Acute secondary erythermalgia and hypertension in children

We studied the clinical symptoms in nine children (seven females and two males; mean age 11.6 years) with severe but transient acute secondary erythermalgia. The classical symptoms at presentation were episodic attacks of painful burning hands and feet which felt warm with congested appearance of the feet. Each attack lasted for a mean period of 25 days (range from 6 to 56 days). The blood pressure was elevated in seven patients. Intravenous sodium nitroprusside was effective in ameliorating the symptoms with drop in blood pressure to normal in five patients; pizotifene, labetolol, prostaglandin E₁ and hypnotherapy were effective in each of four separate cases. The episodes of acute secondary erythermalgia were transient in all and did not recur after a mean follow up period of 1.6 years. These cases suggest that acute secondary erythermalgia, however transient, is not rare and can be associated with mild to moderate hypertension which may respond to sodium nitroprusside. A greater awareness of this condition is necessary to make an accurate and timely diagnosis and institute appropiate therapy in order to prevent undue complications.Erythermalgia Multidisciplinary Study Group: K. Chakravarty, Warrington Hospital NHS Trust, Department of Rheumatology, Warrington, United Kingdom; J.P.H. Drenth, University Hospital St. Radboud, Department of Medicine, Nijmegen, The Netherlands; J.J. Michiels, University Hospital Dijkzigt, Department of Hematology, Rotterdam, The Netherlands: S. Özsoylu, Turkish Health and Therapy Foundation, Medical Center and Memorial Ahmet Örs Hospital, Ankara, Turkey; B.S. Shapiro, Children's Hospital of Philadelphia, Division of General Pediatrics, United States of America