Background: Now a rare disease, acrodynia (painful
extremities) primarily affects young children. The symptoms
of irritability, photophobia, pink discoloration of the
hands and feet, and polyneuritis can be attributed to
chronic exposure to mercury.
Pathophysiology: The most frequent sources of mercury prior
to the legislated removal of the heavy metal from these
preparations were calomel-containing anthelminthics,
laxatives, diaper rinses, teething powders, fungicides in
paint, repeated gamma-globulin injections, termite-
protected wood (mercury bichloride), watch batteries (ie,
via ingestion), and mercurial antibacterial ointments. This
legislation corresponded to the virtual disappearance of
acrodynia. Present-day cases reveal more novel exposure,
such as mercuric oxide used to treat eyelid mites. Some
have suggested the disease may represent a delayed allergic
or hypersensitivity reaction because not all persons
exposed to mercurial compounds develop the disease.
Because the metal can be stored in the body to some extent
and intolerance may develop long after exposure, morbid
symptoms may appear weeks or months after the drug
administration (ie, exposure), with its cause escaping
recognition. The deleterious effects of relatively small
doses of mercury on the nervous system that are sometimes
seen in the course of acrodynia add to the acrodynic
reaction. In acrodynia, no reflex dilatation of the
peripheral vessels occurs in response to heat.
Vasoconstriction is abolished only when the nerve supply to
the arterioles is interrupted.