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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Correnti E, Lo Cascio S, Cernigliaro F, Rossi R, D'Agnano D, Grasso G, Pellegrino A, Lauria B, Santangelo A, Santangelo G, Tripi G, Versace A, Sciruicchio V, Raieli V. Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series. Life (Basel) 2023; 13:life13040861. [PMID: 37109390 PMCID: PMC10144764 DOI: 10.3390/life13040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.
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Affiliation(s)
- Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Roberta Rossi
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Giulia Grasso
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Annamaria Pellegrino
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Barbara Lauria
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | | | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Antonella Versace
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
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Lax DN, Sitterle K, Kacperski J, Hershey AD, Kabbouche M. Indomethacin-responsive idiopathic red ear syndrome: A pediatric case. Headache 2022; 62:1432-1433. [PMID: 36373805 DOI: 10.1111/head.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel N Lax
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Child Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Kelly Sitterle
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Marielle Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Courtney A, Holmes Z, Weston S. If your ears are burning we must be talking about red ear syndrome: A brief report. Australas J Dermatol 2022; 63:e244-e246. [PMID: 35510338 DOI: 10.1111/ajd.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
Red Ear Syndrome is an uncommon disorder that can affect all age groups. It is frequently referred to Dermatology as it can present similarly to erythromelalgia. Although the exact pathophysiology is unknown, a common hypothesis suggests a shared pathophysiological background with migraine due to their well-known association. Currently, there are no established treatment guidelines. Delays in accurate diagnosis and commencing optimal treatment can significantly negatively impact on a patients quality of life. We discuss the clinical presentation and response to treatment of a case of Red Ear Syndrome in an 8-year-old boy.
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Affiliation(s)
- Ashling Courtney
- Dermatology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Zack Holmes
- Dermatology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Stephanie Weston
- Dermatology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Oliveira ADP, Silva-Néto RP. Circadian rhythmicity on red ear syndrome in a patient with migraine: A case report. Headache 2021; 61:1581-1583. [PMID: 34873689 DOI: 10.1111/head.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.
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Brackenrich J, Sternad S, Johnston C. Red Ear Syndrome: A Case Presentation and Discussion. HCA Healthc J Med 2020; 1:155-159. [PMID: 37424711 PMCID: PMC10324698 DOI: 10.36518/2689-0216.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Red Ear Syndrome (RES) is a condition often considered to be a localized form of erythromelalgia. It can be related to structural cervical defects or idiopathic. RES is generally very difficult to treat. Discussion A 57-year-old male presented to the dermatology clinic complaining of a 4-month history of intermittent redness and severe burning of bilateral ears. On examination, the patient exhibited edematous erythema and tenderness to palpation affecting the right and left ear and right malar cheek. A skin biopsy revealed mild superficial perivascular lymphocytic infiltrate with hypertrophy of endothelial cells. The patient was found to have a normal lab work-up including complete blood count, metabolic panel, erythrocyte sedimentation rate, anti-nuclear antibody and type II collagen antibody. A diagnosis of Red Ear Syndrome was made. After failing multiple medications over several months, the patient was started on aspirin and paroxetine which was gradually titrated until he was completely asymptomatic. To date, there is only one other case presentation illustrating the effectiveness of this treatment regimen. Conclusion There are a limited number of cases describing idiopathic RES with inconsistent results in treatment. With a relatively small number of cases reported, further research is needed into the pathophysiology of RES along with the dual therapy of aspirin and paroxetine in patients that suffer from both primary and secondary RES.
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Abstract
Red ear syndrome has been reported in the literature to have similarities to erythromelalgia with auricular involvement; however, the distinction between the two is controversial. Red ear syndrome has previously been classified as idiopathic (primary) or secondary, with headaches being the most common association in the idiopathic or primary form. We present a case of pediatric red ear syndrome with hand and foot involvement that we believe represents auricular erythromelalgia. In this report, we propose a classification system to unify the diagnoses of red ear syndrome and erythromelalgia and review the literature on pediatric cases of red ear syndrome.
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Affiliation(s)
- Allison K Cinats
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard M Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chan TLH, Becker WJ, Jog M. Indomethacin-Responsive Idiopathic Red Ear Syndrome: Case Report and Pathophysiology. Headache 2017; 58:306-308. [PMID: 29193054 DOI: 10.1111/head.13237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tommy L H Chan
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
| | - Werner J Becker
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
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Abstract
BACKGROUND The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks. CASE We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit. CONCLUSION Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases.
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Affiliation(s)
- Marzieh Eghtesadi
- Department of Pain Clinic, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM)
| | - Elizabeth Leroux
- Department of General Neurology, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM)
| | - Grisell Vargas-Schaffer
- Department of Anesthesiology, Pain Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
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Abstract
Red Ear Syndrome (RES) is a very rare disorder, with approximately 100 published cases in the medical literature. Red ear (RE) episodes are characterised by unilateral or bilateral attacks of paroxysmal burning sensations and reddening of the external ear. The duration of these episodes ranges from a few seconds to several hours. The attacks occur with a frequency ranging from several a day to a few per year. Episodes can occur spontaneously or be triggered, most frequently by rubbing or touching the ear, heat or cold, chewing, brushing of the hair, neck movements or exertion. Early-onset idiopathic RES seems to be associated with migraine, whereas late-onset idiopathic forms have been reported in association with trigeminal autonomic cephalalgias (TACs). Secondary forms of RES occur with upper cervical spine disorders or temporo-mandibular joint dysfunction. RES is regarded refractory to medical treatments, although some migraine preventative treatments have shown moderate benefit mainly in patients with migraine-related attacks. The pathophysiology of RES is still unclear but several hypotheses involving peripheral or central nervous system mechanisms have been proposed.
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Affiliation(s)
- Giorgio Lambru
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Sarah Miller
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Manjit S Matharu
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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