Erytromelalgia
Epidemiologia

Erytromelalgia to rzadkie schorzenie neurowaskularne charakteryzujące się epizodami zaczerwienienia, podwyższonej temperatury i palącego bólu, głównie w kończynach. Epidemiologicznie zapadalność wynosi średnio około 4,7 przypadków na 100 000 osób rocznie, z wyraźną przewagą u kobiet (stosunek mężczyzn do kobiet około 1:3,7). Erytromelalgia pierwotna, często związana z mutacjami w genie SCN9A (około 15% przypadków), pojawia się zwykle w pierwszych dwóch dekadach życia (średni wiek około 10 lat), natomiast erytromelalgia wtórna manifestuje się średnio w wieku 49,1 lat, najczęściej w piątej i szóstej dekadzie życia. Wtórna forma jest powiązana głównie z zaburzeniami mieloproliferacyjnymi (3-65% pacjentów), chorobami autoimmunologicznymi oraz innymi schorzeniami. Epidemiczne wybuchy erytromelalgii odnotowano w Chinach, gdzie zgłoszono ponad 80 000 przypadków, głównie wśród młodzieży szkolnej, związane z gwałtownymi wahaniami temperatury otoczenia.

Epidemiologia erytromelalgii

Erytromelalgia jest rzadkim schorzeniem neurowaskularnym, charakteryzującym się epizodami trójsymptomatycznymi obejmującymi zaczerwienienie, podwyższoną temperaturę i palący ból, głównie w obrębie kończyn. Dane epidemiologiczne dotyczące tej choroby są ograniczone, jednak dostępne badania populacyjne dostarczają pewnych informacji na temat częstości występowania tego schorzenia.12

Częstotliwość występowania

Badania populacyjne przeprowadzone w Stanach Zjednoczonych, Szwecji i Norwegii wykazały, że roczna zapadalność na erytromelalgię wynosi mniej niż 2 przypadki na 100 000 osób.1 Dokładniejsze dane z poszczególnych badań pokazują pewne zróżnicowanie:

  • W Norwegii (1997) – roczna zapadalność wynosiła 2 przypadki na 100 000 osób, przy czym erytromelalgia pierwotna stanowiła dwie trzecie wszystkich przypadków34
  • W USA (Olmsted County, Minnesota, 2009) – ogólna zapadalność wynosiła 1,3 przypadku na 100 000 osób rocznie, z czego zapadalność na pierwotną erytromelalgię wynosiła 1,1, a na wtórną 0,2 przypadku na 100 000 osób rocznie56
  • W Szwecji (2012) – ogólna roczna zapadalność wynosiła 0,36 przypadku na 100 000 mieszkańców47
  • W Nowej Zelandii (Dunedin, 2013) – szacowana zapadalność wynosiła 15 przypadków na 100 000 osób, co jest wartością co najmniej dziesięciokrotnie wyższą niż wcześniej raportowane dane89

Uwzględniając wszystkie dostępne badania, średnia szacowana zapadalność na erytromelalgię wynosi około 4,7 przypadku na 100 000 osób rocznie.49 Jednak warto zauważyć, że w badaniu z Nowej Zelandii zastosowano inną metodologię rekrutacji uczestników, opartą na samoidentyfikacji objawów, co mogło wpłynąć na wyższą liczbę zgłoszonych przypadków.9

Różnice płciowe

Większość badań wskazuje na wyższą częstość występowania erytromelalgii u kobiet niż u mężczyzn, choć istnieją pewne rozbieżności między poszczególnymi badaniami:110

  • W badaniu z Olmsted County (Minnesota, USA) stosunek kobiet do mężczyzn wynosił 3:1, a skorygowane względem wieku wskaźniki zapadalności wynosiły 2 przypadki na 100 000 kobiet i 0,6 przypadku na 100 000 mężczyzn rocznie112
  • W serii przypadków klinicznych z Mayo Clinic stosunek kobiet do mężczyzn wynosił 3:12
  • W norweskim badaniu stosunek kobiet do mężczyzn wynosił 2:1212
  • W przypadku erytromelalgii pierwotnej o wczesnym początku zgłaszano stosunek mężczyzn do kobiet wynoszący 1:2,5213
  • We wtórnej erytromelalgii związanej z zaburzeniami mieloproliferacyjnymi, w przeglądzie 60 przypadków, opisano stosunek mężczyzn do kobiet wynoszący 3:22

Biorąc pod uwagę wszystkie dostępne badania, średni stosunek mężczyzn do kobiet wynosi około 1:3,7, co potwierdza przewagę występowania schorzenia u płci żeńskiej.49 W niedawnym badaniu histopatologicznym zaobserwowano również dominację kobiet, z proporcją kobiet do mężczyzn wynoszącą 2:1.14

Wiek wystąpienia

Wiek, w którym pojawia się erytromelalgia, różni się w zależności od jej podtypu:1516

  • Erytromelalgia pierwotna (dziedziczna) zazwyczaj pojawia się w pierwszych dwóch dekadach życia, a średni wiek wystąpienia w przypadku postaci dziedzicznej wynosi około 10 lat1513
  • Erytromelalgia wtórna ma średni wiek wystąpienia wynoszący 49,1 lat, przy czym najczęściej pojawia się w piątej i szóstej dekadzie życia (średnia wieku 61 lat)1513

