Acrodynia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Acrodynia is characterized by pink discoloration of the hands and feet, irritability, photophobia (sensitivity to light) and polyneuritis (inflamed nerves).

It is caused by chronic exposure to mercury.

The most common form of exposure in young children is ingesting mercury from a broken thermometer. The signs and symptoms of mercury toxicity may not appear until weeks or months after exposure has occurred.

Signs and Symptoms

Initial signs

Listlessness, drowsiness, irritability and a tendency to cry
Loss of appetite and subsequent weight loss
More than 50% complain of sensitivity to light
Generalized weakness and painful extremities

Within 2-4 weeks

Tip of the nose, fingers and toes turn a pinkish color, which progressively darkens and spreads into a net-like pattern.
Hands and feet become painful, cold, cyanotic (blue), erythematous (red) and swollen.
Extreme pain and itchiness in the extremity often leads to thickened scratched skin as the child rubs and scratches the area.
Hyperhidrosis (excessive sweating) with a mouselike smell may occur. This may lead to miliaria and secondary bacterial skin infections.
Inflammation, swelling and gum erosion may occur with subsequent loss of teeth.
Alopecia and nail loss have also been reported.

Clinical Characteristics

Central nervous system

Irritability
Extreme photophobia (patient burrows head or covers eyes to block out light)

Cardiovascular

Gastrointestinal

Renal

Proteinuria
Nephrotic syndrome progressing to renal failure in extreme cases

Dermal

Erythema of the palms, soles, and face
Edema and desquamation of the skin of hands and feet
Pruritus

Muscular/Skeletal

Hypotonia

Various

Gingivitis
Diaphoresis
Paresthesia
Generalized pain

Treatment

The goal of treatment is to remove the mercury and correct any fluid or electrolyte imbalances.

Chelating agents such as meso 2,3-dimercaptosuccinic acid are used to prevent methylmercury uptake by erythrocytes (red blood cells) and hepatocytes (liver cells).

Hemodialysis with and without the addition of L-cysteine as a chelating agent has been used in patients with acute renal failure from mercury toxicity.

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