What is Acrodynia?

Acrodynia is a condition that can occur because of chronic mercury poisoning or sensitivity to mercury. It includes skin and systemic symptoms—which affect the whole body—that result from being exposed to different types of mercury. The word acrodynia is of Greek origin and translates to ‘painful limbs.’

This condition has various other names mentioned in medical literature, such as erythema arthricum epidemica, erythredema polyneuropathy, hydrargyria, and Feer syndrome. However, it’s most commonly referred to as ‘pink’s disease.’ These days, acrodynia is rare, but there are still occasional reports of individual cases.

What Causes Acrodynia?

Acrodynia, a disease associated with mercury poisoning, is most commonly linked to elemental mercury — also known as quicksilver — and inorganic mercury salts. Elemental mercury comes in liquid or vapor form, and it’s commonly found in items such as thermometers, blood pressure cuffs, batteries, dental fillings, and fluorescent light bulbs. Inhalation of quicksilver fumes tends to cause more harm than swallowing it.

Organic forms of mercury include both short-chain (like methylmercury and ethylmercury) and long-chain (like methoxyethyl mercury and phenylmercury) varieties. Seasfood contaminated with these forms of mercury can also lead to mercury poisoning.

Risk Factors and Frequency for Acrodynia

Acrodynia, a disease mainly affecting infants and young children, does not have exact current prevalence data available. It was quite common in Europe, America, and Australia in the first half of the 20th century, impacting about one in every 500 children. Specific age groups, namely those below two years and around nine months old, were more likely affected. The disease was linked to exposure from mercury in dental amalgams. The removal of mercury-containing tooth powders from the market has resulted in a drop in its occurrence and related deaths. For instance, deaths from acrodynia in England fell from 585 between 1939 and 1948, to 57 in 1957, and finally to just 7 in 1955.

Nowadays, we only see rare cases of acrodynia, mostly reported as a result of accidental exposure to mercury from non-work-related sources. These sources include:

  • Mercury-containing preservatives (such as thiomersal)
  • Diaper powders containing calomel
  • Plant fungicides
  • Anthelmintics
  • Medicinal ointments with mercury
  • Some bactericidal agents
  • Alternative medicine drugs
  • Traditional folk medicines
  • Indoor latex paints.

In particular, some traditional ayurvedic medicines contain significant amounts of mercury and have been noted to cause cases of acrodynia.

Signs and Symptoms of Acrodynia

Children affected by this condition often exhibit a variety of symptoms, which may seem unrelated at first and can be confused with other illnesses. Initial signs generally include irritability, a bad mood, loss of appetite, excessive sleepiness, weight loss, indifference, painful limbs, and excessive sweating. Parents may also notice that their child is less playful than usual due to muscle weakness and discomfort.

Subsequent symptoms include redness of the toes, fingers, and the tip of the nose, as well as sensitivity to light, eye inflammation, and corneal inflammation. Other important signs include itching, unexplained fever, excessive drooling, nail and tooth degradation, swollen gums, tremors, hair loss, rash, generalized weakness, sleep problems, and secondary skin infections.

Symptoms may also show up on the child’s skin. The palms of the hands and the soles of the feet may develop blisters, followed by peeling of the skin. These areas may also swell and display a muted, dark color. Various types of skin rashes may appear, along with bleeding spots caused by broken blood vessels. Constant scratching may lead to thicker skin, raw areas, and skin conditions that include pus-filled sores. One way these skin symptoms have been described is as ‘puffy, pink, painful, tingling, sweaty, and peeling hands’.

A skin biopsy might reveal general signs of chronic skin inflammation and notably enlarged sweat glands. The child may also display elevated blood pressure and a faster-than-normal heart rate. There may be muscle atrophy, especially in the hip and chest areas. In some cases, the child may adopt a ‘Salaam posture’, sitting with their head between their legs and rubbing their hands together. A nerve biopsy can reveal damage to the protective covering of nerve cells, as well as changes in the cells at the front of the spinal cord. Other symptoms can include bronchitis, indigestion, and upper respiratory tract infections.

