Painful, swollen, and erythematous hands and feet

The patient described herein had 3 features known to be associated with secondary erythermalgia: 1) onset during pregnancy, 2) hypertension, and 3) verapamil treatment (6). Unusual was the fact that while the patient's condition did not respond to aspirin consistently or completely, the skin biopsy did show arteriolar fibromuscular intimal proliferation, which is usually seen with erythromelalgia. Also unusual was the recurrence of symptoms with a second pregnancy 2 years after the presentation reported herein. The syndrome resolved completely within 1 year of delivery. The platelet count was monitored for 4 years after the initial resolution of symptoms (which included the second pregnancy and its associated recurrence of symptoms) and was never higher than 350 x 109/liter. The literature is confusing in mixing of terminology concerning these 3 clinically similar syndromes. The classifications as outlined herein are the emerging standards. A working knowledge of the definitions of these 3 syndromes is critical for appropriate diagnosis and treatment.