The existence of a diverse array of findings among patients with complex regional pain syndrome (CRPS) suggests dermatologists should be aware of the cutaneous manifestations of the disorder, particularly in individuals with a prior history of cutaneous injury, according to details of a case study published in the Journal of Drugs in Dermatology.

With a paucity of literature available that describes dermatologic changes among patients with CRPS, the investigators presented the case study of a 52-year-old Caucasian woman with a 19-year history of reflex sympathetic dystrophy that developed after a nondisplaced left tibia fracture sustained while she was hiking.

The patient was initially referred to the researchers’ clinic because of episodic, mildly tender, clustered, nonblanching, nonpalpable petechiae that presented bilaterally on her lower legs and were histologically consistent with leukocytoclastic vasculitis. Because there was no systemic involvement noted, her symptoms resolved with the use of topical steroids.

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Severe dystrophy in all 10 toenails, with no evidence of onychomycosis, was also noted in this patient. Avulsion of the great toenail was performed to provide the patient with symptomatic relief. Physical examination revealed the presence of lower extremity and facial hypotrichosis. Moreover, the patient required that increasing levels of lidocaine be administered before various office procedures, which was suggestive of lidocaine insensitivity.

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The findings from this case study demonstrate the presence of previously described cutaneous manifestations of CRPS, including vasculitis, extremity hypotrichosis, nail dystrophy, and telangiectasia, of which dermatologists must be aware in their treatment of patients. In addition, such newly described manifestations of CRPS as lidocaine insensitivity and facial hypotrichosis must also be considered.

The recognition of dermatologic symptoms among patients with CRPS is critical for clinicians who care for these patients, possibly providing practitioners with the opportunity to first identify this condition. Additional research is needed to better elucidate the incidence of specific dermatologic findings among large populations of patients with CRPS.


Qureshi AA, Friedman AJ. Complex regional pain syndrome: what the dermatologist should know. J Drugs Dermatol. 2018;17(5):532-536.