Neurology (59)

Abstract

Reflex sympathetic dystrophy. (Mount Sinai School of Medicine, New York, NY) Int J Dermatol 2000;39:481–486.This review aimed to familiarize the dermatologist with the essential features of reflex sympathetic dystrophy. It highlights areas that are most likely to be of interest to the dermatologist. Information regarding diagnosis, pathogenesis theories, and treatment are included. Comment by Enrique Reig, MD.This paper analyses RSD from the point of view of a specialist in dermatology. It addresses in depth the definition of RSD (or the new name, CRPS type I), the symptoms required for adequate diagnosis, some theories to explain this syndrome, and some of the treatments available. It highlights the clinical pictures, which can cause RSD (trauma, ischemia, tumors, infection, neurological and iatrogenic causes), and particularly dermatological syndromes (minor surgery, postherpetic neuralgia, Dupuytren, vasculitis …).The treatment has a bipolar objective: to relieve pain in order to be able to apply appropriate physical therapy, which will allow recovery of the involved limb. There are more than 60 treatments reported in the literature, suggesting that there is no universal protocol. However, prevention of RSD, and particularly the early onset of treatment are essential for achieving functional and pain relief. To suppress sympathetic hyperactivity, nerve blocks (somatic and sympathetic), intravenous regional blockade with guanethidine or reserpine, alpha blockers (phentolamine), beta blockers (propranolol), and calcitonine can be used.No reference is made to anticonvulsants (gabapentine, topiramate), antidepressants (ie, amitriptyline), intravenous lidocaine, or spinal cord stimulation.