eMedicine Specialties > Dermatology > Environmental

Acrodynia: Differential Diagnoses & Workup

Author: Kamila K Padlewska, MD, PhD, Professor, Warsaw Academy of Cosmetics and Health Care; Chief Executive, Cosmetic-Medical Cooperative, Poland
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Mar 31, 2009

Differential Diagnoses

Acanthosis Nigricans
Kawasaki Disease

Other Problems to Be Considered

Toxicities to copper, arsenic, gold, or thallium7
Poliomyelitis
Kawasaki disease (differential)8,9

Workup

Laboratory Studies

  • Evidence of excess mercury in the urine of affected persons has been noted. A 24-hour urine collection is recommended because urinary elimination of mercury is unpredictable and may vary from day to day or from hour to hour.
    • Mercury values in persons with acrodynia can vary from 0-401 mcg/L.
    • A value of less than 10 mcg/L is generally considered within reference range.
    • Concentrations greater than 300 mcg/L are considered the threshold of toxicity, and symptoms rarely occur until mercury excretion rises to this level.
  • Blood evaluation is recommended, particularly for acute intoxication.
    • Normal levels rarely exceed 15 mcg/L.
    • Mercury levels in the plasma may be elevated for prolonged periods because of slow release from erythrocytes after oxidation.
  • Mercury blocks the action of catechol methyl transferase, leading to increased amounts of vanillylmandelic and homovanillic acid in urine.
  • Excretion of 17-ketosteroid has also been shown to be increased in these patients.
  • Analysis of hair strands by means of x-ray fluorescence for mercury contamination also may be considered, but the results may be falsely elevated in persons residing in environments with increased ambient atmospheric concentrations or in populations consuming methylmercury-contaminated seafood.

Histologic Findings

Hyperplastic sweat glands and nonspecific inflammation have been observed in skin biopsy specimens. Degenerative changes have been found in peripheral nerves and chromatolytic changes at the anterior horn cells of the spinal cord.

More on Acrodynia

Overview: Acrodynia
Differential Diagnoses & Workup: Acrodynia
Treatment & Medication: Acrodynia
Follow-up: Acrodynia
References
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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. 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].

  6. 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].

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

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

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

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

  11. 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.

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

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Further Reading

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Keywords

acrodynia, mercury poisoning, mercury toxicity, pink disease, Feer disease, Feer's disease, Swift syndrome, Swift's disease, Swift disease, Swift-Feer disease, vegetative neurosis, dermatopolyneuritis, erythredema polyneuritis, trophodermatoneurosis, heavy metal toxicity, heavy metal poisoning, chronic mercury poisoning, chronic heavy metal poisoning

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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, Poland
Kamila K Padlewska, MD, PhD is a member of the following medical societies: Academy of Medical Royal Colleges
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, UMDNJ-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.

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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