Peripheral Neuropathy vs. Erythromelalgia

Posted by jlander @jlander, Mar 20, 2021

I am new to the Connect site so will have lots of questions but will pace myself! I have been reading about PN and EM. I don't understand the difference between them. When I asked the Neurologist who diagnosed me with EM, he said with EM your feet are red all the time. Can anyone else provide me with more differences please? Thank you!

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Profile picture for gardeningjunkie @gardeningjunkie

I lived with burning feet for years so understand your misery. You might consider you have multiple issues causing burning feet. Often with autoimmune issues it's not simply one issue but multiple issues causes symptoms. I had burning feet starting in middle age: my foot pads the most afflicted and the redness, burning and pain much worse in the evening; trying to sleep was difficult. Could you also have allergies to contact materials? Were any contact allergies ruled out with the 5 Day Extended Patch Test? This is not the simple 30 minute test for environmental allergens, Google information about it. This 5 Day Test test revealed reactions to over a dozen daily contacts. To stop the burning feet I needed to create a barrier or walk on allergen free surfaces. I can walk barefoot on dirt or sand. But even barefoot inside on surfaces safe for me the soles of other peoples shoes contain an element from rubber which contaminates the floors. Or the floor is cleaned with cleaners I'm allergic to. The only shoes safe for me are 100% plastic, vinyl or leather contacts. Otherwise, in a tennis shoe for example because of elastic allergies I wear a 100% cotton sock; Buster Brown and Cottonique online, both sell elastic free, 100% cotton socks. I then put on a plastic bag and cover that with sock containing elastic to support this layering. I can then wear tennis shoes or shoes of other blended materials. Yes my feet get hot, but in my case that doesn't trigger my burning fee. In your case that would be an issue. A cotton sock alone will not provide a barrier from surfaces you are allergic to. There are a few 100% vinyl flip flops and shower shoes , but EVA, Ethylene Vinyl Acetate, is replacing the 100% vinyl and I have found one brand that seems safe so far, yet haven't used long enough to be sure because I but have bought other EVA sandals and my foot pads begin to burn again. The expensive 100% leather shoes are supposedly safe for me, as I didn't test positive to formaldehyde for example which is often used to tan the leather, yet some brands make my feet feel hot, not to the burning point, but I only wear these shoes for a few hours at a time when I need a specific style for social situations.
I hope you can find some relief.

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This is a different "Deb," but I am now very curious about the 5 day patch test. I find I cannot wear shoes (tennis shoes or even sandals) with foam footbeds, and almost all of them do have foam. I have tried cotton and also wool socks, but neither have helped with the burning that begins within minutes. Was this patch test recommended by the doctor treating your EM, or did you seek it out yourself? I have not seen a dermatologist for EM, only my primary doctor and a podiatrist. Could I ask what brand of 100% vinyl shoes you found? Thanks in advance!

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Sure seems like you have an allergy if you react within minutes. I can tell in a few minutes if a fabric chair has Scotch Guard, Fire Retardant, or his made with blended materials containing Mercaptobenzothiazole. I bring a large clear plastic bag to movie theaters and even doctor's offices that have fabric seat. Google True Test Patch Test Kit, that's the kit my allergist ordered. It's expensive, around $1,500 however Medicare pays for this test as well as other insurance programs. Dermatologist's also use these test kits, however the allergist or dermatologist must be licensed with the test kit company and not all are. Ask them if they are licensed before you make an appointment.
You mentioned irritation from foam footbeds. Because of this test I learned I am allergic to memory foam because it is synthesized using an element from rubber, Mercaptobenzothiazole. It is a known human carcinogen and yet our FDA allows its use, stating that it is used at safe levels. For me any level causes inflammation. It is not used in polyurethane foam, but most shoe inserts these days use memory foam. Or you tennis shoes could have elements of rubber, latex is an example of a rubber element. This element is also used accelerate the blending of many other materials.
I wish I could give you recommendations for vinyl shoes. The company from which I bought dozens of these shoes, Native Shoes in Canada, no longer makes these vinyl shoes, they now only sell EVA. Randomly searching the internet I have found shower shoes made from vinyl. Ugly for sure. Plastic is also safe for me.
If you have one contact allergy, chances are you have several. I've have close to a dozen. These allergies cause various eczema symptoms', it's called Allergic Contact Dermatitis, ACD. It's chronic, no cure, just avoidance. Your reactions will become more severe with continual contact of an allergen. Your histamine armies become more reactive.
Try layering with the socks and plastic bags as I mentioned next time you wear tennis shoes and see if that helps. Mercaptobenzothiazole off gases, you must provide an occlusive barrier, simply wearing socks of any type won't block the chemical off gassing. My new mattress had memory foam, I believe this is what triggered my allergic reaction. I didn't develop this until middle age, about 50.

