eMedicine Specialties > Dermatology > Environmental

Acrodynia: Treatment & Medication

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

Treatment

Medical Care

Removal of the inciting agent is the goal of treatment. Correcting fluid and electrolyte losses and rectifying any nutritional imbalances (vitamin-rich diets, vitamin-B complex) are of utmost importance in the treatment of the disease.

  • Recently, the chelating agent meso 2,3-dimercaptosuccinic acid has been shown to be the preferred treatment modality. It can almost completely prevent methylmercury uptake by erythrocytes and hepatocytes.
  • In the past, dimercaprol (British antilewisite; 2,3-dimer-capto-l-propanol) and D-penicillamine were the most popular treatment modalities. Disodium edetate (Versene) was also used.
    • Neither disodium edetate nor British antilewisite has proven reliable. British antilewisite has now been shown to increase CNS levels and exacerbate toxicity.
    • N -acetyl-penicillamine has been successfully given to patients with mercury-induced neuropathies and chronic toxicity, although it is not approved for such uses. It has a less favorable adverse effect profile than meso 2,3-dimercaptosuccinic acid.10
  • Hemodialysis with and without the addition of L-cysteine as a chelating agent has been used in some patients experiencing acute renal failure from mercury toxicity.
  • Peritoneal dialysis and plasma exchange also may be of benefit.
  • Tolazoline (Priscoline) has been shown to offer symptomatic relief from sympathetic overactivity.
  • Antibiotics are necessary when massive hyperhidrosis, which may rapidly lead to miliaria rubra, is present. This can easily progress to bacterial secondary infection with a tendency for ulcerating pyoderma.

Medication

The goals of pharmacotherapy are to remove the causing agent, to reduce morbidity, and to prevent complications.

Chelating agents

Succimer almost completely prevents methylmercury uptake by erythrocytes and hepatocytes.


Succimer (Chemet)

Metal chelating agent, analog of dimercaprol, used in lead poisoning. Available as 100-mg cap.

Adult

10 mg/kg q8h for 5 d, followed by 10 mg/kg q12h for 14 d

Pediatric

Administer as in adults

Do not administer concomitantly with edetate calcium disodium or penicillamine

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

CBC with white blood cell differential and platelet count should be performed prior to and weekly during therapy; discontinue therapy if absolute neutrophil count drops to 1200/μ l and monitor until count returns to 1500/μ l or patients baseline neutrophil count; caution in renal or hepatic impairment; to prevent toxicity, patient should be well hydrated; adverse effects include rash, GI symptoms (eg, nausea, vomiting, diarrhea, appetite loss, metallic taste in mouth), and increases in serum transaminase levels

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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