and reciprocal amplification between two factors are considered to lead to thrombosis in MPNs: (1) circulating blood cell-intrinsic abnormalities caused by an MPN driver mutation in their hematopoietic progenitor/stem cells, interacting with vascular endothelial cells, show prothrombotic and proadhesive phenotypes; and (2) a state of usually subclinical systemic inflammation that fuels the thrombotic tendency. Prevention and treatment require maintenance of hematocrit less than 45% and cytoreductive therapy in patients with a high risk for thrombotic and vascular complications.
Collapse
Affiliation(s)
- Andrew I Schafer
- Weill Cornell Medicine, 1305 York Avenue, 8th Floor, Room Y-811, New York, NY 10021, USA.
| |
Collapse
|
16
|
Sooy M, Randell RL, Tchapyjnikov D, Werner K, Nazareth-Pidgeon K. Painful, reappearing eruption in a medically complex 4-year-old. BMJ Case Rep 2021; 14:14/2/e239310. [PMID: 33602765 PMCID: PMC7896574 DOI: 10.1136/bcr-2020-239310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 4-year-old boy with atypical, complete DiGeorge and CHARGE (coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities and ear abnormalities) syndromes presented with frequent episodes of a painful, markedly erythematous eruption associated with swelling. Evaluation revealed non-specific findings on skin biopsy at the time of eruption and no pathogenic mutation in the SCN9A gene. The patient was diagnosed with secondary erythromelalgia based on clinical presentation. Erythromelalgia is a rare disorder characterised by recurrent episodes of pain and erythema typically affecting the distal extremities. This case represents the first case of erythromelalgia in the setting of DiGeorge and CHARGE syndromes.
Collapse
Affiliation(s)
- Meredith Sooy
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Rachel L Randell
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Dmitry Tchapyjnikov
- Division of Pediatric Neurology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Klaus Werner
- Division of Pediatric Neurology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Kristina Nazareth-Pidgeon
- Pediatric Hospitalist Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| |
Collapse
|
17
|
Gil F, Luís P, Duarte M, Martins C. Eritromelalgia secundaria: informe de caso. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:885-886. [DOI: 10.1016/j.ad.2019.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 10/23/2022] Open
|
18
|
Gil F, Luís P, Duarte M, Martins C. Secondary erythromelalgia – case report. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
19
|
Zhu Y, Wang F, Zhu T. Successful ultrasound-guided stellate ganglion block treatment in a patient with upper limb erythromelalgia. Dermatol Ther 2020; 33:e14459. [PMID: 33107104 DOI: 10.1111/dth.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Yihao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
20
|
Demuth S, Courtois S, Cohen E, Goudot M. Acute dysautonomia and erythromelalgia associated with testicular seminoma: A case report. Rev Neurol (Paris) 2020; 177:146-147. [PMID: 32631673 DOI: 10.1016/j.neurol.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- S Demuth
- Service de Neurologie, groupe hospitalier de la région sud Alsace, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France.
| | - S Courtois
- Service de Neurologie, groupe hospitalier de la région sud Alsace, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France.
| | - E Cohen
- Service de Neurologie, groupe hospitalier de la région sud Alsace, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France.
| | - M Goudot
- Service de Neurologie, groupe hospitalier de la région sud Alsace, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France.
| |
Collapse
|
21
|
Khalil S, Kurban M, Abbas O. Red scrotum syndrome: An update on clinicopathologic features, pathogenesis, diagnosis, and management. J Am Acad Dermatol 2020; 87:614-622. [DOI: 10.1016/j.jaad.2020.05.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
|
22
|
Abstract
When looking for diseases of the skin, this is usually done in a holistic way, automatically and unconsciously, by recognizing localization, distribution, and appearance of the primary or secondary skin lesions. When Robert Willan (1757-1812) introduced the concept of morphology of skin lesions, it became the basis for the classification of dermatoses. Apart from ethnic factors, the various dermatoses comprise a rainbow of colors ranging from the most common red color to yellow, blue, brown, silver, green, black, and white.