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Profile picture for debinsf8 @debinsf8

This is a different "Deb," but I am now very curious about the 5 day patch test. I find I cannot wear shoes (tennis shoes or even sandals) with foam footbeds, and almost all of them do have foam. I have tried cotton and also wool socks, but neither have helped with the burning that begins within minutes. Was this patch test recommended by the doctor treating your EM, or did you seek it out yourself? I have not seen a dermatologist for EM, only my primary doctor and a podiatrist. Could I ask what brand of 100% vinyl shoes you found? Thanks in advance!

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A clog that is 100% vinyl I can wear I buy on Amazon, made by Backdoorshoes. It has a removable insert and I don't know what the insert materials are. The reason I hesitated to recommend it is because it has a wide front and with the insert removed it's made even wider. Plus these clogs squeak! Still, I have several pairs because I slip off my safe clean house sandals of vinyl or leather and put these on to go outside if walking on gravel or rocks. You might consider wooden clogs if they have an all wood footbed, some clogs have rubber on the bottom of the shoe but you won't have contact with the rubber, a common allergen. The trouble with all clogs is that they are elevated and that can be a hazardous if balance is an issue.

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Profile picture for drolker @drolker

I also have both , PN and Erythromelagia . It’s a constant daily struggle for sure. Both of these affect my feet from just below my ankles to the tips of all toes. My diagnosis is Sjogrens ( includes Raynauds both feet and hands) PN and Erythromelagia. I started with Raynauds in my late teens. The rest of it has developed over the years and I’m now 75. For the EM/PN I take Gabapentin. I also take Hydroxychloraquine, Mobic and Evoxac . I have been applying Rhofade cream to my feet three times a day for the EM. This helps for about 2-3 hrs. I also have “ cold socks” that I use when my feet are on fire.
I see a Rheumatologist at JHH. He is constantly researching for treatments for the Erythromelagia. The nights are the worst as it seems lying down causes the symptoms to flare. Showing the cold socks that I use to reduce the inflammation.

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Hello, I would love to know where you got cold socks???Please I must find these...
I too have Raynaulds and it starts when ever there is a temperature change of just a few degrees .When I walk down the refrigerator aisle of the food store even if it is 68 degrees and my body was in a 74 degree area before that...After that I get Raynaulds my fingers turn white and get numb and cold....I then develop EM several hours later or the next day. First it starts with a bad headache then I know EM is on the way. My fingers and tops of hands get red itchy and very hot.My toes and bottom of feet get beet red and hot and burning. The headache and EM usually last about 3 to 4 days. Doctors at Stanford told me it a thermostat problem with the brain cooling down(Raynaulds) and heating up( EM) hands and feet( and some people face) Wearing sneakers and walking causes the feet to get hot and starts EM flare ups too. I stay away from MSG and salt and spicy foods, all alcohol, but still present with same problems but not as bad.My twin brother also has EM.I also have Ehlers Danlos which also is an auto immune disease... Lots of people who have one autoimmune disease also have several. I also have peripheral neuropathy in my feet and toes caused by the EM and circulation problem. I am 73 years old and thin and otherwise in good health other than these issues.
Please tell me where you got the cold socks. I live in Northern California ( SF bay area)where temperature is mild all year long. Could never live in very cold or very hot weather... ellen

REPLY
Profile picture for gardeningjunkie @gardeningjunkie

A clog that is 100% vinyl I can wear I buy on Amazon, made by Backdoorshoes. It has a removable insert and I don't know what the insert materials are. The reason I hesitated to recommend it is because it has a wide front and with the insert removed it's made even wider. Plus these clogs squeak! Still, I have several pairs because I slip off my safe clean house sandals of vinyl or leather and put these on to go outside if walking on gravel or rocks. You might consider wooden clogs if they have an all wood footbed, some clogs have rubber on the bottom of the shoe but you won't have contact with the rubber, a common allergen. The trouble with all clogs is that they are elevated and that can be a hazardous if balance is an issue.

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@gardeningjunkie
FYI: Birkenstocks have brought out a vinyl sandal that is flat and shaped the same as the usual Birkenstock.
No, I am not an owner!

