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Erythromelalgia Clinical Presentation

  • Author: Antoine N Saliba, MD; Chief Editor: Emmanuel C Besa, MD  more...
Updated: Dec 01, 2015


The classic description of erythromelalgia is a triad of redness, pain, and warmth in the extremities, brought on by warming or dependency and relieved by cooling (see the image below).

Cardinal symptoms of erythromelalgia. Cardinal symptoms of erythromelalgia.

Paroxysmal burning pain has been also reported to be a presenting symptom of erythromelalgia.[25] Erythromelalgia has also been reported to involve parts other than the extremities (eg, auricular erythromelalgia).[26]

Symptomatic episodes may last minutes to days. They often begin with an itching sensation, progressing to a more severe pain with a burning quality. Pain may be so intense that the patient cannot walk; some must even keep their feet immersed in ice water.

The lower extremities are affected more often than the upper extremities. The soles of feet and toes are most commonly involved. Involvement as high as the knees is observed but is rare. Involvement is usually bilateral, though not necessarily symmetric. Warming the extremity or placing and maintaining the extremity in a dependent position can exacerbate symptoms; cooling and elevating the extremity can relieve symptoms.

Raynaud phenomenon has been reported to occur between episodes of erythromelalgia, but this may be coincidental.

In cases associated with a myeloproliferative disorder, erythromelalgia usually precedes diagnosis of the myeloproliferative disorder by a median of 2.5 years. Dramatic relief with aspirin is typical of this type of erythromelalgia and can be used as an aid to diagnosis.

Given the association with myeloproliferative disorders, the clinician should inquire about a possible history of pruritus, thrombotic episodes (eg, transient visual loss), constitutional symptoms, and abdominal discomfort that could accompany myeloproliferative disorders.


Physical Examination

Between episodes, examination findings may be normal. During an episode, the affected extremity becomes warm, tender, and appears dusky, red, and sometimes mottled.

Peripheral pulses may be normal or bounding. Acrocyanosis may be observed; rarely, it progresses to necrosis of the distal ends of digits. Ischemic ulcers may be observed and may become infected secondarily.

Checking for possible splenomegaly and lymphadenopathy should also be part of a comprehensive physical examination in a patient with suspected erythromelalgia.

Contributor Information and Disclosures

Antoine N Saliba, MD Post-Doctoral Research Fellow, Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center

Disclosure: Nothing to disclose.


Ali T Taher, MD, PhD, FRCP Professor of Medicine, Associate Chair of Research, Department of Internal Medicine, Division of Hematology/Oncology, Director of Research, NK Basile Cancer Center, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.


Robert J Nardino, MD Director, Internal Medicine Residency Program, Assistant Clinical Professor, Department of Internal Medicine, Hospital of Saint Raphael, Yale University School of Medicine

Robert J Nardino, MD is a member of the following medical societies: American College of Physicians, Association of Program Directors in Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Andrea LM Silber, MD Medical Oncologist, Father Michael J McGivney Center for Cancer Care, Saint Raphael Hospital

Andrea LM Silber, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Society of Preventive Oncology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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Cardinal symptoms of erythromelalgia.
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