Collapse
Affiliation(s)
- Günter Burg
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
| |
Collapse
|
23
|
Patel P, Zhang Y, Unikel LH, Edwards C. A case of sporadic erythromelalgia presenting with small fibre neuropathy. BMJ Case Rep 2019; 12:12/10/e230549. [PMID: 31601551 DOI: 10.1136/bcr-2019-230549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Erythromelalgia (EM) is a rare disorder of small nerve fibres that leads to painful flushing and burning paresthesisas of the distal extremities and is typically associated with heat or physical activity; relief is found using cooling measures. Its effects are often debilitating in the general population, but this patient had an excellent response to specific treatment options and continues to maintain employment, something many individuals suffering from EM are unable to do. His presentation was also unique in that he had isolated, proximal involvement as his condition progressed whereas typically only the distal extremities are affected. Routine electromyography and nerve conduction studies were normal, whereas nerve biopsy demonstrated findings of small fibre neuropathy. Ultimately, his condition was managed with carbamazepine and his symptoms have almost entirely resolved to date.
Collapse
Affiliation(s)
- Pavan Patel
- Neurology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Yan Zhang
- Neurology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Lynne H Unikel
- Neurology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | | |
Collapse
|
24
|
Golińska J, Sar-Pomian M, Rudnicka L. Erythromelalgia successfully treated with sulodexide. Clin Exp Dermatol 2019; 45:376-378. [PMID: 31495920 DOI: 10.1111/ced.14076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/06/2019] [Accepted: 07/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
- J Golińska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - M Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
25
|
Vounotrypidis P, Pyrpasopoulou A, Sakellariou GT, Zisopoulos D, Kefala N, Oikonomou DI, Stefanis C, Aslanidis S, Bermperidis C, Pappas P. Vascular acrosyndromes in young adult population. Definition of clinical symptoms and connections to joint hypermobility. Clin Rheumatol 2019; 38:2925-2932. [PMID: 31177398 DOI: 10.1007/s10067-019-04627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Clinical recognition of vascular acrosyndromes is often challenging. The term Raynaud's phenomenon (RP) is commonly overused to describe any form of cold-related disorder. This study aims to formally evaluate peripheral vascular symptoms affecting the population, aged ≤ 40 years, and identify any correlations to joint hypermobility (JH). PATIENTS AND METHODS Fifty patients (31 males, 19 females) with vasomotor symptoms enrolled in this five-year prospective observational study. Clinical examination by a rheumatologist and a vascular surgeon was performed along with cardiology, echocardiographic and Doppler evaluation. Patients underwent blood cell count, biochemistry, thyroid and selectively immunologic testing. Twenty-four (48%) of them performed nailfold capillaroscopy. The SPSS for Windows, v.17.0, Chicago, USA, was used for the statistical analyses. RESULTS Twenty-eight patients (56%) presented with erythromelalgia (EM), 6 (12%) with acrocyanosis (AC) and 9 (18%) as a combination of the above disorder. RP diagnosed in five (10%) while two patients (4%) presented as a mix of EM-RP. There was no correlation with abnormal laboratory tests. Increased incidence of JH was found in EM and AC patients. Among those who were tested with nailfold capillaroscopy, 75% had abnormalities ranged from mild to autoimmune-like diseases. CONCLUSIONS Erythromelalgia is the commonest functional vasculopathy in young population followed by acrocyanosis and a combination of these conditions. Joint hypermobility is markedly increased, indicating that dysautonomy may be considered the causative factor following a trigger event. Overall, RP was observed in 14% of patients. Clinical recognition of these disorders avoids unnecessary investigation. Key Points • Vascular acrosyndromes in young adults are commonly functional disorders resembling vascular algodystrophy induced by thermic stress. • Dysautonomy of joint hypermobility is the co-factor influencing the appearance of the vascular disorders. • Raynaud's phenomenon accounts to approximately 14% of vascular acrosyndromes presented in the young adult population.
