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LETTER TO EDITOR
  
Year : 1996  |  Volume : 62  |  Issue : 3  |  Page : 204-205

Erythromelalgia responding to aspirin

SGS Krishnan, P Devakar Yesudian, M Jayaraman, Jan 
 

Correspondence Address:
SGS Krishnan





How to cite this article:
Krishnan S, Yesudian P D, Jayaraman M, Jan. Erythromelalgia responding to aspirin.Indian J Dermatol Venereol Leprol 1996;62:204-205


How to cite this URL:
Krishnan S, Yesudian P D, Jayaraman M, Jan. Erythromelalgia responding to aspirin. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2020 Jan 25 ];62:204-205
Available from: http://www.ijdvl.com/text.asp?1996/62/3/204/4390


Full Text

 To the Editor,



A 14-year-old dumb girl was brought for the complaints of white soddening of the skin of both hands of 2 weeks duration. History revealed that the patient had for the past 3 months constantly immersed her hands in water. On examination, patient had candidal intertrigo of the webs of the fingers with keratolysis punctata of both hands. Skin over the hands was red and warm. Peripheral pulses were normally felt. Lower extremities were normal. There were no features to suggest any collagen vascular disease or peripheral occlusive vascular disease. Investigations revealed a normal RBC, platelet and WBC counts. ESR was normal. Rheumatoid factor and ANA were negative. A diagnosis of erythromelalgia was made and the patient was put on tab aspirin 1/2 tab per day and was simultaneously treated for candidal intertrigo. Response was dramatic. Patient stopped immersing her hands in water and the warmth and redness of the hands decreased considerably.

Erythromelalgia is a condition of painful red extremities in which a sensation of burning is associated with an increased temperature in the affected limb.[1] There are 3 types of erythromelalgia.[2] Our patient with bilateral involvement is likely to belong to type 2. This type is generally confined to the lower legs and is thought to share similarities with reflex sympathetic dystrophy. It usually does not respond to aspirin and may require sympathetic blockade for relief of symptoms. Aspirin is useful in treatment of type 1 in which there may be thrombocythaemia or other defects of platelet functions. It acts presumably by preventing platelet aggregation.[3] This type is generally seen in persons past their middle age.

It may be worthwhile trying aspirin in all cases of erythromelalgia as many patients irrespective of the type get considerable relief. Regular follow up of our patient is essential as erythromelalgia may be a presenting and premonitory symptom, often by several years, of myeloproliferative disorders like polycythaemia vera and thrombocythaemia.

References

1Mitcheli SW. A rare vasomotor neurosis of the extremities and on maladies with which it may be confounded. Am J Med Sci 1878; 76: 2-36.
2Ryan TJ, Burnand K. Diseases of the veins and arteries. In: Champion RH, Burton JL, Ebling FJG, editors. Textbook of dermatology. Oxford: Blackwell, 1992:1972.
3Michiels JJ, Abels J, Steketee J, et al. Erythromelalgia caused by platelet-mediated arteriolar inflammation and thrombosis. Ann Intern Med 1985;102:466-71.

 

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