International Journal of
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Case Report Volume 1 Issue 1
Intermittent signs of erythromelalgia diagnosed by smartphone selfie
Hiroki Maita,1 
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Tadashi Kobayashi,2 Hiroshi Osawa,2 Takahiro Hirano,3 Hiroyuki Kato3
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1Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Japan
2Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Japan
3General Medicine, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Japan
Correspondence: Hiroki Maita, Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Japan, Tel +81-172-33-5111, Fax +81-172-39-8189
Received: July 21, 2017 | Published: September 8, 2017
Citation: Maita H, Kobayashi T, Osawa H, et al. Intermittent signs of erythromelalgia diagnosed by smartphone selfie. Int J Fam Commun Med. 2017;1(1):19-20. DOI: 10.15406/ijfcm.2017.01.00006
Abstract
Erythromelalgia, a rare condition associated with myeloproliferative disorders, causes intermittent ischemic pain in the extremities. A 42-year-old woman presented to our hospital with severe bilateral leg pain and intermittent red-violet skin discoloration for 4 years. A Smartphone “selfie” can accurately record the intermittent signs of erythromelalgia, enabling correct diagnosis of this uncommon condition.
Keywords: erythromelalgia, selfie, smartphone, essential thrombocytosis, myeloproliferative disorders, intermittent signs, polypharmacy, remote medicine, telemedicine, mhealth
Introduction
Erythromelalgia is a rare condition associated with myeloproliferative disorders such as essential thrombocythemia or polycythemia vera.1 Erythromelalgia causes microvascular thrombotic occlusions induced by platelet hyperaggregability in acral vessels,2 with intermittent ischemic symptoms presenting as a triad of redness, warmth, and pain of the extremities.3 Aspirin, a common and inexpensive drug is the first choice of therapy.1,2 It is difficult to record the typically intermittent skin findings noted in this condition.4 We describe how a photo taken by a patient on her smartphone (selfie) established the correct diagnosis, and helped reduce the use of multiple analgesics.
Case presentation
A 42-year-old woman presented to our hospital with intermittent severe bilateral leg pain and red-violet skin discoloration for 4 years. She was known to have essential thrombocytosis for 7 years. High doses of analgesics (loxoprofen 600mg/day, pregabalin 100mg/day) provided temporary relief. in the outpatient department revealed normal skin findings and no ischemic signs in her legs. Paroxysmal skin findings noted on a photograph she took using her smartphone, (Figure 1) revealed erythromelalgia. Oral aspirin (100mg/day) relieved her pain and reduced the need for other analgesics.
Figure 1 Photograph of Patient’s Left Toe using her Smartphone Selfie. Edema and Erythema during attacks are found in the Third to Fifth Toes and Sole of the Foot.
a. Picture of Patient’s Smartphone Screen Taken by a Physician in an Outpatient Department.
b. An Enlarged Image of Photo A.
Discussion
The patient’s smartphone, a product commercially available in Japan without need for additional software, recorded her typically intermittent abnormal skin findings, established a diagnosis of erythromelalgia, and reduced polypharmacy with analgesics. Recording of definitive skin findings at the time of a patient visit is difficult because erythromelalgia typically shows intermittent symptoms.4,5 Once diagnosis is confirmed, aspirin is an inexpensive treatment option compared to expensive analgesics. A smartphone “selfie” can accurately record the intermittent signs of erythromelalgia, enabling correct diagnosis of this uncommon condition. We believe that “selfies” will become more useful in general practice, as well as in telemedicine, in the future.
Patient consent form
Written informed consent for patient information and images to be published was provided by the patient.
Acknowledgements
None.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
References
- Kurzrock R, Cohen PR. Erythromelalgia and Myeloproliferative Disorders. Arch Intern Med. 1989;149(1):105–109.
- Michiels JJ, Johannes A, Steketee J, et al. Erythromelalgia Caused by Platelet-mediated Arteriolar Inflammation and Thrombosis in Thrombocythemia. Ann Intern Med. 1985;102(4):466–471.
- Davis MD, O Fallon WM, Rogers RS, et al. Natural History of Erythromelalgia: Presentation and Outcome in 168 Patients. Arch Dermatol. 2000;136(3):330–336.
- Cohen JS. Erythromelalgia: New Theories and New Therapies. J Am Acad Dermatol. 2000;43(5):841–847.
- Norton JV, Zager E, Grady JF. Erythromelalgia: Diagnosis and Classification. Foot and Ankle Surg. 1999;38(3):238–241.
©2017 Maita, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.