Treatment of erythromelalgia with active wine-cooler and amitriptyline-ketamine-gel

Erythromelalgia is a rare clinical syndrome, characterized by erythrodermia and burning heat sensations in the affected extremities. We report about a fifty-seven year old woman with primary erythromelalgia of the feet, who treated herself with active wine-cooler. She soothed the devasting pain sensations by slipping the cold wine-coolers over her toes and feet. Additional treatment with amitriptyline-ketamine-gel led to a satisfactory treatment result. Primary erythromelalgia was considered to be caused by a primary microcirculation dysfunction, yet recent work identified mutations in the SCN9A-subunit of the voltage gain sodium cannels, lowering thresholds for single action potentials and high frequency firing in sensory and sympathetic neurons and nociceptors. Therefore, erythromelalgia is a hereditary neurogen pain syndrome. The multitude of doubtful empirically based therapies promotes self-treatment of the patients. The amitriptylin-ketamine-gel depicts antiexcitatory effects. The classification of erythromelalgia as a channelopathy and the better understanding of its molecular basis give hope that more effective and more selective treatment will become available in the future.