The cause of erythromelalgia is not completely understood. Recent research has shown changes in the small nerves controlling sweating and changes in the control of blood flow through the skin vessels in some sufferers. It may also be seen in association with blood disorders such as leukaemia, lymphoma, polycythemia vera or conditions in which the there is an increase in the number of platelets, or connective tissue disorders and other conditions that may result in damage to the nerve supply to the blood vessels
The patient gives a history of episodes redness, burning and warmth of the skin of feet (involved in 90% of patients) and in 25% of cases the hands will also be involved.
The patient experiences heat and burning pain in the feet or hands that is relieved to some extent by cooling the affected areas. Attacks occur most commonly at night and often interfere with sleep. Patients often describe sleeping with their feet stuck out from under the blankets as warming often makes symptoms worse
There are other other conditions of nerves and blood vessels that may show some some of the same symptoms and changes in appearance of the skin. Further investigations or evaluation by other specialists may be needed
Treatment is often difficult – there is no single simple solution for the chronic fluctuating pain experienced Some degree of trial and error is often needed.
A good supportive relationship with family doctorand specialist is helpful. Avoid hanging the legs down, don’t use heavy warm blankets at night. Alcohol causes blood vessels to dilate so may aggravate the symptoms. Heat and exercise often make symptoms worse. Using ice packs should be avoided on the affected area as it aggravates the symptoms
Capsaicin cream applied regularly may reduce the pain in the skin as does Amitryptiline cream. or lLdocaine patches. Gabapentin or Amitryptiyline in small doses taken regularly may be helpful in controlling the chronic pain and discomfort.
Sometimes assistance must be sought from Pain Management experts.
This information has been written by Dr Cathy Zhao and Dr Tanumay Raychaudhury
This page is currently under review.