Gravitational Erythema: Case Study and Differential Diagnosis

Background. Gravitational erythema is rare pathologic condition that is characterized by abnormal vascular response on venous pressure changes. It is benign disease, and it is included in differential diagnosis of vasculitis, vasculopathies, neuropathies and does not require treatment. Compression garments may be required in some cases.

Clinical Case Description. The case of gravitational erythema in 13 years old patient of is presented. The disease was presented with erythematous mosaic rash on the lower limbs skin. It has appeared in 4-6 minutes after verticalisation and mostly on the lower legs. The rash was accompanied with some bluish spots disappearing after pressure. The elements of rush were itchy, there was pain in distal parts of the feet. The rash was reversed after walking and changing of limb position. Positive compression test was mentioned.

Conclusion. Differential diagnosis of gravitational erythema with other clinically similar conditions remains relevant. The rare diagnosis of gravitational erythema and low awareness of doctors about it cause misdiagnosis, costly continuous examination and ineffective treatment.

1. Berth-Jones J, Graham-Brown RA. Gravitational erythema. Clin Exp Dermatol. 1988;13(4):259. doi: 10.1111/j.1365-2230.1988.tb00694.x.

2. Perret CM, Berth-Jones J, Dharma B. Gravitational erythema. Br J Dermatol. 2003;148(6):1267. doi: 10.1046/j.1365-2133.2003.05189.x.

3. Pereira T, Vieira AP Fernandes JC, Sousa Basto A. Gravitational erythema. Pediatr Dermatol. 2007;24(3):316-317. doi: 10.1111/j.1525-1470.2007.00411.x.

4. Monteiro M, Aguiar EA, Guimaraes MB, Lupi O. Gravitational erythema. JAАD. 2009;60(3):AB46. doi: 10.1016/j.jaad.2008.11.221.

5. Rahmatulla S, Scharrer K, Schofield J, et al. Gravitational erythema. Pediatr Dermatol. 2015;32(3):e130-131. doi: 10.1111/pde.12556.

6. Chasnyk VG, Kostik MM, Dubko MF, et al. Vaskulity u detey. Uchebnoye posobiye. St. Petersburg: St. Petersburg State Pediatric Medical Academy, 2011. 52 р. (In Russ).

7. Asady A, Ruft J, Ellrich A, et al. Cholinergic urticaria patients of different age groups have distinct features. Clin Exp Allergy. 2017;47(12):1609-1614. doi: 10.1111/cea.13023.

8. Breivik H. Erythromelalgia — a dramatic pain of genetic origin, revealing pain mechanisms with implications for neuropathic pain in general. Scand J Pain. 2014;5(4):215-216. doi: 10.1016/j.sjpain.2014.09.001.

9. Goldman RD. Raynaud phenomenon in children. Can Fam Physician. 2019;65(4):264-265.

10. Pauling JD, Hughes M, Pope JE. Raynaud's phenomenon-an update on diagnosis, classification and management. Clin Rheumatol. 2019;38(12):3317-3330. doi: 10.1007/s10067-019-04745-5.

11. Pauling JD, Reilly E, Smith T, Frech TM. Evolving symptom characteristics of raynaud's phenomenon in systemic sclerosis and their association with physician and patient-reported assessments of disease severity. Arthritis Care Res (Hoboken). 2019;71(8): 1119-1126. doi: 10.1002/acr.23729.

12. Ingegnoli F, Schioppo T, Allanore Y, et al. Practical suggestions on intravenous iloprost in Raynaud's phenomenon and digital ulcer secondary to systemic sclerosis: systematic literature review and expert consensus. Semin Arthritis Rheum. 2019;48(4):686-693. doi: 10.1016/j.semarthrit.2018.03.019.

13. Korsten P, Muller GA, Rademacher JG, et al. Rheopheresis for digital ulcers and raynaud's phenomenon in systemic sclerosis refractory to conventional treatments. Front Med (Lausanne). 2019;6:208. doi: 10.3389/fmed.2019.00208.

14. Saraiva LA, Cunha RN, Sousa MP, et al. Critical digital ischaemia-a rare complication of systemic sclerosis. Rheumatology (Oxford). 2019. pii: kez507. doi: 10.1093/rheumatology/kez507.