Check-up: Erythromelalgia

 

I’ve been diagnosed with erythromelalgia. My symptoms include redness and a burning pain in my feet and up my legs.

Erythromelalgia is a rare condition characterised by intense burning pain, marked redness and increased skin temperature. Symptoms are caused by the arterioles in the skin dilating periodically.

While some sufferers experience continual burning pain, others experience “flare-ups” of symptoms lasting from minutes to days. Attacks can be triggered by environmental temperatures of more than 29 degrees.

The condition is classified as primary or secondary erythromelalgia. Primary erythromelalgia develops spontaneously without any associated underlying disease. Secondary erythromelalgia develops in association with other medical conditions.

These can include neurological diseases, diabetes mellitus, rheumatoid arthritis and some blood disorders. In many cases the actual cause is unknown.

Are symptoms usually confined to the feet and legs?

The feet and toes are most commonly involved. In a minority it may involve the legs up to the knees. Less commonly, the fingers and hands may also be affected, as can the face, ears and other parts of the body. The pain and burning sensations can be severe.

Even in mild-to-moderate cases, everyday activities such as walking, standing, exercising, and sleeping can be affected.

Are there any tests for the condition?

Diagnosis is usually based on symptoms and the increase in skin temperature. Blood tests may be used to help identify a cause. Where an underlying cause is found this is treated.

Symptoms may be relieved by a combination of conservative measures, drug therapy and surgical interventions. Conservative measures such as rest, cooling and elevation of the extremity during attacks help. However, care should be taken if using cold water immersions for cooling.

Frequent immersion into cold water can create a vicious cycle, as the changes in temperature may cause reactive flaring. It can also lead to breakdown of the skin, ulceration and infection.

The topical application of capsaicin cream has been found to help some sufferers. Response to drug therapy can vary and no single therapy has proved consistently effective.

Oral medications used in the treatment of the condition include aspirin, certain antidepressant medications (selective serotonin reuptake inhibitors and tricyclics) and anticonvulsant medications.

Other drugs called calcium antagonists and prostaglandins may also help bring some symptom relief. Surgery in which the sympathetic nerve fibres are selectively cut may be considered in severe cases. Spontaneous remission can occur, but this is rare.