Collapse
Affiliation(s)
- Periklis Vounotrypidis
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece.
| | - Athina Pyrpasopoulou
- 2nd Propaedeutic Clinic, Department of Internal Medicine, "Ippokration" Hospital, Thessaloniki, Greece
| | - Grigorios T Sakellariou
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Dimitrios Zisopoulos
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Nikoleta Kefala
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Dimitrios I Oikonomou
- Department of Immunology and Microbiology, 424 General Military Hospital, Thessaloniki, Greece
| | | | - Spyros Aslanidis
- 2nd Propaedeutic Clinic, Department of Internal Medicine, "Ippokration" Hospital, Thessaloniki, Greece
| | - Charalambos Bermperidis
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Periklis Pappas
- Vascular Surgery Department, 424 General Military Hospital, Thessaloniki, Greece
| |
Collapse
|
26
|
López-Valverde N, López-Valverde A, Ramírez JM, Gómez de Diego R. Manifestations in the Oral Mucosa of Erythromelalgia. A Case Report. Open Dent J 2019. [DOI: 10.2174/1874210601913010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:Erythromelalgia or erythermalgia, is a peripheral paroxysmal vascular disease of the distal extremities, although it can also affect the face, ears and knees. It is characterized by increased skin temperature, erythema and intermittent episodes of burning pain. Likewise, it can also be characterized by lesions of the oral mucosa.Case report:Here we present the case of a 6-year old female with EM presenting ulcerative and scaly lesions in the oral cavity and whitish linear branching ulcerative lesions on the tongue. Fabry disease and rheumatoid conditions were ruled out and there were no mutations in SCN9A gene. Treatment with voltage-gated sodium channel blockers (oxcarbacepine-Trileptal®) and anticonvulsants (Perampanel-Fycompa®) did not improve pain symptoms, however, performing moderate physical activity, use of comfortable footwear, and local application of cold resulted in the restoration of patient´s quality of lifeConclusion:To our knowledge, this report described for the first time, the successful treatment of ulcerative lesions of the oral mucosa in Erythromelalgia. We believe that the treatments described here (exercise, comfortable footwear and local application of cold) could improve the quality of life of Erythromelalgia patients.
Collapse
|
27
|
Mann N, King T, Murphy R. Review of primary and secondary erythromelalgia. Clin Exp Dermatol 2019; 44:477-482. [PMID: 30609105 DOI: 10.1111/ced.13891] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 01/15/2023]
Abstract
Erythromelalgia is a condition characterized by episodic pain, erythema and temperature of the extremities, which is relieved by cooling and aggravated by warming. It is useful to review this topic in light of recent discoveries of the genetic mutations that now define primary erythromelalgia, as opposed to secondary erythromelalgia, which is often associated with underlying medical disorders.
Collapse
Affiliation(s)
- N Mann
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - T King
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
28
|
Bibb LA, Winter RP, Leicht SS. Cyclosporine-induced Erythromelalgia. Cureus 2018; 10:e3506. [PMID: 30648046 PMCID: PMC6318136 DOI: 10.7759/cureus.3506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/26/2018] [Indexed: 12/03/2022] Open
Abstract
Erythromelalgia is a neurovascular disorder which causes pain, swelling, erythema, and warmth of the distal extremities. Primary disease is due to a genetic mutation in the SCN9A gene, but secondary erythromelalgia can be the consequence of a variety of underlying etiologies, including drug and toxin exposures. The disease is rare, occurring in only 1.3 out of every 100,000 in the United States, and symptoms can vary significantly in severity and presentation. Therefore, it can be difficult to recognize the disorder, identify the source, and promptly treat the condition. We report a reversible cause of erythromelalgia induced by the use of oral cyclosporine. This correlation is poorly documented in literature, with limited accounts identifying an association between erythromelalgia and cyclosporine. As drug-induced erythromelalgia represents a reversible cause of disease, physicians should obtain a detailed medication history during the diagnostic workup, specifically inquiring about the use of cyclosporine.
Collapse
Affiliation(s)
- Lorin A Bibb
- Dermatology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Randi P Winter
- Dermatology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Stuart S Leicht
- Dermatology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| |
Collapse
|