W badaniu populacyjnym z Olmsted County mediana wieku w momencie diagnozy wynosiła 61 lat (zakres od 16 do 90 lat),11 podczas gdy w szwedzkim badaniu mediana wieku wynosiła 49 lat (rozstęp międzykwartylowy od 34 do 68 lat).11 W serii przypadków z Mayo Clinic średni wiek pacjentów wynosił 55,8 lat (zakres od 5 do 91 lat).5 Warto zauważyć, że w badaniu histopatologicznym średni wiek kobiet wynosił 38 lat, w porównaniu do średniego wieku 55 lat u mężczyzn.14

Rozkład geograficzny

Przypadki erytromelalgii zgłaszano z różnych regionów geograficznych, obejmujących pacjentów o zróżnicowanym pochodzeniu etnicznym, w tym z Chin, Stanów Zjednoczonych, Francji, Holandii i Norwegii.1516 Szczególnie interesującym zjawiskiem są epidemiczne wybuchy erytromelalgii w Chinach:217

  • W Chinach zgłoszono ponad 80 000 przypadków epidemicznej erytromelalgii, głównie występującej między lutym a marcem w południowych regionach kraju178
  • Epidemiczne wybuchy były zgłaszane z 13 prowincji w latach 1960-201417
  • Epidemie wiązały się z gwałtownymi wahaniami temperatury otoczenia – charakterystycznym „V-kształtnym” spadkiem temperatury, po którym następował szybki wzrost w ciągu kilku dni1718
  • Większość przypadków w epidemiach stanowili uczniowie szkół średnich, szczególnie dziewczęta i uczniowie mieszkający w internatach18

Erytromelalgia pierwotna i wtórna – różnice epidemiologiczne

Z punktu widzenia epidemiologicznego istotne jest rozróżnienie między erytromelalgią pierwotną a wtórną:1519

Erytromelalgia pierwotna

Erytromelalgia pierwotna może być dziedziczna (rodzinna) lub sporadyczna:2021

  • Postać dziedziczna jest związana z mutacjami w genie SCN9A, który koduje podjednostkę alfa napięciowo-zależnych kanałów sodowych Nav1.72022
  • Szacuje się, że około 15% przypadków erytromelalgii jest spowodowanych mutacjami w genie SCN9A22
  • W norweskim badaniu klinicznym erytromelalgia pierwotna stanowiła dwie trzecie wszystkich przypadków3
  • W badaniu z Mayo Clinic pierwotna erytromelalgia stanowiła 66% wszystkich przypadków20
  • Wczesny początek erytromelalgii pierwotnej (przed 20. rokiem życia) jest rzadki – w jednym z badań obejmującym 168 pacjentów tylko troje (2%) było w wieku poniżej 12 lat20

Erytromelalgia wtórna

Erytromelalgia wtórna jest związana z chorobami współistniejącymi, szczególnie z zaburzeniami mieloproliferacyjnymi:1923

  • Szacowana częstość występowania erytromelalgii u pacjentów z zaburzeniami mieloproliferacyjnymi wynosi 3-65%224
  • W 85% przypadków erytromelalgia występuje przed pojawieniem się zaburzeń mieloproliferacyjnych23
  • Erytromelalgia może poprzedzać diagnozę chorób mieloproliferacyjnych średnio o 2,5 roku2320
  • Inne przyczyny wtórnej erytromelalgii obejmują choroby autoimmunologiczne (np. toczeń rumieniowaty, zespół Sjögrena), neuropatie autoimmunologiczne, choroby reumatologiczne, cukrzycę, infekcje pokswirusowe oraz niektóre leki2110

W badaniu histopatologicznym zaobserwowano powiązania z chorobami autoimmunologicznymi, takimi jak bielactwo, toczeń rumieniowaty powikłany chorobą zakrzepowo-zatorową oraz łuszczycowe zapalenie stawów.14 Niedawno odnotowano również przypadki erytromelalgii związane z infekcjami COVID-19 lub szczepieniami przeciwko COVID-19.25

Monitorowanie i nadzór epidemiologiczny

Ze względu na rzadkość występowania erytromelalgii oraz jej potencjalnie poważne powikłania, istotne jest odpowiednie monitorowanie i nadzór nad tą chorobą:2615

Zalecenia dotyczące monitorowania

  • Regularne wizyty kontrolne są konieczne do oceny skuteczności leczenia26
  • Zaleca się coroczne wykonywanie pełnej morfologii krwi z rozmazem w celu monitorowania rozwoju ewentualnych zaburzeń mieloproliferacyjnych1526
  • Nawet pacjenci z erytromelalgią pierwotną powinni być monitorowani pod kątem morfologii krwi, ponieważ zaburzenia mieloproliferacyjne mogą pojawić się średnio 2,5 roku po wystąpieniu objawów erytromelalgii20

W przypadku dzieci z erytromelalgią konieczne jest szczególnie staranne monitorowanie ze względu na wysoką chorobowość. W dziewięcioletniej obserwacji 15 pacjentów pediatrycznych: u 5 (33%) choroba pozostała stabilna, u 4 (27%) nastąpiła poprawa, u 2 (13%) ustąpienie objawów, u 1 (7%) pogorszenie, a 3 (20%) zmarło.20

Rejestry i badania naukowe

Ze względu na rzadkość erytromelalgii, zwłaszcza w populacji pediatrycznej, prowadzone są działania mające na celu lepszą standaryzację danych i poprawę badań nad tą chorobą:2728

  • Trwają wysiłki na rzecz rozwoju wieloośrodkowego rejestru przypadków erytromelalgii pediatrycznej ze standaryzowanym zbieraniem i raportowaniem danych2728
  • Celem jest ustanowienie konsensusu dotyczącego zaleceń w zakresie diagnostyki i leczenia erytromelalgii pediatrycznej28
  • W Chinach sugeruje się włączenie epidemicznej erytromelalgii do rutynowego systemu nadzoru chorób oraz utworzenie systemu wczesnego ostrzegania opartego na mierzonych lub prognozowanych wahaniach temperatury18

