Erythrocyanosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Erythrocyanosis was first reported by Packers Weber in 1925. Erythrocyanosis is the cutaneous condition characterized as the reddish-blue discoloration of the skin due to cold exposure. The mottled discoloration is seen on the lower legs. Erythrocyanosis is most commonly seen in girls and young women and rarely seen among men. The reddish-blue discoloration is evident in the area above the malleolus. Erythrocyanosis also affects the upper arms, especially in the skin over the triceps region.

What Is Erythrocyanosis?

Erythrocyanosis is characterized as the reddish-blue discoloration of the lower legs, particularly on the posterior surface of the legs. Erythrocyanosis is mostly seen on the site with underlying thick fatty tissue. Mild forms of erythrocyanosis present on the legs are very common, but sometimes they lead to serious complications. The overlying skin is tense and erythematous. People with erythrocyanosis experience a painful itching sensation in the affected area. In a severe erythrocyanosis, nodules are enlarged and cause ulceration in addition to pain and itching. The reddish-blue discoloration is blanchable under pressure. Most erythrocyanosis occurs in women in fatty areas such as the legs, around the knee, buttocks, and sometimes in breasts.

What Are the Clinical Features of Erythrocyanosis?

Erythrocyanosis is clinically present with reddish-blue discoloration on the skin, especially on the skin over the lower half of the legs and the area above the malleolus. Symptoms like pain, tenderness, and mottled or dusky discoloration are present.

Other features of erythrocyanosis are mentioned below,

• Erythrocyanosis sometimes produces a clumsy and evident deformity.

• The overlying skin is stippled with small red points and a keratinized focus in the center.

• Over time the indurated nodules will appear on the subcutaneous tissue.

• Circular plaques of about 1 to 2 cm in diameter are present.

• A discrete induration, thin fibrous skin, inflammation, and a small ulcer with a tough adherent sloughed base are present.

What Are the Symptoms of Erythrocyanosis?

Symptoms of erythrocyanosis usually last for 7-14 days. Various symptoms are seen. In the more severe form of erythrocyanosis, the patient is disturbed with intolerable pain, weight, and cold sensation in the leg, itching, and burning pain in combination with ulcers, thereby causing the patient to be unfit for work.

• Reddish to purple discoloration of skin in lower legs.

• Itching.

• Burning sensation.

• Pain and tenderness.

• Affected skin shows blisters.

• Sometimes skin shows ulcers.

• Infection might occur.

What Are the Causes of Erythrocyanosis?

Erythrocyanosis is caused by vascular disturbance due to extreme cold exposure. Blood vessels are constricted due to the action of cold-causing the deficient venous return. Erythrocyanosis is also present due to systemic conditions that include endocrine dysfunction, tuberculosis, pituitary dysfunction, anterior poliomyelitis, neoplastic conditions, body weight, and other connective tissue disorders.

Causative factors for erythrocyanosis include,

• Exposure to cold.

• Very scanty clothing in cold weather.

• Tuberculosis (Bazin's disease).

• Endocrine dysfunction.

• Thyroid dysfunction.

• Parathyroid dysfunction.

• Ovarian dysfunction.

• Pituitary gland dysfunction.

• Venous insufficiency.

• Local infection.

• Neoplasm.

• Poliomyelitis.

• Excess body weight.

What Is the Diagnosis of Erythrocyanosis?

Erythrocyanosis is diagnosed with a history and physical examination. History of cold exposure and physical examination includes the location of reddish-blue discoloration in the lower half of the leg and the fatty area. Routine blood tests were found to be normal, including blood coagulation tests, blood biochemistry, and blood sedimentation rate. The antistreptolysin level is slightly elevated in some patients. A skin biopsy is done. Histopathological examination reveals the presence of lymphocytic infiltration in the upper epidermis, blood capillaries are dilated, swollen endothelial cells, thrombosis is present in capillaries, and erythrocytes extravasation. Blood capillaries are dilated in the dermis layer, and the perivascular layer is infiltrated with lymphocytes.

Diagnostic Features of Erythrocyanosis Include:

• Proper history.

• Physical examination.

• Complete blood count.

• Skin biopsy in severe cases.

Histopathological Findings Include:

Upper Epidermis:

• Lymphocytic infiltration.

• Dilated blood capillaries.

• Swelling in endothelial cells.

• Thrombosis in blood capillaries.

• Extravasation of erythrocytes.

Dermis:

• Dilated capillaries.

• Perivascular layer:

• Lymphocytic infiltration.

What Is the Differential Diagnosis of Erythrocyanosis?

The clinical features of erythrocyanosis will mimic the following skin conditions. The differential diagnosis of erythrocyanosis is mentioned below.

• Livedo reticularis.

• Erythema induratum.

• Erythromelalgia.

What Are the Complications of Erythrocyanosis?

Erythrocyanosis may lead to its severe form with complications. The complications in erythrocyanosis arise due to bursting the blisters and poor healing of the body.

The complications of erythrocyanosis are listed below.

• Inflammation.

• Severe pain.

• Burning and itching sensation.

• Ulceration.

• Scarring.

What Are the Treatments for Erythrocyanosis?

Erythrocyanosis usually requires no specific treatment. Patients with the symptoms of erythrocyanosis will be improved with warm clothing. Excess body weight can be reduced with diet and exercise. Treatment is essential in the severe forms of erythrocyanosis presenting with pain, disability, and total incapacity. Satisfactory results are obtained with bilateral lumbar cord ganglionectomy. Beneficial effects are obtained from the calcium lactate and ultraviolet light baths.

Always keep your feet warm using woolen socks and footwear, and avoid rubbing or scratching the erythrocyanosis. Pain can be relieved with pain-relieving lotions and creams.

Some of the preventive measures for erythrocyanosis are pointed out below.

• Soothing lotions such as calamine lotion can be applied to relieve pain.

• Stimulate the blood circulation with limp elevation, exercise, and with diet.

• Homeopathy and naturopathy remedies can also be recommended.

• Diabetic patients and people with poor circulatory disorders can visit general physicians to prevent risk.

Some preventive methods are used at home to avoid the triggers of erythrocyanosis and improve blood circulation in cold weather conditions.

The preventive measures are followed below.

• House and workplace can be done with moisture-proofing.

• Stay active.

• Regular exercises are helpful.

• Weight should be reduced.

• Consumption of foods to keep the body warm and improve blood circulation includes cayenne pepper, pomegranate, leafy greens, and eating bananas.

• Drink ginger tea.

• Eat oats.

• Eat red meat, sweet potatoes, and squash.

• Drink plenty of water and take citrus fruits.

• Avoid alcohol.

• Quit smoking.

Conclusion:

Erythrocyanosis is reddish-purple skin discoloration, especially on the lower legs. The body's reaction toward extreme cold weather causes the condition, which usually requires no treatment. Lifestyle modifications improve blood circulation through physical activity, warm layered clothes, and reducing body weight. In severe cases, visit the general physician. However, Erythrocyanosis is not a life-threatening condition. A healthy lifestyle and a nutritious diet will prevent the disease.