Differential Diagnosis for Redness and Burning of Hands and Feet

Single Most Likely Diagnosis

• Erythromelalgia: A condition characterized by burning pain, heat, and redness in the hands and feet, often associated with increased blood flow to these areas. It can be primary (idiopathic) or secondary to other conditions like myeloproliferative disorders.

Other Likely Diagnoses

• Peripheral Artery Disease (PAD): Although more commonly associated with intermittent claudication, PAD can cause burning sensations in the hands and feet due to reduced blood flow.
• Diabetic Neuropathy: High blood sugar levels can damage nerves, leading to burning sensations in the extremities.
• Raynaud's Phenomenon: A condition that affects blood flow to the fingers and toes, and sometimes the ears, nose, and lips, causing them to turn blue and feel cold and painful in response to cold temperatures or stress. It can also cause burning sensations during the rewarming phase.
• Vitamin Deficiency (B12, B6, or Niacin): Deficiencies in these vitamins can cause neurological symptoms, including burning sensations in the hands and feet.

Do Not Miss Diagnoses

• Complex Regional Pain Syndrome (CRPS): A chronic pain condition that most often affects one of the arms, legs, hands, or feet after an injury or trauma. It's characterized by intense burning or aching pain and can be debilitating if not recognized and treated early.
• Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause a variety of symptoms, including changes in sensation in the hands and feet, though these are less common presentations.
• Heavy Metal Poisoning: Exposure to heavy metals like arsenic or mercury can cause a range of neurological and dermatological symptoms, including burning sensations in the extremities.

Rare Diagnoses

• Erythromelalgia as a Paraneoplastic Syndrome: In rare cases, erythromelalgia can be associated with underlying malignancies, such as myeloproliferative neoplasms.
• Fabry Disease: A genetic disorder that results from the buildup of a particular type of fat in the body's cells, affecting many parts of the body including the skin, kidneys, heart, and nervous system. It can cause burning sensations in the hands and feet among other symptoms.
• Sjögren's Syndrome: An autoimmune disorder that primarily affects the glands that produce tears and saliva but can also cause a variety of other symptoms, including neuropathic pain and burning sensations in the extremities.