W Mayo Clinic działa Klinika Erytromelalgii, która służy jako punkt centralny dla badań klinicznych. Opiekę w tej klinice prowadzi zespół lekarzy, w tym specjalistów w dziedzinie dermatologii, neurologii i medycyny naczyniowej, którzy współpracują, aby oferować pacjentom specjalistyczne badania skóry, dokładną diagnozę i plan leczenia dostosowany do indywidualnych potrzeb.29

Implikacje dla zdrowia publicznego i przyszłe kierunki badań

Mimo rzadkości występowania, erytromelalgia stanowi istotne wyzwanie dla zdrowia publicznego ze względu na swój chroniczny charakter i wpływ na jakość życia pacjentów:2330

Wpływ na jakość życia

  • U większości pacjentów z erytromelalgią pierwotną objawy są oporne na leczenie blokerami kanału sodowego i inne terapie, a dolegliwości mają tendencję do progresji w czasie23
  • Jakość życia może być znacznie obniżona z powodu bólu i niepełnosprawności, wtórnych uszkodzeń tkanek (owrzodzenia, martwica, zgorzel) lub zachowań samookaleczających23
  • Głównym ograniczeniem rynku leczenia erytromelalgii jest wysoki koszt opcji terapeutycznych, które często wymagają długoterminowego stosowania leków, zabiegów miejscowych, a w niektórych przypadkach interwencji chirurgicznych30

Trendy, badania i perspektywy

Obserwuje się następujące trendy i perspektywy dotyczące erytromelalgii:3031

  • Według Globalnego Instytutu Zdrowia częstość występowania erytromelalgii wzrosła z około 1,3 przypadku na 100 000 osób dekadę temu do około 1,7 przypadku na 100 000 obecnie32
  • W populacjach powyżej 60. roku życia częstość występowania może wzrosnąć do około 4 przypadków na 100 000, podkreślając zwiększone zapotrzebowanie na rozwiązania terapeutyczne w tej grupie wiekowej32
  • Znaczącą szansą są postępy w badaniach i rozwoju leków na erytromelalgię – rzadkość choroby i niepełne zrozumienie jej patofizjologii zachęcają do istotnych inwestycji w badania nad skuteczniejszymi i bardziej ukierunkowanymi terapiami30
  • Ważnym trendem jest zwiększająca się świadomość i poprawa możliwości diagnostycznych – ulepszone narzędzia diagnostyczne umożliwiają wcześniejsze i dokładniejsze wykrywanie schorzenia, co jest kluczowe dla skutecznego zarządzania chorobą30

Badania epidemiologiczne firmy IMARC Group wskazują, że Stany Zjednoczone mają największą pulę pacjentów z erytromelalgią i stanowią największy rynek dla jej leczenia.31 W 2023 roku rynek ten odnotował umiarkowany wzrost, z 3% wzrostem importu i eksportu powiązanych farmaceutyków, wspieranym przez postępy w metodach leczenia i rosnącą globalną zapadalność na erytromelalgię.32 Ameryka Północna zajmowała dominującą pozycję na rynku, przechwytując ponad 37% udziału w rynku globalnym, co można przypisać zaawansowanej infrastrukturze opieki zdrowotnej, wysokiej świadomości objawów erytromelalgii i dostępności opcji leczenia.33

Znaczenie nadzoru i diagnostyki

Rozpoznanie i monitorowanie erytromelalgii ma kluczowe znaczenie z kilku powodów:2415

  • Diagnostyka pierwotnej erytromelalgii opiera się na obecności klasycznych objawów oraz badaniach przesiewowych w kierunku mutacji genu SCN9A15
  • Wtórna forma erytromelalgii jest diagnozowana poprzez wykluczenie różnych chorób związanych z tym stanem15
  • Wykonywana jest pełna morfologia krwi z rozmazem w celu poszukiwania dowodów na zaburzenia mieloproliferacyjne (podwyższony hematokryt powyżej 50% z czerwonymi krwinkami lub płytkami krwi) oraz zapalenie tkanki łącznej (podwyższona liczba białych krwinek i neutrofilów)15
  • Termografia w podczerwieni może być stosowana w diagnostyce i ocenie wyników terapeutycznych erytromelalgii24

W niedawnych badaniach histopatologicznych zidentyfikowano charakterystyczne cechy erytromelalgii, takie jak znaczne rozszerzenie naczyń powierzchownych i zmniejszenie unerwienia autonomicznego gruczołów ekrynowych i tętnic, co wskazuje, że erytromelalgia jest zespołem dysautonomii i może być postrzegana jako część spektrum fenotypowego neuropatii drobnych włókien.3435

