Erythromelalgia is a rare condition defined by red, hot and painful extremities. Warmth intensifies the discomfort while cold provides relief. The clinical picture is heterogeneous with respect to aetiology and severity. We have previously postulated arteriovenous shunting in the skin as a common pathogenetic mechanism. Defects in prostaglandin synthesis, metabolism or functional response have been implicated in the pathogenesis of erythromelalgia. In this pilot study we wanted to describe the skin microcirculation before and after misoprostol treatment, an oral PGE1 analogue.
A non-randomised, placebo-compared study investigating the effect of misoprostol on the skin microcirculation in patients with erythromelalgia using Laser Doppler Perfusion Imaging (LDPI) and Computer Assisted Capillary Microscopy (CACM).
EM was treated with placebo for six weeks followed by misoprostol for the next six weeks. Cutaneous microcirculation was evaluated as determined by the analysis of laser Doppler perfusion imager (global skin perfusion) and computer assisted capillary microscopy (capillary perfusion) before and after whole body heating at baseline, after placebo and misoprostol treatment.
There were a significant increase in skin temperature, global perfusion and reduction in capillary density in non-treated erythromelalgia patients. After misoprostol treatment the changes in the microcirculation are reduced.
The results are consistent with earlier findings of increased global perfusion and reduced capillary density during central body heating. The microcirculatory changes after misoprostol treatment indicate reduced arteriovenous shunting and increased nutritive perfusion.