Burning pain attacks and red skin in a young woman.

A 21-year-old woman presented with a five-year history of burning pain, redness, swelling and heat in her feet. The medical history disclosed palmar hyperhidrosis. Her family history was unremarkable. Examination showed erythema, heat and marked swelling in her feet, which improved after gabapentin and acetylsalicylic acid treatment (Figure). An extensive evaluation for secondary causes was unremarkable. Erythromelalgia is characterized by recurrent attacks of intense pain, redness, warmth and swelling, localized to the distal extremities due to secondary etiologies such as myeloproliferative or rheumatologic disorders, drugs (bromocriptine; calcium channel blockers)1, or as primary erythromelalgia2 caused by mutations in the SCN9A gene, coding sodium channel subtype Nav1.7.