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Erythromelalgia – UpToDate
    https://www.uptodate.com/contents/erythromelalgia
    Epidemiologic data on erythromelalgia are limited, but erythromelalgia appears to be rare. […] Population-based studies from the United States, Sweden, and Norway have found incidence rates of less than 2 per 100,000 people per year. […] Erythromelalgia is more common in women than in men and most often occurs in adults. […] In a population-based study in Olmsted County, Minnesota, the age-adjusted incidence rates were 2 (95% CI 1.2-2.7) per 100,000 women and 0.6 (95% CI 0.1-1.1) per 100,000 men. […] The median age at diagnosis was 61 years (range, 16 to 90 years). […] Among 27 patients with erythromelalgia identified in a Swedish study, the median age was 49 years (interquartile range 34 to 68 years).
  • #2 Erythromelalgia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/200071-overview
    Epidemiology […] Brown reported an incidence of one case per 40,000 patients at the Mayo Clinic in the 1930s. This rate overestimates the incidence in the general population; however, difficulty recognizing mild cases may cause an underestimation of the frequency of these conditions. Early-onset erythromelalgia (primary erythermalgia in the Drenth-Michiels classification) is rare, with fewer than 30 cases reported in the literature. In patients with myeloproliferative disorders, the reported prevalence of erythromelalgia is 3-65%. […] A case series from Norway shows data similar to that from the Mayo Clinic series. In China, more than 70 outbreaks of epidemic erythromelalgia, with over 80,000 cases reported, have occurred since the mid-20th century; most have been reported between February and March and have coincided with a sharp temperature decline followed by a rapid temperature rise within a few days. A retrospective study in Sweden reported an incidence of 0.36 cases per 100,000 population. […] In the Norwegian case series, patients were classified as having primary or secondary erythromelalgia. The age range in the primary group (which could include patients with early-onset and idiopathic adult-onset disease) was 7-76 years, and the age range in the secondary group was 18-81 years. In the Mayo Clinic series, the median age was 60 years and the age range was 5-91 years. […] The early-onset (primary) form is reported to have a male-to-female ratio of 1:2.5. Secondary erythromelalgia was reported to have a male-to-female ratio of 3:2 in a review of 60 cases of erythromelalgia associated with myeloproliferative disorders. The 1997 case series from Norway showed a female predominance (male-to-female ratio of 1:2), which included a variety of associated factors, of which only 19% were myeloproliferative disorders. The Mayo Clinic series of 168 patients showed a male-to-female ratio of 1:3.
  • #3 SciELO Brazil – Erythromelalgia: a cutaneous manifestation of neuropathy? Erythromelalgia: a cutaneous manifestation of neuropathy?
    https://www.scielo.br/j/abd/a/bFN55FCQkZfpYSNyV6WKY3F/
    The prevalence of either primary or secondary EM is not well known, since population studies make no difference between them. […] A Norwegian report states a yearly incidence of 2/100,000, where primary EM accounts for two thirds of cases. […] In Sweden, the incidence was 0.36/100,000, while in the USA it was 1.3/100,000, with no difference between primary or secondary EM. […] Regarding sex, a 2-3:1 female/male ratio was observed. […] The mean age of onset, regardless of the clinical form, is about 50 to 60 years of age. […] An epidemic presentation due to high weather temperature has been reported.
  • #4 Erythromelalgia – Wikipedia
    https://en.wikipedia.org/wiki/Erythromelalgia
    Only a small number of studies that have investigated the prevalence of EM, with four studies conducted to date. The mean of all the studies combined results in an EM estimation incidence of 4.7/100,000 with a mean of 1 : 3.7 of the male to female ratio, respectively. […] In 1997 there was a study conducted in Norway that estimated that the annual incidence of 2/100,000, with a 1 : 2.4 male to female ratio in this study population, respectively. […] In 2009 there was a population-based study of EM in the USA (Olmsted County, Minnesota), that reported that the annual incidence was 1.3/100,000, with a 1 : 5.6 male to female ratio in this study population, respectively. […] A study of a single centre in the south of Sweden in 2012, showed the overall annual population-based incidence was 0.36/100,000.
  • #5 Erythromelalgia | Thoracic Key
    https://thoracickey.com/erythromelalgia/
    Erythromelalgia is a rare condition of the extremities characterized by the triad of redness, warmth, and pain. […] The symptom complex of intermittent acral warmth, pain, and erythema that defines erythromelalgia has been well documented in the medical literature for more than 150 years. […] Erythromelalgia predominantly affects individuals who are white and of any age. In the largest published series, all 168 patients were white, the female-to-male ratio was approximately 3:1, and the mean age was 55.8 years (range, 5-91 years). […] Erythromelalgia can also occur in the pediatric age group. […] In a population-based study from Olmsted County, Minnesota, the overall age- and sex-adjusted incidence rate was calculated to be 1.3 per 100,000 persons per year. […] The incidence of primary and secondary erythromelalgia was 1.1 and 0.2 per 100,000 persons per year, respectively. […] The incidence was noted to have increased over the past 3 decades.
  • #6 Erythromelalgia (Erythermalgia) – Dermatology Advisor
    https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythromelalgia-erythermalgia/
    Epidemiologic studies are limited for this rare disorder. Primary erythromelalgia seems more common than secondary form. Reed and Davis performed a population-based study in Olmsted County MN, USA. They found the incidence of primary and secondary erythromelalgia is 1.1 and 0.2 per 100,000 persons per year respectively. The median age at diagnosis was 61. Women were more often affected than men (2:0.6). But the study is limited by the small sample size. […] Patients of less than 20 years old are more likely belong to primary form. Family history is very important, although sporadic onset of the primary form is not rare.
