erythematous extremity pain
Introduction
Introduction to erythematous limb pain Erythematous limb pain is a rare vasodilator disease of the extremities. The disease is a plant neurological disease characterized by paroxysmal vasodilatation of the distal extremity, elevated skin temperature, flushing of the skin color, and severe burning pain. The disease is most likely to invade the distal end of the limb, especially the lower extremities, which are characterized by paroxysmal pain, cutaneous congestion of the skin, and increased skin temperature. The pathogenesis may be due to dysfunction of peripheral blood vessels caused by autonomic dysfunction, resulting in excessive expansion of blood vessels and local congestion. The cause of this disease is not fully understood, but the patient is extremely painful. At present, Western medicine still lacks effective treatment methods for this disease. basic knowledge The proportion of illness: 0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: Hypertension Diabetes Multiple sclerosis Infectious mononucleosis Systemic lupus erythematosus
Cause
Causes of erythematous limb pain
(1) Causes of the disease
The etiology and pathogenesis of erythematous limb pain is not clear, and may be related to cold-induced vasomotor dysfunction of the extremities. Due to the expansion of the arterioles, the blood flow is significantly increased, local congestion, increased intravascular tension, compression or stimulation of the artery. And adjacent to the nerve endings before the occurrence of severe pain, often caused by sudden temperature drop by cold or long-distance march, is generally considered to be divided into three types:
1. Primary erythematous limb pain: the cause is unknown, may be related to autonomic or vascular nerve center dysfunction, the skin is allergic to warmth and some pyrogens in the blood increase, a few patients have family factors.
2. Secondary erythematous limb pain: secondary to certain diseases such as diabetes, polycythemia vera, pernicious anemia, gout, light cellulitis, rheumatoid arthritis, systemic lupus erythematosus, thromboembolism Vasculitis, carbon monoxide poisoning, heart failure, high blood pressure, etc.
3. Idiopathic erythema limb pain: The pathogenic factors of this disease may not be single, but the result of a combination of many factors, first of all, it is related to sudden changes in temperature, cold stimulation, adolescent students are prone to this disease It indicates that the autonomic and endocrine systems are unstable during puberty, and the ability to adapt to changes in external environment is poor. Whether it is related to certain biological pathogenic factors or nutritional deficiencies is still uncertain.
(two) pathogenesis
1. The pathogenesis of primary erythematous limb pain is unclear and is currently considered to be related to autonomic or vasomotor nerve central dysfunction, but there is no evidence of pathological basis in the vasomotor system, hypothalamic center or ganglion, some patients After sympathectomy, the clinical manifestations improved, so Buerger proposed the theory of sympathetic dysfunction. Others believe that erythematous pain is caused by the expansion of the arteries and the narrow capillaries or arterioles. The vasomotor coordination dysfunction occurs. When the blood flows through the dilated arteries and encounters obstruction in the arterioles and capillaries, it strongly attacks the venous anastomosis of the receptors, thus causing a strong burning pain. Vasomotor arrhythmia is not the only cause of this pain. It may be related to excessive sensitivity of the skin to hyperthermia or excessive hyperthermia to small blood vessels. In recent years, it has been thought that blood serotonin (serotonin and serotonin may be caused by some reason). The accumulation of peptides is related.
2. The pathogenesis of secondary erythema limb pain may be due to the above reasons leading to vascular nerve dysfunction, causing excessive opening of the anterior capillary artery, causing increased blood flow to the local skin arteries, causing local redness, swelling, pain, and heat. Clinical manifestations.
Prevention
Erythematosus pain prevention
Do a good job of physical and mental care, relieve the patient's ideological concerns, and establish confidence in the fight against disease. It is essential in the cold season, pay attention to the extremity insulation, keep the shoes and socks dry; long time ride, stand, whistle, walk, should change posture in time Regularly get off the car, can prevent or reduce the onset, or reduce the symptoms, mainly symptomatic treatment, local cold or cold water can be given to the affected limb during the attack to relieve symptoms; raise the affected limb, avoid overheating or touching and other adverse stimuli Oral reserpine, chlorpromazine, and rifampic may improve symptoms, and the internal sacral nerve block and lumbar sympathetic block have a good effect.
