Erythromelalgia: review of clinical characteristics and pathophysiology
Article Abstract:
A review is presented of the clinical and physiological characteristics of erythromelalgia, a condition affecting the extremities that is distinguished a warm, burning pain, and redness. Two forms have been identified: primary, or idiopathic, erythromelalgia, where no underlying disease is present; and secondary erythromelalgia, usually associated with a disorder of blood cell synthesis within the bone marrow (myeloproliferative). A better system would classify erythromelalgia into early-onset (in childhood) and adult-onset forms. The most extensively studied forms of the disease are the adult-onset types, which are associated with thrombocythemia (an abnormally large number of platelets, cells essential for blood clotting) due to polycythemia vera (where the numbers of all blood cell types, especially the red blood cells, increase dramatically) or essential thrombocythemia. Patients with secondary erythromelalgia are more often male than female and are commonly affected late in the sixth decade of life. The lower extremities are affected more often than the upper extremities, and the symptoms may strike asymmetrically. The patient first experiences an itching or prickling of the soles, toes, or fingertips, which then progresses to severe burning pain and throbbing. Skin biopsy specimens show lesions of the arterioles (arterial blood vessels) and swelling of the cells that line them; clots are often present. Erythromelalgia is probably caused by the activation of platelets, which then aggregate and plug arterioles. Acetylsalicylic acid (aspirin) improves the condition and patients are advised to take one 500-milligram dose when symptoms begin. Early-onset erythromelalgia is more common in females than males and is usually bilateral and symmetric. The feet, ankles, and lower legs may be affected, in addition to the toes and soles. This form of erythromelalgia is severe and can progress to ulceration, infection, and disability. It is completely resistant to treatment in most cases. In both forms of the disease, heat, exercise, or holding the extremity in a dependent position exacerbate the condition. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports
Article Abstract:
The synthetic agent phenylpropanolamine (PPA) is a constituent of about 106 pharmaceutical products, including 62 over-the-counter (OTC) preparations and 44 prescription drugs. Ninety-six of these PPA-containing products are cough and cold remedies, while the other 10 are OTC diet aids. Since more than nine million Americans consumed OTC diet aids in 1981, PPA became the fifth most commonly used drug in the United States, with greater than $200 million in sales. However, it remains unclear whether PPA is completely safe. Studies show that recommended doses of PPA cause only mild increases in blood pressure, yet adverse reactions to PPA have been consistently reported. Eighty-five studies since 1965 have recorded a total of 142 adverse effects of PPA, and 69 percent of these unfavorable reactions were reported in North America. Most adverse reactions occurred in females and persons under 30 years of age. Eighty-five percent of adverse effects were associated with the use of OTC products and 15 percent with the use of prescription drugs. The preparations containing PPA often consisted of other ingredients, and PPA was commonly consumed in conjunction with other medications. One third of the cases of adverse reactions to PPA were due to overdose with this agent, and 82 percent of overdoses were severe. The most common side effects of PPA were symptoms of high blood pressure, including headache. Consumption of PPA was also associated with 24 cases of bleeding within the brain cavity, 8 seizures, and 8 deaths, mostly resulting from strokes. Physicians should be aware of the prevalent use of PPA-containing products and potential adverse reactions to the compound. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: Prevalence and clinical characteristics of a high cardiac output state in patients with multiple myeloma. Complement abnormalities in multiple myeloma
- Abstracts: Legal and practical impact of clinical practice guidelines on nursing and medical practice. The cost of healing pressure ulcers across multiple health care settings
- Abstracts: Questioning the chains of habit. Cardiovascular clinical specialist: insights and inspirations
- Abstracts: The medical review officer. Medical management of hydrofluoric acid exposure. Hepatitis B in a medical center
- Abstracts: Threshold limit values: historical perspectives and current practice. Measurement of vibration of hand-held tools: weighted or unweighted?