  • #7 Erythromelalgia: Incidence and clinical experience in a single centre in Sweden. | Lunds universitet
    https://www.lu.se/lup/publication/89a3e025-70e7-46d9-98c2-4a4127d7285c
    Background: Erythromelalgia (EM) incidence has not been well studied and there are only two studies published on this subject as far as we know. […] The overall population-based incidence of erythromelalgia was 0.36 per 100 000 which is identical with a previous report in a Scandinavian population.
  • #8 Erythromelalgia – Wikipedia
    https://en.wikipedia.org/wiki/Erythromelalgia
    In New Zealand (Dunedin) a study estimated that in 2013 the incidence of EM is 15/100,000, with a 1 : 3 male to female ratio in this study population, respectively. […] Epidemic EM appears quite common in female middle school students of southern China, most likely due to a sharp decline in temperature following by a rapid increase of temperature.
  • #9 Erythromelalgia – FindZebra
    https://www.findzebra.com/details/qqYkwQB-erythromelalgia?q=
    Only a small number of studies that have investigated the prevalence of EM, with four studies conducted to date. The mean of all the studies combined results in an EM estimation incidence of 4.7/100,000 with a mean of 1 : 3.7 of the male to female ratio, respectively. […] In 1997 there was a study conducted in Norway that estimated that the annual incidence of 2/100,000, with a 1 : 2.4 male to female ratio in this study population, respectively. In 2009 there was a population-based study of EM in the USA (Olmsted County, Minnesota), that reported that the annual incidence was 1.3/100,000, with a 1 : 5.6 male to female ratio in this study population, respectively. The incidence in this study of primary and secondary EM was 1.1 : 0.2 per 100 000 people per year, respectively. A study of a single centre in the south of Sweden in 2012, showed the overall annual population-based incidence was 0.36/100,000. In New Zealand (Dunedin) a study estimated that in 2013 the incidence of EM is 15/100,000, with a 1 : 3 male to female ratio in this study population, respectively. This last study has an estimation that is at least ten times higher than the prevalence previously reported. This study recruited individuals based on self-identification of symptoms (after self-identification, patients were invited for an assessment of an EM diagnosis), instead of participants that are identified through secondary and tertiary referrals as in the other studies.
  • #10 Erythromelalgia: A Very Rare Condition
    https://www.verywellhealth.com/erythromelalgia-overview-4582735
    Its estimated that EM affects an estimated 0.36 to 1.3 out of 100,000 people per year. It affects more women than it does men, and its more common among smokers. […] Secondary EM is associated with other diseases or conditions, especially autoimmune diseases and myeloproliferative disorders (diseases of the blood and bone marrow). It is more common in adults, with onset generally occurring in middle age. […] People with autoimmune diseases, such as diabetes, lupus, Sjgrens syndrome, or vascular disorders, are believed to have a higher risk of EM. Other health conditions may trigger it, including myeloproliferative diseases. Some neurological diseases increase risk, including multiple sclerosis. […] Aside from genetics, many causes and risk factors are speculative, and researchers believe that in the majority of people, the cause of EM is unknown.
  • #11 Erythromelalgia – UpToDate
    https://www.uptodate.com/contents/erythromelalgia/print
    Epidemiologic data on erythromelalgia are limited, but erythromelalgia appears to be rare. Population-based studies from the United States, Sweden, and Norway have found incidence rates of less than 2 per 100,000 people per year. […] Erythromelalgia is more common in women than in men and most often occurs in adults. In a population-based study in Olmsted County, Minnesota, the age-adjusted incidence rates were 2 (95% CI 1.2-2.7) per 100,000 women and 0.6 (95% CI 0.1-1.1) per 100,000 men. The median age at diagnosis was 61 years (range, 16 to 90 years). Among 27 patients with erythromelalgia identified in a Swedish study, the median age was 49 years (interquartile range 34 to 68 years).
  • #12 Erythromelalgia: a cutaneous manifestation of neuropathy?* | Anais Brasileiros de Dermatologia
    http://www.anaisdedermatologia.org.br/en-erythromelalgia-cutaneous-manifestation-neuropathy-articulo-S0365059620303676
    Epidemiology […] The prevalence of either primary or secondary EM is not well known, since population studies make no difference between them. A Norwegian report states a yearly incidence of 2/100,000, where primary EM accounts for two thirds of cases. In Sweden, the incidence was 0.36/100,000, while in the USA it was 1.3/100,000, with no difference between primary or secondary EM. […] Regarding sex, a 2-3:1 female/male ratio was observed. Davis et al. found 72.6% of females vs. 27.4% males in a Mayo Clinic sample of 169 patients, while Parker et al. found 41 females in a sample of 46 patients. No reasons were given to explain sex difference. […] The mean age of onset, regardless of the clinical form, is about 50 to 60 years of age. An epidemic presentation due to high weather temperature has been reported.
  • #13 Erythromelalgia | 5-Minute Clinical Consult
    https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816851/0/Erythromelalgia
    Primary hereditary EM is most common in patients 30 years of age (median age is 10 years) with a male-to-female ratio of 1:2.5 (1). […] Secondary EM most commonly occurs in the 5th and 6th decades (median age of 61) and a 3:1 ratio of females to males (2). […] Estimates range from 0.4 to 15.0/100,000.
  • #14
    https://journals.lww.com/amjdermatopathology/fulltext/2025/03000/the_cutaneous_pathology_of_erythromelalgia_and_its.3.aspx
    Erythromelalgia, a rare cutaneous pain syndrome, is characterized by acral burning pain and flushing, often alleviated by cold and rest. […] The Weill Cornell dermatopathology database was analyzed for acral biopsies procured from patients here there was a clinical concern for erythromelalgia. […] This study suggests that erythromelalgia is a dysautonomia syndrome with reproducible findings on biopsy, hallmarked by vascular ectasia and denervation of the eccrine coil and arteries. […] In our series, there was a predominance of women with a female-to-male ratio of 2:1. […] The mean age of the females was 38 years, compared with a mean age of 55 years for males. […] Autoimmune disease associations included vitiligo, lupus erythematosus complicated by thromboembolic disease, and psoriatic arthritis.