Testing for Acrodynia

Before starting the analysis for potential mercury poisoning, your doctor will need to understand your full medical history. They’ll particularly be interested in whether you’ve been exposed to mercury in your home or at work. They will then order specific lab tests, which may include measuring the levels of mercury in your blood, urine, and body tissue.

In the first round of tests, they’ll screen for toxins and run a set of standard tests. These tests can include examining your basic metabolic rate, liver function, and complete blood profile. Spot urine samples may be collected to estimate your creatinine level, but to get an accurate estimate of your kidneys’ mercury concentration, a 24-hour urine sample would be required.

Two specific techniques, gas chromatography and thin layer chromatography, may help to differentiate between organic and inorganic mercury salts. This is important because the different forms of mercury affect your body in different ways. Your doctor may also screen for other heavy metal poisonings to rule out additional causes. If you are also experiencing high blood pressure or other hormone-related symptoms, your doctor may order tests to estimate the levels of specific substances in your urine, like vanillylmandelic acid, homovanillic acid, and a hormone called 17-ketosteroid.

Depending on your symptoms, further tests may be needed including nerve and muscle function tests, heart function tests, and psychological assessments.

However, it’s crucial to remember that the symptoms of mercury toxicity don’t always correspond to the concentration of mercury in the body. Some resources mention testing the levels of mercury in the hair for chronic poisoning, but this can be prone to misinterpretation.

Treatment Options for Acrodynia

The first step to treating exposure to mercury is to remove the source of exposure. After this, initial treatment focuses on fixing any imbalances in body fluids and electrolytes. It’s critical to monitor the vital organs in instances of mercury inhalation. Two methods, called whole-bowel irrigation and gastric decontamination, are occasionally used but aren’t common.

A compound named Meso 2,3-dimercaptosuccinic acid (succimer, DMSA) is commonly used as the primary treatment. The World Health Organization recommends starting succimer therapy in children who show high urine mercury levels, even if they don’t have any symptoms. DMSA can be administered orally or through an injection. Treatment often starts at a high dosage, which gradually reduces over a total period of 19 days.

Medical professionals monitor children’s blood counts, kidney, and liver functions during this treatment. Other substances like BAL (dimercaprol) and D-penicillamine have previously been used, but BAL may have detrimental effects by making mercury accumulate in our nervous system. D-penicillamine is an alternative, but it isn’t effective for organic mercury and could cause side effects such as kidney damage.

Conditions resulting from mercury exposure, like high blood pressure, can be managed with specific medications. If mercury exposure leads to severe kidney failure, hemodialysis can be employed. Other methods like peritoneal dialysis and plasma exchange also have roles in treating the condition.

The discomfort from mercury exposure can be relieved with pain medications or topical creams containing local anesthetics and anti-inflammatory drugs. Conditions like skin infections can be treated with antibiotics as relevant to the specific infection.

It’s also crucial to enhance the dietary intake of patients who have lost their appetite due to mercury poisoning. Furthermore, thorough decontamination of domestic and industrial surroundings of the patient is essential to their recovery and prevention of future exposure.

Diagnosing acrodynia, a type of mercury poisoning, can be tough for doctors because it’s rare and shows up as a variety of common symptoms. Moreover, the skin changes can look like many other skin diseases, such as rashes after viral infections, Kawasaki disease, or erythromelalgia, a condition that causes redness and pain in the hands or feet.

It’s more challenging to recognize acrodynia, as mercury toxicity can also lead to conditions like acute generalized exanthematous pustulosis and symmetric flexural exanthema, which are different types of skin rashes.

Moreover, acrodynia can affect different parts of the body, including the nervous system, digestive system, cardiovascular system, and respiratory system, making the diagnosis trickier. It can often be confused with other medical conditions like pheochromocytoma (a rare tumor of adrenal gland tissue), unknown cause of high blood pressure in kids, and again, Kawasaki disease.

