Acrodynia Clinical Presentation

  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

History

  • Children initially become listless, drowsy, and irritable, with a tendency to cry.
  • Anorexia and subsequent weight loss can occur.
  • More than 50% of patients demonstrate photophobia.
  • Hypotonia, the ability to hyperextend or overextend the limbs, and atrophy of muscles are noted. The child may refuse to walk.
Next

Physical

  • The initial symptoms are followed by the numerous cutaneous manifestations in 2-4 weeks. The skin changes are characteristic. The review by Dinehart et al from 1988 is notable.[6]
  • Early in the course of the disease, the tip of the nose, fingers, and toes acquire a pinkish color, which subsequently develops into a reticulate erythema of deeper hue.[7]
  • The hands and feet become painful, cold, cyanotic, erythematous, and swollen. Erythema is usually blotchy but may be diffuse. Hemorrhagic puncta are also noted. On the trunk, the erythema is blotchy and may be macular or papular.
  • Extreme pain and pruritus in the extremity often leads to lichenified, excoriated changes as the child constantly rubs and scratches his or her skin.
  • Patients may assume the "salaam position" in which they sit with their heads between their legs and rub their hands together.
  • Inflammation, swelling, and focal gum erosion can been seen with subsequent loss of teeth. These changes are early.
  • A notable symptom is massive hyperhidrosis with a mouselike smell, which may lead rapidly to miliaria rubra. This can easily turn to bacterial secondary infection with a tendency for ulcerating pyoderma.
  • Persistent hypertension, tachycardia, susceptibility to bronchitis, dyspepsia, precipitant micturition, salivation, and hypotonia can be observed. Usually, the patient develops a moderate upper respiratory tract infection with a sore throat.[8]
  • Alopecia has also been noted.
  • Nail loss has been reported.
Previous
Next

Causes

  • Mercury exposure in a sensitive person is considered to be responsible for the development of acrodynia. A genetic predisposition is possible.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Kamila K Padlewska, MD, PhD  Professor, Warsaw Academy of Cosmetics and Health Care; Chief Executive, Cosmetic-Medical Cooperative Izis, Poland

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Shyam Verma  MBBS, DVD, FAAD, Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania

Shyam Verma is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Barbacki M. [Acrodynia in Poland after the 2d World War]. Przegl Lek. 1970;26(10):762-4. [Medline].

  2. Boyd AS, Seger D, Vannucci S, Langley M, Abraham JL, King LE Jr. Mercury exposure and cutaneous disease. J Am Acad Dermatol. Jul 2000;43(1 Pt 1):81-90. [Medline].

  3. Kazantzis G. Mercury exposure and early effects: an overview. Med Lav. May-Jun 2002;93(3):139-47. [Medline].

  4. Baughman TA. Elemental mercury spills. Environ Health Perspect. Feb 2006;114(2):147-52. [Medline].

  5. Mahajan VK, Sharma NL. Metallic mercury vapour poisoning revisited. Australas J Dermatol. Nov 2011;52(4):e5-7. [Medline].

  6. Dinehart SM, Dillard R, Raimer SS, Diven S, Cobos R, Pupo R. Cutaneous manifestations of acrodynia (pink disease). Arch Dermatol. Jan 1988;124(1):107-9. [Medline].

  7. Shandley K, Austin DW. Ancestry of pink disease (infantile acrodynia) identified as a risk factor for autism spectrum disorders. J Toxicol Environ Health A. Sep 15 2011;74(18):1185-94. [Medline]. [Full Text].

  8. Torres AD, Rai AN, Hardiek ML. Mercury intoxication and arterial hypertension: report of two patients and review of the literature. Pediatrics. Mar 2000;105(3):E34. [Medline].

  9. Graeme KA, Pollack CV Jr. Heavy metal toxicity, Part I: arsenic and mercury. J Emerg Med. Jan-Feb 1998;16(1):45-56. [Medline].

  10. Beck C, Krafchik B, Traubici J, Jacobson S. Mercury intoxication: it still exists. Pediatr Dermatol. May-Jun 2004;21(3):254-9. [Medline].

  11. Mutter J, Yeter D. Kawasaki's disease, acrodynia, and mercury. Curr Med Chem. 2008;15(28):3000-10. [Medline].

  12. Abbaslou P, Zaman T. A Child with elemental mercury poisoning and unusual brain MRI findings. Clin Toxicol (Phila). 2006;44(1):85-8. [Medline].

  13. Ellenhorn MJ, Schonwold S, Ordag G, Wassenberger J, eds. Metals and related compounds. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. William & Wilkins: Baltimore, Md; 1997:1532-613.

  14. Selter P. Arch Kinderheilkd. 1926-1927;80:244.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.