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Profile picture for Christine @thisoldewe

@gardeningjunkie
FYI: Birkenstocks have brought out a vinyl sandal that is flat and shaped the same as the usual Birkenstock.
No, I am not an owner!

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Thank you! I will definately research this vinyl sandal. All previous makers I had bought from have switched to EVA , a blended material, which will cause burning of my feet, especially the foot pad within a day.

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Profile picture for gardeningjunkie @gardeningjunkie

Thank you! I will definately research this vinyl sandal. All previous makers I had bought from have switched to EVA , a blended material, which will cause burning of my feet, especially the foot pad within a day.

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Yes, please check this out. I have thrown out the material, so cannot give the true content.
I like them as slippers, but I do find them hot after a couple of hours.
Wish you success.

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Profile picture for Christine @thisoldewe

@gardeningjunkie
FYI: Birkenstocks have brought out a vinyl sandal that is flat and shaped the same as the usual Birkenstock.
No, I am not an owner!

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I followed up on the Birkenstock sandal you thought was vinyl. I can understand your confusion believing EVA or ethylene vinyl acetate is vinyl because it looks the same and has the word vinyl in it.
I am allergic to blended materials because an element from rubber, Mercaptobenzothiazole, MBT, which is used to accelorate the blending process. For example it is used in poly-cotton, elastics and such. I react to MBT. This element is never listed as the final material you contact. I can wear 100% cotton, 100% silk, 100%polyester, 100% vinyl for example because this element derived from rubber is not used making this material.
Still hopeful, in the past I have tried EVA footwear and sadly learned that by the end of the day my foot pad will begin to burn.

REPLY
Profile picture for gardeningjunkie @gardeningjunkie

I followed up on the Birkenstock sandal you thought was vinyl. I can understand your confusion believing EVA or ethylene vinyl acetate is vinyl because it looks the same and has the word vinyl in it.
I am allergic to blended materials because an element from rubber, Mercaptobenzothiazole, MBT, which is used to accelorate the blending process. For example it is used in poly-cotton, elastics and such. I react to MBT. This element is never listed as the final material you contact. I can wear 100% cotton, 100% silk, 100%polyester, 100% vinyl for example because this element derived from rubber is not used making this material.
Still hopeful, in the past I have tried EVA footwear and sadly learned that by the end of the day my foot pad will begin to burn.

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Thank you @gardeningjunkie
Sorry about the confusion. (The manager had the same misconception)
Interesting, re the fabric material... I too 'sweat out' with certain clothes... I will give this more attention.
All the best in finding the right stuff!

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Profile picture for ell735 @ell735

Hello, I would love to know where you got cold socks???Please I must find these...
I too have Raynaulds and it starts when ever there is a temperature change of just a few degrees .When I walk down the refrigerator aisle of the food store even if it is 68 degrees and my body was in a 74 degree area before that...After that I get Raynaulds my fingers turn white and get numb and cold....I then develop EM several hours later or the next day. First it starts with a bad headache then I know EM is on the way. My fingers and tops of hands get red itchy and very hot.My toes and bottom of feet get beet red and hot and burning. The headache and EM usually last about 3 to 4 days. Doctors at Stanford told me it a thermostat problem with the brain cooling down(Raynaulds) and heating up( EM) hands and feet( and some people face) Wearing sneakers and walking causes the feet to get hot and starts EM flare ups too. I stay away from MSG and salt and spicy foods, all alcohol, but still present with same problems but not as bad.My twin brother also has EM.I also have Ehlers Danlos which also is an auto immune disease... Lots of people who have one autoimmune disease also have several. I also have peripheral neuropathy in my feet and toes caused by the EM and circulation problem. I am 73 years old and thin and otherwise in good health other than these issues.
Please tell me where you got the cold socks. I live in Northern California ( SF bay area)where temperature is mild all year long. Could never live in very cold or very hot weather... ellen

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I prefer the soft socks sold at Dollar Tree only in winter
weave non irritating. No recall of sock fabric or name of manufacturer Also socks may have elastic I have no allergies or reaction
Do have same shoe issues with hard crease on feet
Can only wear sandals with my socks all year .
Have SCS pain relief device that makes almost all day free from sharp burning feet But still have intermittent night breakthrus. Sleep unpredictable since RLS and foot neuro seem to trigger each other. Patch of rotigotine mostly prevents RLS all day But night Neuro pain can trigger it and vice versa.

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