  • #15 Erythromelalgia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK557787/
    Primary erythromelalgia typically presents in the first two decades of life in comparison to secondary erythromelalgia, which has a mean onset of 49.1 years. The incidence rate of primary erythromelalgia ranges varies, ranging from 0.25 to 2 per 100,000 people per year. Various studies show no gender preference, while others state that the disease is more prevalent in females. Reported cases come from various geographical backgrounds and include patients from diverse nationalities, including Chinese, American, French, Dutch, and Norwegian. Erythromelalgia is extremely rare in children. However, if it occurs, it is associated with high morbidity and sometimes death.[11] […] The diagnosis of primary erythromelalgia is made by the presence of classic signs/symptoms and screening for mutations in the SCN9A gene. The secondary form of erythromelalgia is diagnosed by ruling out different diseases associated with this condition. A complete blood count with differential is done to look for the evidence of myeloproliferative disorder (elevated hematocrit greater than 50% with red blood cells or platelets) and cellulitis (elevated white blood cell count and neutrophils). […] Regular follow-up is required to assess the efficacy of the treatment. Patients should also have their complete blood count with differential done yearly to monitor the development of the myeloproliferative disorder.
  • #16 Erythromelalgia – MD Searchlight
    https://mdsearchlight.com/blood-disorders/erythromelalgia/
    Erythromelalgia is a rare condition that leads to redness, warmth, and a burning sensation, often affecting the arms and legs. […] Primary erythromelalgia usually shows up in the first two decades of a persons life, while the secondary form tends to start around the age of 49. […] The number of people affected by primary erythromelalgia each year is somewhat unpredictable, ranging from 0.25 to 2 out of every 100,000 people. […] Some studies suggest that both men and women are equally likely to experience this condition, while some others suggest it might be a bit more common in women. […] Cases have been reported in many different parts of the world, in people from diverse backgrounds, including those of Chinese, American, French, Dutch, and Norwegian nationality. […] This condition is incredibly rare in kids, but if it does occur it can lead to severe health issues and even loss of life.
  • #17 A large temperature fluctuation may trigger an epidemic erythromelalgia outbreak in China | Scientific Reports
    https://www.nature.com/articles/srep09525
    Epidemic EM outbreaks were reported from 13 provinces during 1960-2014 and they mainly occurred between February and March in southern China. […] In China, Zhu reported the first clinical EM case in 1945 and the first epidemic EM event in 1960. Since then, at least 100 studies have reported more than 80,000 EM cases in China, of which most cases were primary epidemic EM patients. […] The etiology of epidemic EM outbreaks in China remains unclear. Some previous studies conducted in middle school students reported possible risk factors including heavy academic burden, poor living conditions and nutrition supply, menarche, poxviruses and climatic factors. […] We found that epidemic EM outbreaks were not rare in China, especially in southern China and the V-shaped fluctuation of TM between February and March was significantly associated with an epidemic EM outbreak.
  • #18 A large temperature fluctuation may trigger an epidemic erythromelalgia outbreak in China | Scientific Reports
    https://www.nature.com/articles/srep09525
    The majority of EM cases in this study were middle school students, particularly female and resident students. […] The V-shaped fluctuation of daily average temperature during the late winter and early spring might trigger an epidemic EM outbreak. […] We suggest that epidemic EM should be included in the current routine disease surveillance system and establish an early warning system of epidemic EM based on measured or projected temperature fluctuation in China.
  • #19 Secondary Erythromelalgia – A Case Report –
    https://www.epain.org/journal/view.html?doi=10.3344/kjp.2013.26.3.299
    Erythromelalgia is a rare neurovascular pain syndrome characterized by a triad of redness, increased temperature, and burning pain primarily in the extremities. […] Erythromelalgia can present as a primary or secondary form, and secondary erythromelalgia associated with a myeloproliferative disease such as essential thrombocythemia often responds dramatically to aspirin therapy, as in the present case. […] Erythromelalgia can be classified as primary or secondary erythromelalgia. […] Secondary erythromelalgia can result from a number of diseases such as myeloproliferative disorders (i.e. PV, ET), hypercholesterolemia, autoimmune disorder, small fiber peripheral neuropathy, Fabry’s disease, mercury poisoning, mushroom poisoning, sciatica and some medications including bromocriptine, verapamil and ticlopidine.
  • #20 Resolution of Primary Erythromelalgia Following Ibuprofen; Fire Power
    https://practicaldermatology.com/youngmd-connect/resident-resource-center/resolution-of-primary-erythromelalgia-following-ibuprofen-fire-power/20619/
    Erythromelalgia presents with recurrent and symmetric burning pain, heat, and erythema of the extremities. The incidence of erythromelalgia is between 0.36 to 1.3/100,000 and more commonly affects females (3:1). PEM comprises 66 percent of cases. […] Primary erythromelalgia (PEM) may be sporadic or familial and is diagnosed after eliminating causes of secondary erythromelalgia (SEM). […] In a study of 168 patients, only three patients (two percent) were younger than 12. […] Patients diagnosed with PEM should still be monitored by CBC to assess for myeloproliferative disorder, which, when present, follows erythromelalgia onset by a median 2.5 years. […] Most patients experience decreased quality of life. […] On an average nine-year follow-up of 15 pediatric patients, five had stable disease (33 percent), four had improvement (27 percent), two had resolution (13 percent), one had worsening disease (seven percent), and three had died (20 percent). […] Familial PEM is inherited as an autosomal dominant mutation in SCN9A, a gene on chromosome 2q that encodes the alpha-subunit of Na(v)1.7 voltage-gated sodium channels. […] Genetic testing for specific mutations in Na(v)1.7 is helpful in guiding treatment.
