Can secondary lymphedema in a limb contribute to symptoms of Raynaud’s phenomenon and/or erythromelalgia in the digits? — BONNIE FAHERTY, PhD, APRN, BC, Northridge, Calif.

Raynaud’s phenomenon is a condition in which episodic vasospasm of peripheral blood vessels is subsequently followed by reperfusion and accompanying reactive vasodilatation. Stimuli (particularly cold and stress) induce the vasospasm, which results in changes in color, temperature, and sensation in the skin of the fingers and other acral areas. When there is no known cause or associated disease, Raynaud’s phenomenon is classified as primary. When there is a predisposing occupational or environmental exposure or when there is an associated systemic disease, Raynaud’s phenomenon is classified as secondary. Erythromelalgia presents as painful extremities that are erythematous, warm, and edematous. Heat and dependency precipitate the burning or throbbing and aching pain, whereas cold and elevation arrest the pain. Erythromelalgia has an adult-onset form (which is either idiopathic or secondary to myeloproliferative disease, thromobocytosis, another systemic disease, or drug exposure) and an early-onset (childhood or adolescent) form (Am J Med. 1991;91:416-422 and Clin Dermatol. 1993;11:73-82). A computerized search of the medical literature did not turn up any matches for secondary lymphedema with either Raynaud’s phenomenon or erythromelalgia. — Philip R.Cohen, MD (145-3)ꆱ