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Acrodynia Clinical Presentation

  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 14, 2016
 

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.

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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 been noted. Nail loss has also been reported.

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Causes

Mercury exposure in a sensitive person is considered to be responsible for the development of acrodynia. A genetic predisposition is possible.

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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 of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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

Shyam Verma, MBBS, DVD, FAAD 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. 2000 Jul. 43(1 Pt 1):81-90. [Medline].

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

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

  5. Mahajan VK, Sharma NL. Metallic mercury vapour poisoning revisited. Australas J Dermatol. 2011 Nov. 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. 1988 Jan. 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. 2011 Sep 15. 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. 2000 Mar. 105(3):E34. [Medline].

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

  10. Beck C, Krafchik B, Traubici J, Jacobson S. Mercury intoxication: it still exists. Pediatr Dermatol. 2004 May-Jun. 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. Yeter D, Deth R, Kuo HC. Mercury Promotes Catecholamines Which Potentiate Mercurial Autoimmunity and Vasodilation: Implications for Inositol 1,4,5-Triphosphate 3-Kinase C Susceptibility in Kawasaki Syndrome. Korean Circ J. 2013 Sep. 43(9):581-591. [Medline].

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

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

  15. Selter P. Arch Kinderheilkd. 1926-1927. 80:244.

 
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