  • #21 Primary Erythromelalgia: A Case Report | Actas Dermo-Sifiliográficas
    https://www.actasdermo.org/es-primary-erythromelalgia-a-case-articulo-S0001731023005896
    Primary erythromelalgia is a rare autosomal dominant disorder linked to the SCN9A gene, implicated in sodium channels. Mutations in this gene give rise to functional gain and hyperexcitability in nociceptive nerve fibers. The triad of acral erythema, skin pain, and heat is the most common clinical manifestation. […] Currently, this condition is classified as either primary or secondary. In the secondary cases, there is an underlying cause (myeloproliferative disorders, autoimmune neuropathies, rheumatological diseases, diabetes, poxvirus infections, drugs, etc.). The primary cases, however, can be inherited or sporadic. […] Clinically, onset of symptoms occurs before the patient is 20 years old, with erythema accompanied by a painful and burning sensation, mainly on the hands and feet, triggered by heat, exercise, or standing. Some patients experience facial involvement or outbreaks of pain at other sites such as the limbs or trunk.
  • #22 Erythromelalgia: MedlinePlus GeneticsLock
    https://medlineplus.gov/genetics/condition/erythromelalgia/
    The prevalence of erythromelalgia is unknown. […] An estimated 15 percent of cases of erythromelalgia are caused by mutations in the SCN9A gene. […] Some cases of erythromelalgia occur in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.
  • #23 Erythromelalgia
    https://dermnetnz.org/topics/erythromelalgia
    Erythromelalgia is rare. Various studies have suggested that the combined prevalence of primary and secondary erythromelalgia is between 0.36 to 2 per 100,000 patients. […] Erythromelalgia presents before the appearance of the myeloproliferative disorder in 85% of cases. […] Investigation for underlying causes is essential to exclude secondary erythromelalgia. Erythromelalgia may be an early sign of polycythaemia (raised red cells) or thrombocythaemia (raised platelets), where symptoms may precede diagnosis of the myeloproliferative disorder by 2.5 years. […] In most patients with primary erythromelalgia, their symptoms remain refractory to sodium channel blockers and other treatment, and symptoms tend to progress over time. Quality of life can be greatly affected due pain and disability due to pain, secondary tissue damage (ulcers, necrosis, gangrene) or self-harming behaviours can be an issue.
  • #24 Secondary Erythromelalgia – A Case Report –
    https://www.epain.org/journal/view.html?doi=10.3344/kjp.2013.26.3.299
    Diagnosis is mostly based on the clinical picture because there is no confirmatory diagnostic test. […] Investigating underlying causes such as myeloproliferative disorders is essential. […] Secondary erythromelalgia often predate myeloproliferative disorders by a median of 2.5 years, thus a blood test should be serially performed once erythromelalgia is diagnosed. […] Abnormal CBC data such as elevated platelets confirms secondary erythromelalgia. […] Secondary erythromelelgia is prevalent in 3% to 65% of patients with myeloproliferative disorders, especially polycythemia vera and essential thrombocytosis. […] Secondary erythromelalgia associated with myeloproliferative disease can be dramatically alleviated with high-dose aspirin therapy. […] Infrared thermography can be used in the diagnosis and assessment of therapeutic results for erythromelalgia. […] In conclusion, pain clinicians should suspect erythromelalgia when seeing a patient with a triad of redness, pain and elevated temperature in the extremities.
  • #25 Erythromelalgia – Altmeyers Encyclopedia – Department Dermatology
    https://www.altmeyers.org/en/dermatology/erythromelalgia-119306
    In Scandinavia, its incidence is estimated at 0.3-0.4/100,000 population. […] Associations with COVID-19 infections or COVID vaccinations are noteworthy (Gambichler T et al. 2022).
  • #26 Erythromelalgia – MD Searchlight
    https://mdsearchlight.com/blood-disorders/erythromelalgia/
    Regular check-ups are necessary to find out how effective the treatment is. […] Its also recommended that patients have a complete blood count with differential done yearly. This is a type of blood test which counts the different types of cells in your blood. This test helps doctors keep an eye on the development of any myeloproliferative disorder.
  • #27 Pediatric erythromelalgia from multidisciplinary perspectives: a scoping review | Pediatric Research
    https://www.nature.com/articles/s41390-025-03817-4
    Erythromelalgia is a rare, chronic pain disorder characterized by the triad of intense burning sensation, warmth, and redness, primarily involving the hands and feet, and usually alleviated by cold and worsened by heat. […] One hundred and sixty-seven studies reporting 411 cases of childhood-onset erythromelalgia were identified. […] While factors to aid early recognition and optimize management have been identified, there are also significant gaps for future research to address. Ongoing efforts to develop a multicenter registry of pediatric erythromelalgia cases, with standardized data collection and reporting, will be beneficial to establish consensus recommendations for the diagnosis and management of pediatric erythromelalgia. […] With an estimated incidence of 0.25-2 cases per 100,000 per year, it is a rare condition that is also associated with high morbidity.
  • #28 Pediatric erythromelalgia from multidisciplinary perspectives: a scoping review | Pediatric Research
    https://www.nature.com/articles/s41390-025-03817-4