Other heavy metals like gold, arsenic, copper, and thallium can also cause similar symptoms as acrodynia. In children, acrodynia can sometimes be mistakenly identified as illnesses like brucellosis (a bacterial infection), hyperthyroidism (overactive thyroid), Guillain Barré syndrome (a nerve disorder), or sepsis (a life-threatening reaction to an infection).

Historically, acrodynia had been misdiagnosed as viral infections or nutritional deficiencies. So it’s essential for doctors to consider all these factors while trying to diagnose this condition.

What to expect with Acrodynia

The outcome of a patient’s condition can be influenced by several factors, including age, individual sensitivity, dosage, and the length of exposure. Generally, the outcome is often positive. In most cases, symptoms can be significantly reduced through a treatment known as chelation therapy. It seems that older children tend to have a better chance of recovery.

In the past, as many as 10 to 33% of patients did not survive the illness. For those who did survive, some ended up facing infertility, bronchiectasis (damage to the airways), cognitive problems, and long-term neurological issues. Research has also found a higher than usual occurrence of autism spectrum disorders in the offspring of individuals who survived pink’s disease.

Frequently asked questions

Acrodynia is a condition that can occur because of chronic mercury poisoning or sensitivity to mercury. It includes skin and systemic symptoms that result from being exposed to different types of mercury.

Acrodynia was quite common in Europe, America, and Australia in the first half of the 20th century, impacting about one in every 500 children.

Signs and symptoms of Acrodynia include: - Irritability - Bad mood - Loss of appetite - Excessive sleepiness - Weight loss - Indifference - Painful limbs - Excessive sweating - Muscle weakness - Discomfort - Redness of the toes, fingers, and the tip of the nose - Sensitivity to light - Eye inflammation - Corneal inflammation - Itching - Unexplained fever - Excessive drooling - Nail and tooth degradation - Swollen gums - Tremors - Hair loss - Rash - Generalized weakness - Sleep problems - Secondary skin infections - Blisters on the palms of the hands and the soles of the feet - Peeling of the skin - Swelling and dark color in affected areas - Various types of skin rashes - Bleeding spots caused by broken blood vessels - Thicker skin due to constant scratching - Raw areas and pus-filled sores - General signs of chronic skin inflammation on skin biopsy - Enlarged sweat glands on skin biopsy - Elevated blood pressure - Faster-than-normal heart rate - Muscle atrophy, especially in the hip and chest areas - Adoption of a "Salaam posture" (sitting with head between legs and rubbing hands together) - Damage to the protective covering of nerve cells on nerve biopsy - Changes in the cells at the front of the spinal cord on nerve biopsy - Bronchitis - Indigestion - Upper respiratory tract infections.

Acrodynia can be caused by exposure to mercury, particularly elemental mercury and inorganic mercury salts. It can also be caused by consuming seafood contaminated with organic forms of mercury.

The doctor needs to rule out the following conditions when diagnosing Acrodynia: 1. Erythema arthricum epidemica 2. Erythredema polyneuropathy 3. Hydrargyria 4. Feer syndrome 5. Pink's disease 6. Other heavy metal poisonings 7. High blood pressure or other hormone-related symptoms 8. Nerve and muscle function abnormalities 9. Heart function abnormalities 10. Psychological conditions 11. Rashes after viral infections 12. Kawasaki disease 13. Erythromelalgia 14. Acute generalized exanthematous pustulosis 15. Symmetric flexural exanthema 16. Pheochromocytoma 17. Unknown cause of high blood pressure in kids 18. Brucellosis 19. Hyperthyroidism 20. Guillain Barré syndrome 21. Sepsis 22. Viral infections 23. Nutritional deficiencies

The prognosis for Acrodynia is generally positive, with symptoms often being significantly reduced through chelation therapy. Older children tend to have a better chance of recovery. In the past, as many as 10 to 33% of patients did not survive the illness, and those who did survive may face long-term neurological issues, cognitive problems, infertility, bronchiectasis, and a higher occurrence of autism spectrum disorders in their offspring.

A medical professional or doctor specializing in toxicology or environmental medicine.

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