Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
A picture is worth a thousand words. The excellent section “IMAGES IN CLINICAL MEDICINE” appears from time to time in the New England Journal of Medicine. I’m delighted when the topic chosen is one that’s relevant to outdoor or even wilderness medicine. Such was the case with the page entitled “A White Hand and a Red Hand – Erythromelalgia” (2010;363:1463) authored by Dan Lipsker, MD. There is shown a dramatic photograph of a 14 year old girl’s normal left hand side by side with her brightly reddened right hand, which is a manifestation of a phenomenon known as erythromelalgia. As described by Dr. Lipsker, the child sought medical attention for three years of intermittent episodes of sudden pain in her hands and feet without any prior other significant medical history. These episodes were often triggered by physical exercise or bathing.
When the doctor examined the child, exercise or immersion of the right hand into warm water was noted to trigger a burning pain and redness of the hand. The diagnosis of erythromelalgia was made (“erythro” = red; “melalgia” = pain in a limb), which sometimes also includes swelling along with the pain and redness. Occasionally, the affected limb will appear dusky or mottled. Sometimes the discomfort and redness can extend beyond just the hands or feet. The problem is treated by exposure to cold temperature using immersion in cool or cold water, or using an electric fan. Like many other symptoms in medicine, erythromelalgia can be associated with other problems. For this particular malady, these include certain blood clotting or component formation disorders, connective tissue disorders, inflammation of the blood vessels, diabetes, gout, multiple sclerosis, and certain drug ingestions. Different logical drug remedies have been attempted, but so far, with the exception of using aspirin to treat some of the blood component formation disorders (in which there is an overabundance of certain blood components, such as platelets), there is not an effective therapy beyond symptomatic treatment, so prevention is key. It is possible that there is a genetic basis for predisposition, but this possibility has not thus far led to any new approach to prevention or treatment.
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