A 5 years old child with erythromelalgia and presented with severe bilateral feet pain resistant tol all of the following combination treatment: gabapentin, amitryptilin, prednisolon, Sandimmune, Local lidoocain. tramadol , NSAIDs, and aspirin. How to treat her? what we can do for her?
For primary erythromelalgia, the best therapy is variable by patient repsonse. Case reports of treatment with propranolol, intravenous bupivacaine, the lidocaine patch, lidocaine plus mexiletine., biofeedback, magnesiom, sodium nitroprusside, gabapentin, cymbalta and typhoid vaccine appear in the literature. I have read of reported benefit with the alpha1-agonist midodrine, 0.2%, compounded in a moisturizing skin cream and applied topically three times a day during symptoms. I know of no randomized trial of therapy for this disease. In those that I have treated It is so patient variable with combinations of medications I cannot say what is best for 1 patient in my experience.
To my experience erythromelalgia is a vasodilating condition, an analogous to vascular algodystrophy. Primary treatment should focus on identifying and avoiding the triggering factor, which is most commonly the exposure to different and extreme temperatures or repetitive microtrauma. Elevating the extremities above the level of the body softens the symptoms and this can confirm if the condition is erythromelalgia or not.
Medications are rarely helpful. The use of analgesics and NSAIDS may help to subside symptoms but time is needed far from the triggering factor in order someone to be cured.
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