Increased skin temperature

Introduction Elevated skin temperature is common in erythematous limb pain. Erythermalgia (erythermalgia) is a disease caused by excessive expansion of acral vasculature. Clinically, it is mainly manifested by paroxysmal acromegaly, increased skin temperature and burning pain in a warm environment. Primary people are more common. This disease is rare. Most of the patients were children or >40 years old. Foreign reports of more male patients than females, about 2/1. However, among the 433 cases reported in Guangzhou, the youngest women accounted for the most, accounting for 92.86%, and the ratio of male to female was 1/13.

Cause

The etiology and pathogenesis of this disease are still unclear. Some people think that it is caused by some obstacles in the vasomotor center, so the affected parts are often symmetrically distributed. Some people think that the blood flow in the superficial and deep arteries of both limbs increases, the skin circulation increases, the skin becomes red and the temperature rises. The dilated small blood vessels compress and stimulate the nerve endings, causing burning pain. It has also been suggested that the disease is associated with an increase in serotonin in the peripheral circulation, or an anti-mechanism of excessive microvascular vascular response to heat. In addition, the effects of some harmful factors, such as chronic inflammation of the skin, UV damage, freezing, burns and abrasions, can cause the microvascular weakness of the skin to disappear and induce the disease. Occasionally hereditary.

The disease often has no obvious pathological anatomical changes, and is not accompanied by organic abnormalities and nutritional changes of local tissues. Mainly involving both feet, a few only involved the soles of the feet, heels, toes, the hands and feet at the same time only accounted for 3.3%, often symmetrical. The seizure depends on the skin temperature, and the rise in skin temperature above the critical temperature (31.7 to 36.1 °C) causes seizures, and the critical temperature point is fairly constant in each patient. Vasodilation and subsequent congestion are the cause of elevated skin temperature. However, the increase in blood flow is not the main factor, because once the symptoms are induced by warming, that is, when the pressure is applied to the level of systolic blood pressure above the systolic blood pressure level to reduce the blood flow to 0, the symptoms are still sustainable, suggesting that the cause of the lesion is skin pain. The abnormal sensitivity of the fiber to the tension of the heat or dilated vessel wall. At the time of onset, local capillaries rapidly dilate, congested, and local skin temperature increased (up to 35 to 37 ° C), and the pulsation of the dorsal and posterior tibial arteries was enhanced.

an examination

Related inspection

Abdominal vascular ultrasound examination of urine routine

First, clinical manifestations

Rapid onset, often causing seizures or exacerbating seizures when the limbs sag, stand or move in a warm environment. When the local skin temperature exceeds the critical temperature, it often causes seizures, and nighttime episodes are often more severe than white ones. The characteristics of the attack are bipolar symmetry, paroxysmal severe pain, pain is mostly burning, occasionally stinging or pain. The skin is flushed with blood, and the skin temperature is increased with sweating. The pulsation of the foot and posterior tibial artery is enhanced. Cold compressing, raising the affected limb or exposing the foot to the outside, the local temperature is lower than the critical temperature, the seizure can be relieved, and the skin color returns to normal. The pain is usually limited to the big toe and toe of the foot, and less common is in the corresponding part of the hand. Each episode lasts for a few minutes, even hours, occasionally with local edema. Intermittent seizures often leave a slight numbness or pain in the extremities, but are not accompanied by neurotrophic disorders such as ulcers or gangrene.

Second, check

(1) Skin critical temperature test: Soak the foot or hand in water at 32 ~ 36 ° C, if the symptoms appear or the symptoms are aggravated, it is positive.

(2) The micro-circle microcirculation examination showed that the capillary sputum contour was blurred and expanded, and the internal pressure was increased, which was more serious after the heat stimulation.

(3) blood routine, urine routine, blood biochemical examination.

(4) Ultrasound examination of blood vessels.

Third, diagnosis

The disease is more common in young adults aged 20 to 40 years old, more men than women, the onset can be acute and slow, and more than both sides of the limbs, more common to both feet. 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. Under certain incentives, paroxysmal redness, swelling, heat, pain and other characteristics can often be diagnosed.

According to the characteristic clinical manifestations, the diagnosis of erythematous limb pain is not difficult. About 60% of the disease is primary. Others may be caused by polycythemia vera, hyperthyroidism, systemic lupus erythematosus, hypertension, alcoholism, pernicious anemia, thromboangiitis obliterans, gout, rheumatoid arthritis, venous insufficiency, and diabetes-related surroundings. Neuritis, caused by diseases such as sputum, mercury or arsenic poisoning and pellagra, is called "secondary erythematous limb pain".

Differential diagnosis

Differential diagnosis of elevated skin temperature:

1. Temporary erythematous limb pain: After complete arterial bypass grafting of vascular disease, with the recovery of distal perfusion pressure, there may be significant reactive hyperemia in the ischemic area. This phenomenon is called "temporary erythematous limb pain" and its performance may last for a few days or even weeks.

2, fever: fever (feVer, pyrexie) refers to the pathological increase in body temperature, is the body's role in pyrogens caused by the shift of the body temperature regulation center, is the most common clinical symptoms, is the disease progression process Important clinical manifestations. Can be seen in a variety of infectious diseases and non-infectious diseases. It has typical heat type and disease course, specific clinical features, and general diagnosis is easy; however, some patients with fever have long heat history, no specific signs, and lack of diagnostically meaningful data, often referred to as fever or unexplained fever. (fever of unknown origin, FUO). These patients have many potential lesions in the body, but they have not been identified in the short term. After clinical observation and special examination, most of them can be diagnosed in the end. About 10% of the patients have not been diagnosed by various examinations, and the disease is delayed. For several months, the diagnosis of unexplained long-term fever is indeed an important clinical issue.

3. Relaxation heat: Relaxation heat refers to the body temperature lasting above 39 degrees, and the fluctuation range is large. The body temperature fluctuation range exceeds 2 degrees within 24 hours, but both are above the normal level.

4. Persistent fever: When the mouth temperature is higher than 37.3 °C or the anus temperature is higher than 37.6 °C, the change in one day exceeds 1.2 °C, which is called fever. According to the level of fever, it can be divided into the following clinical classifications: low heat 37.4 ° C ~ 38 ° C moderate heat 38.1 ° C ~ 39 ° C high heat 39.1 ° C ~ 41 ° C ultra high heat 41 ° C or more, lasting more than 4 weeks, for continuous fever .

5, central fever: central fever refers to fever caused by abnormalities of the body temperature regulation center caused by central nervous system diseases.

6, heart fire: heart fire in Chinese medicine refers to the internal heat of the human body. Often manifested as five upset hot, dry throat, dry mouth, mouth sores and other symptoms. Chinese medicine has the heart to say the name of the fire.

7. Irregular heat: Some febrile diseases have their own special heat type, which occurs in the extreme stage of febrile diseases. The heat type has certain clinical significance in diagnosis and differential diagnosis. Irregular heat means that there is no regularity in fever, and the duration is not necessarily. Can be seen in a variety of lung diseases, heart pleurisy.

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