Erythromelalgia

What is erythromelalgia?

Erythromelalgia is a rare skin condition that commonly affects your hands or feet. It’s also known as Mitchell’s disease or erythermalgia.

What are the symptoms of erythromelalgia?

The pain from erythromelalgia can come and go. These are known as flares or episodes. Flares are more common in the evening and night.

Flares often involve painful, burning areas of skin that are also: 

• itchy
• red
• swollen
• warm
• tender and sore to touch

Erythromelalgia usually affects the hands or feet on both sides of the body. However, you can get it in other areas, or just on one side.

Erythromelalgia can be mild, but it can also be very severe.

Flares can be made worse in warm conditions, caused by:

• warm weather
• a hot bath or shower
• wearing socks and shoes
• physical activity
• stress

What causes erythromelalgia?

The cause of erythromelalgia is not well understood. Possible causes for erythromelalgia include: 

• changes in the small nerves that control sweating
• changes in how blood flow is controlled through your skin
• too many platelets (blood cells that help blood to clot when bleeding)
• inherited genetic mutations

Erythromelalgia can also be associated with conditions such as:

• diabetes
• lupus
• some diseases of the brain and nervous system
• polycythaemia vera (too many red blood cells)

When should I see my doctor?

If you experience symptoms of erythromelalgia, see a doctor. They can diagnose the cause of your condition. They can also refer you to a specialist if needed, such as a:

• neurologist (brain doctor)
• dermatologist (skin doctor)
• rheumatologist (a doctor who treats diseases of the joints, muscles and bones)
• vascular surgeon (a doctor who treats diseases of the arteries and veins)

How is erythromelalgia diagnosed?

Because the cause of erythromelalgia is largely unknown, there is no specific test to diagnose it. 

Your doctor will need to know how your skin looks and feels during an episode. It can help to take photos of your skin during a flare-up, to show your doctor.

Your doctor might also ask you to put your feet or hands in warm water. This is so they can observe how your skin reacts.

They might also ask you about your family history. This can help rule out other conditions and consider whether your symptoms may be inherited.

If you have erythromelalgia, you might be asked to have a blood test. This is to see if your erythromelalgia is caused by too many platelets or blood cells.

How is erythromelalgia treated?

Erythromelalgia can’t be cured. But there are ways to cool your skin during a flare. This can help to relieve your symptoms. You can:

• raise the affected area
• immerse the area in cool water
• use a fan
• use a cool (not frozen) gel pack to the area

Wearing loose clothing and not letting yourself get too hot can also help prevent or reduce flares.

Other treatments include:

• aspirin
• capsaicin cream
• anticonvulsant medicines
• antidepressants 
• surgery to stop your nerve pain

If you have erythromelalgia, avoid applying ice to your affected area, as this can worsen your symptoms.

Using cold water for long periods (such as in an ice bath) can cause tissue damage and ulcers (deep sores).

Keeping the room at a steady temperature can be helpful. Avoid strenuous exercise and alcohol, as these can make your symptoms worse.

What works for one person may not work for another. Treatments can also have risks and side effects. Talk to your doctor about what treatment might be best for you.

Can erythromelalgia be prevented?

Because the cause of erythromelalgia is not well understood, it can’t be prevented.

Complications of erythromelalgia

Flares of erythromelalgia can lead to skin injury and other complications such as:

• infection
• skin ulcers
• necrosis (tissue death)

Severe erythromelalgia can cause ongoing pain and affect your quality of life. It can also interfere with walking and other activities.