Complication
Erythematous limb pain complications Complications Hypertension Diabetes Multiple sclerosis Infectious mononucleosis Systemic lupus erythematosus
A small number of patients have dystrophic disorders in the late stage, thickened skin and nails, ulceration, occasional skin gangrene, secondary erythematous limb pain combined with primary hypertension, diabetes, multiple sclerosis, infectious mononuclear The clinical manifestations of cell hyperplasia, systemic lupus erythematosus and other diseases, the disease often remission, recurrence, can be a chronic course, most of the prognosis is good, can naturally recover.
Symptom
Symptoms of erythematous limb pain Common symptoms
The disease is more common in young adults aged 20 to 40, more men than women. Onset can be urgent and slow, and at the same time, both sides of the extremities are involved, and the feet are more common. It is characterized by redness of the toes, soles, fingers and palms, increased pulsation of the arteries, increased skin temperature, and unbearable burning pain. More often at night or aggravated, usually lasting for hours. Increased heat, ambient temperature, exercise, standing, foot drop or stroke of the affected limb can lead to clinical onset or increased symptoms; rest in bed, raise the affected limb, expose the affected limb to cold air or soak in cold water Can reduce or alleviate pain. The patient did not want to wear shoes, socks and put his limbs in the quilt, fearing the doctor to check. The extremities may have an objective sensation, a thickening of the nails, and atrophy of the muscles, but few ulcers and gangrene. Symptoms with long duration and/or severe illness are not limited to the extremities, but can extend to the entire lower limbs and involve the upper limbs.
Examine
Examination of erythematous limb pain
1, blood, urine routine, often with thrombocytosis and erythrocytosis.
2, blood biochemical routine, blood biochemical examination and routine examination of cerebrospinal fluid are mostly non-specific, but secondary red hot limb pain is related to the primary disease, drug and poison detection have differential diagnosis significance.
3, B-ultrasound, color ultrasound.
4, microcirculation examination showed that the microvascular of the extremities increased the warming response, the capillary pressure increased, the lumen was obviously dilated, and the acne capillary was blurred.
5, skin critical temperature test, soak hands or feet in 32 ~ 36 ° C water, if symptoms appear or increase, it is positive.
Diagnosis
Diagnosis and diagnosis of erythematous limb pain
diagnosis
According to its clinical manifestations and auxiliary examinations and without systemic symptoms and certain primary diseases, the diagnosis of primary erythematous limb pain can be diagnosed:
1. It can be irritated at any age, but it is more common in young and middle-aged people. It is often caused by sudden drop in temperature and acute onset after cold or long-distance walking.
2. Mainly invades the hands and feet, especially the two feet.
3. The onset of the attack is the burning pain of the distal part (hand, foot) of one or both limbs. The local skin is red, the skin temperature is elevated, swelling, and sweating.
4. Performance as a paroxysmal episode, lasting for a few minutes, or hours, or even days, each episode is mostly in the evening.
5. Local heat, exercise, standing for a long time or sagging of the limbs can induce and aggravate the pain; rest, cold compress, raise the affected limb, and the symptoms can be alleviated and disappeared.
6. The affected limb arterial pulsation is enhanced. After a long illness, there may be a loss of extremity, a thickened toenail, and even atrophy of the muscle.
Differential diagnosis
1. erythroderosis This disease is a group of syndromes characterized by delicate skin and bright red on the palms and sputum. It may have hyperesthesia and mild pain. The local temperature does not rise, and it has a comfortable feeling in hot water. Appears in the case of eczema or chronic inflammation and liver disease.
2. Foot inflammation lesions such as athlete's foot complicated by lymphedema inflammation, may have red, swollen, hot, pain four major symptoms, with elevated body temperature, mostly single, edema of the foot.
3. Neuralgia caused by various causes of polyneuritis, mainly with paresthesia and pain; traumatic or postoperative painful neuralgia, mainly with pain and local pain; traumatic autonomic dysfunction, with blood vessels The systolic dysfunction and numbness, the skin is characterized by hairpinness. These patients have low skin temperature and are hot and cold.
Under certain incentives, paroxysmal red feet, swelling, heat, pain and other characteristics can often be diagnosed, but with frostbite, occlusive vasculitis, polycythemia vera, Renault phenomenon, diabetic neuropathy, spinal cord Identification of sputum and toxic peripheral neuritis.