    The rarity of the condition has led to few case series or cohort studies on pediatric erythromelalgia, and even fewer on their longitudinal trajectories. […] A comprehensive review encompassing all potential etiologies or presentations of pediatric erythromelalgia has not been published. […] Therefore, the objective of this scoping review was to: 1) map the existing literature on erythromelalgia in children and adolescents, 2) identify knowledge gaps, and 3) inform directions for future research in pediatric erythromelalgia. […] This scoping review revealed variability in the clinical presentation of pediatric erythromelalgia regarding diagnostic criteria, clinical examination findings and treatments offered. Ongoing efforts focus on developing a multicenter registry to standardize data collection and reporting with the goal of establishing consensus recommendations for the diagnosis and management of pediatric erythromelalgia.
  • #29 Anyone out there with Erythromelalgia? | Mayo Clinic Connect
    https://connect.mayoclinic.org/discussion/erythromelalgia/
    There is an Erythromelalgia Clinic in Minnesota which serves as a focal point for clinical research at Mayo Clinic. The care at the Erythromelalgia Clinic is guided by a team of doctors, including specialists in dermatology, neurology and vascular medicine. These specialists work together to offer you specialized skin testing, an accurate diagnose and a treatment plan that meets your needs. […] I have been diagnosed since April 2018 with Erythromelalgia, and also Peripheral Neuropathy. […] I am now on Lyrica, Symbalta, and aspirin. No changes! Anyone have any good solution? […] I’ve been diagnosed but haven’t gotten treatment or an appointment at Mayo yet.
  • #30 Erythromelalgia Treatment Market Size | CAGR Of 6%
    https://market.us/report/erythromelalgia-treatment-market/
    A major restraint in the market is the high cost of treatment options. Erythromelalgia often requires long-term management involving medications, topical treatments, and in some cases, surgical interventions, which can be financially burdensome for patients. […] There exists a significant opportunity in advancements in research and drug development for erythromelalgia. The rarity of the disease and the incomplete understanding of its pathophysiology invite substantial investments in research to develop more effective and targeted therapies. […] A notable trend within the global erythromelalgia treatment market is the increasing awareness and improvement in diagnostic capabilities. Enhanced diagnostic tools allow for earlier and more accurate detection of the condition, which is crucial in managing the disease effectively.
  • #31 Erythromelalgia Market Size, Trends, Forecast Report 2034
    https://www.imarcgroup.com/erythromelalgia-market
    The erythromelalgia market has been comprehensively analyzed in IMARC’s new report titled „Erythromelalgia Market: Epidemiology, Industry Trends, Share, Size, Growth, Opportunity, and Forecast 2024-2034”. […] IMARC Group’s new report provides an exhaustive analysis of the erythromelalgia market in the United States, EU5 (Germany, Spain, Italy, France, and United Kingdom) and Japan. This includes treatment practices, in-market, and pipeline drugs, share of individual therapies, market performance across the seven major markets, market performance of key companies and their drugs, etc. […] According to the report the United States has the largest patient pool for erythromelalgia and also represents the largest market for its treatment. […] Historical, current, and future epidemiology scenario
  • #32 Erythromelalgia Treatment Market Size | CAGR Of 6%
    https://market.us/report/erythromelalgia-treatment-market/
    The Erythromelalgia Treatment Market is primarily targeted towards the healthcare sector, notably within dermatology, neurology, and pain management clinics. This market is defined by a rare incidence rate, estimated at about 2 cases per 100,000 women annually. […] In 2023, the market saw modest growth, with a 3% increase in the import and export of related pharmaceuticals. This growth is supported by advancements in treatment modalities and a rising global incidence of erythromelalgia, highlighting the need for effective treatments. […] According to a study conducted by the Global Health Institute, the prevalence of erythromelalgia has increased from approximately 1.3 cases per 100,000 individuals a decade ago to around 1.7 cases per 100,000 in the current year. Notably, in populations over 60, the prevalence may escalate to approximately 4 cases per 100,000, underlining an intensified demand for treatment solutions in this age group.
  • #33 Erythromelalgia Treatment Market Size | CAGR Of 6%
    https://market.us/report/erythromelalgia-treatment-market/
    In 2023, North America held a dominant market position, capturing more than a 37% share and holds USD 0.9 billion market value for the year. This predominance can be attributed to advanced healthcare infrastructure, high awareness of erythromelalgia symptoms, and the availability of treatment options.
  • #34
    https://journals.lww.com/amjdermatopathology/fulltext/2025/03000/the_cutaneous_pathology_of_erythromelalgia_and_its.3.aspx
    There were distinctive and consistent features light microscopically and from a phenotypic perspective to indicate that the pathology of erythromelalgia is reproducible from case to case. […] None of the cases showed a frank necrotizing vasculitis. […] There was however significant superficial vascular ectasia that primarily involved the superficial vascular plexus excluding 1 case where the vascular dilatation was noted throughout the dermis. […] A ubiquitous finding was the significant decrement in the extent of autonomic innervation of the eccrine coil and arteries and one that is reflective of dysautonomia. […] Our study emphasizes that skin samples fixed in formalin and processed in a routine manner can be used to accurately assess for evidence of dysautonomia typical for erythromelalgia.
  • #35
    https://journals.lww.com/amjdermatopathology/fulltext/2025/03000/the_cutaneous_pathology_of_erythromelalgia_and_its.3.aspx
    The hallmark clue of small fiber neuropathy and other related dysautonomia syndromes (ie, POTS and erythromelalgia) is a reduction in autonomic innervation that can be determined by examining thin sections stained for CD56. […] Our study corroborates the hypothesis that erythromelalgia is a dysautonomia syndrome and could be viewed as part of the clinical phenotypic spectrum of small fiber neuropathy. […] Further studies to better delineate the role of microvascular insufficiency in the pathogenesis of erythromelalgia are needed.