Hand and foot color change: Diagnosis and management

1. Dustin E. Fleck, MD* 2. Mark F. Hoeltzel, MD* 1. *Division of Pediatric Rheumatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI * ADHD: : attention-deficit/hyperactivity disorder ANA: : antinuclear antibody POTS: : postural tachycardia syndrome Primary care clinicians are challenged to evaluate an array of different hand and foot color changes in kids, as treatment may range from reassurance of a benign, self-limited condition to further diagnostic evaluation and treatment with vasodilator pharmacotherapy. The most common and well-known causes of these color changes are Raynaud phenomenon, acrocyanosis, and the more rare but serious erythromelalgia. Clinicians should be aware of the clinical presentation, symptoms, etiologic origins, diagnostic evaluation, treatment, and potential complications of Raynaud phenomenon, acrocyanosis, and erythromelalgia in children. After completing this article, readers should be able to: 1. Identify the various causes of hand and foot color change in children and adolescents. 2. Recognize the differences in signs and symptoms of acrocyanosis, erythromelalgia, and Raynaud phenomenon. 3. Recognize complications associated with acrocyanosis, erythromelalgia, and Raynaud phenomenon. 4. Describe current treatments for acrocyanosis, erythromelalgia, and Raynaud phenomenon. ### Clinical Presentation Acrocyanosis is a clinically benign process that is known to cause alarm in patients and their parents. Acrocyanosis typically presents as symmetrical blue and/or purple discoloration in the peripheral extremities, usually either the hands or the feet (Figs 1, 2, 3, 4). In infants, acrocyanosis also includes the perioral area but not the lips or tongue, where central cyanosis becomes a concern. It is often seen after bathing, after feeding, or in a cool environment. It is evanescent and benign. The bluish discoloration in acrocyanosis is often asymptomatic, without clear demarcation of color change. Acrocyanosis episodes can be either precipitated or exacerbated by external factors, such as cold temperatures. Acrocyanosis may also be a process secondary to an underlying systemic disease or a side effect of certain medications. Figure 1. Teenage …