Erythromelalgia (EM) is a chronic disorder characterized by intermittent burning pain, warmth and erythema of the extremities. Increasing the local temperature and dependency of the affected limb(s) precipitates the symptoms, whereas direct cooling and elevation of the limb(s) can provide partial relief. Our previous findings showed that patients with EM have enhanced cutaneous vascular tone at rest and during stimulation, which may be due to an increase in sympathetic neural activity. To test this, we measured skin vasoconstrictor responses to contralateral arm cold challenge (CC) and inspiratory gasp (IG) using laser Doppler flowmetry at the toe pulp and fingertip. These areas were chosen because of their dense sympathetic innervation. An index of the vasoconstrictor response (between 0 and 1) was calculated from the change in skin perfusion from baseline following CC and IG. In control subjects, vasoconstrictor responses to CC at the toe and fingertip were both 0.70±0.02 (mean±S.E.M.), which were significantly greater (P < 0.001) than corresponding values in patients with EM (0.37±0.04 and 0.45±0.04 respectively). Similarly, vasoconstrictor responses to IG were significantly greater (P < 0.001) at the toe and fingertip in control subjects (0.70±0.03 and 0.70±0.02 respectively) compared with values in EM patients (0.27±0.03 and 0.45±0.15 respectively). These data show that, in contrast with control subjects, patients with EM have diminished sympathetic vasoconstrictor responses to both CC and IG. Denervation supersensitivity may play a part by increasing vasoconstrictor responses to circulating catecholamines, leading to a reduction in skin blood flow. Therefore an interplay between neural and vasoactive agents may be involved in the pathophysiology of EM.
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Research Article|
April 14 1999
Impaired skin vasomotor reflexes in patients with erythromelalgia
Roberta C. LITTLEFORD;
Roberta C. LITTLEFORD
1University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K.
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Faisel KHAN;
1University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K.
Correspondence: Dr Faisel Khan
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Jill J. F. BELCH
Jill J. F. BELCH
1University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K.
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Publisher: Portland Press Ltd
Received:
October 05 1998
Revision Received:
January 08 1999
Accepted:
January 15 1999
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 1999
1999
Clin Sci (Lond) (1999) 96 (5): 507–512.
Article history
Received:
October 05 1998
Revision Received:
January 08 1999
Accepted:
January 15 1999
Citation
Roberta C. LITTLEFORD, Faisel KHAN, Jill J. F. BELCH; Impaired skin vasomotor reflexes in patients with erythromelalgia. Clin Sci (Lond) 1 May 1999; 96 (5): 507–512. doi: https://doi.org/10.1042/cs0960507
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