Erythromelalgia is an uncommon skin disorder that causes painful burning sensations and redness on the hands and feet. Symptoms are typically the worst when a person's extremities are exposed to warm temperatures or bound by shoes or gloves. In some cases, erythromelalgia is severe enough to become debilitating. Treatment decisions are made based on the seriousness of symptoms and whether or not an underlying medical cause can be discovered. Home remedies and medications are usually enough to relieve the problem, but some patients eventually require surgery to sever nerve connections and prevent serious complications.
Many cases of erythromelalgia have no identifiable cause. The majority of patients with idiopathic erythromelalgia are over the age of 60. Younger individuals may experience symptoms if they have a genetic blood vessel disease or an underlying autoimmune disorder such as lupus or diabetes. The disease has also been correlated with such neurological conditions as multiple sclerosis. Rarely, erythromelalgia can run in families and be passed down to a child if one of his or her parents is a carrier of a specific genetic mutation.
The severity of symptoms can range widely from patient to patient. Some people experience slight itching and tingling sensations that only last for a few minutes. Others have intense pain in their extremities and severe skin discoloration for weeks or months at a time. Problems are usually triggered by hot temperatures or friction, though flare-ups can be somewhat spontaneous as well. It is possible, but very rare, for burning and redness symptoms to affect other areas of the body, such as the scalp and ears.
A dermatologist can usually make an initial diagnosis of erythromelalgia based on a patient's reported symptoms and the physical characteristics of his or her extremities. If the patient is not experiencing a flare-up at the time of the exam, the doctor may try to induce an episode by soaking a hand or foot in hot water. Blood tests, neurological exams, and imaging scans are then taken to look for signs of an underlying condition.
People with idiopathic erythromelalgia and relatively mild symptoms may not need medical treatment. A doctor may suggest that the patient avoid wearing shoes, stay indoors on hot days, and try immersing the feet and hands in cool water during active flares. In more serious cases, a soothing topical cream may be prescribed. Aspirin and other oral anti-inflammatory drugs are effective in reducing symptoms in many patients.
Surgery may be considered if all other treatments fail. A procedure called a sympathectomy involves cutting nerve endings that transmit pain signals from the extremities. There are serious risks to be considered with sympathectomy procedures, but it is generally considered more beneficial than dangerous for a patient whose quality of life is severely impacted from debilitating erythromelalgia.
