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Skin perfusion in patients with erythromelalgia
Author(s) -
Roberta Littleford,
Faisel Khan,
J. J. F. Belch
Publication year - 1999
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.1999.00510.x
Subject(s) - medicine , erythromelalgia , pathophysiology , basal (medicine) , erythema , laser doppler velocimetry , dorsum , perfusion , foot (prosody) , anesthesia , cardiology , surgery , anatomy , blood flow , linguistics , philosophy , insulin
Background Erythromelalgia (EM) is a chronic disorder characterized by intermittent pain, warmth and erythema of the extremities. Symptoms can be precipitated by increasing the temperature of the affected limb and can be partially relieved by direct cooling. Materials and methods Microvascular assessment was conducted under ‘hot’ (28°C) environmental conditions in 61 EM (EMI) patients and 30 control subjects. Twenty patients with many of the symptoms of EM were enrolled as an active control group (EMII). Using laser Doppler flowmetry, basal skin erythrocyte flux (SkEF) and the hyperaemic response to local heating (44°C) were measured. Results Compared with control subjects, basal SkEF was reduced at the toe ( P < 0.001), index finger ( P < 0.05), dorsal and plantar aspects of the foot ( P < 0.01) in both patient groups and at the medial mid‐calf ( P < 0.05) in EMI patients. Both EM groups also had a significantly reduced maximum SkEF at the dorsum of foot and medial mid‐calf (all P < 0.001) compared with control values. In a subset of patients and control subjects, transcutaneous carbon dioxide levels were raised in EMI patients ( P < 0.02) compared with levels in control subjects. Toe temperature was significantly reduced in both EM groups compared with control subjects (both P < 0.001). Conclusion Our study indicates for the first time that there is a vasoconstrictor tendency in patients with EM, which may be related to functional or structural changes in skin microvessels. Thus, the previous hypothesis that the pathophysiology of EM relates to vasodilatation is not supported in our patients. We believe that, in EM, vasoconstriction precedes reactive hyperaemia, similar to that seen in Raynaud's phenomenon.