Dermatological Manifestations of Postural Tachycardia Syndrome Are Common and Diverse
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Background and Purpose Postural tachycardia syndrome (POTS) is a syndrome of orthostatic intolerance in the setting of excessive tachycardia with orthostatic challenge, and these symptoms are relieved when recumbent. Apart from symptoms of orthostatic intolerance, there are many other comorbid conditions such as chronic headache, fbromyalgia, gastrointestinal disorders, and sleep disturbances. Dermatological manifestations of POTS are also common and range widely from livedo reticularis to Raynaud’s phenomenon. Methods Questionnaires were distributed to 26 patients with POTS who presented to the neurology clinic. They were asked to report on various characteristics of dermatological symptoms, with their answers recorded on a Likert rating scale. Symptoms were considered positive if patients answered with “strongly agree” or “agree”, and negative if they answered with “neutral”, “strongly disagree”, or “disagree”. Results Te most commonly reported symptom was rash (77%). Raynaud’s phenomenon was reported by over half of the patients, and about a quarter of patients reported livedo reticularis. Te rash was most commonly found on the arms, legs, and trunk. Some patients reported that the rash could spread, and was likely to be pruritic or painful. Very few reported worsening of symptoms on standing. Conclusions Te results suggest that dermatological manifestations in POTS vary but are highly prevalent, and are therefore of important diagnostic and therapeutic signifcance for physicians and patients alike to gain a better understanding thereof. Further research exploring the underlying pathophysiology, incidence, and treatment strategies is necessary.
Abstract
Background and Purpose Postural tachycardia syndrome (POTS) is a syndrome of orthostatic intolerance in the setting of excessive tachycardia with orthostatic challenge, and these symptoms are relieved when recumbent. Apart from symptoms of orthostatic intolerance, there are many other comorbid conditions such as chronic headache, fbromyalgia, gastrointestinal disorders, and sleep disturbances. Dermatological manifestations of POTS are also common and range widely from livedo reticularis to Raynaud’s phenomenon. Methods Questionnaires were distributed to 26 patients with POTS who presented to the neurology clinic. They were asked to report on various characteristics of dermatological symptoms, with their answers recorded on a Likert rating scale. Symptoms were considered positive if patients answered with “strongly agree” or “agree”, and negative if they answered with “neutral”, “strongly disagree”, or “disagree”. Results Te most commonly reported symptom was rash (77%). Raynaud’s phenomenon was reported by over half of the patients, and about a quarter of patients reported livedo reticularis. Te rash was most commonly found on the arms, legs, and trunk. Some patients reported that the rash could spread, and was likely to be pruritic or painful. Very few reported worsening of symptoms on standing. Conclusions Te results suggest that dermatological manifestations in POTS vary but are highly prevalent, and are therefore of important diagnostic and therapeutic signifcance for physicians and patients alike to gain a better understanding thereof. Further research exploring the underlying pathophysiology, incidence, and treatment strategies is necessary.
참고문헌 (22)
- Stewart JM, "Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects", Circulation, 105, pp.2274~2281 (2002)
- Schondorf R, "Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?", Neurology, 43, pp.132~137 (1993)
- Low PA, "Comparison of the postural tachycardia syndrome (POTS) with orthostatic hypotension due to autonomic failure", J Auton Nerv Syst, 50, pp.181~188 (1994)
- Benarroch EE, "Postural tachycardia syndrome: a heterogeneous and multifactorial disorder", Mayo Clin Proc, 87, pp.1214~1225 (2012)
- Raj SR, "Blood volume perturbations in the postural tachycardia syndrome", Am J Med Sci, 334, pp.57~60 (2007)
- Jordan J, "Increased sympathetic activation in idiopathic orthostatic intolerance: role of systemic adrenoreceptor sensitivity", Hypertension, 39, pp.173~178 (2002)
- Jacob G, "The neuropathic postural tachycardia syndrome", N Engl J Med, 343, pp.1008~1014 (2000)
- Joyner MJ, "POTS versus deconditioning: the same or different?", Clin Auton Res, 18, pp.300~307 (2008)
- Ojha A, "Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome", J Pediatr, 158, pp.20~23 (2011)
- Landero J, "Postural orthostatic tachycardia syndrome: a dermatologic perspective and successful treatment with losartan", J Clin Aesthet Dermatol, 7, pp.41~47 (2014)
- Suter LG, "The incidence and natural history of Raynaud’s phenomenon in the community", Arthritis Rheum, 52, pp.1259~1263 (2005)
- Maricq HR, "Geographic variation in the prevalence of Raynaud’s phenomenon:Charleston, SC, USA, vs Tarentaise, Savoie, France", J Rheumatol, 20, pp.70~76 (1993)
- Stewart JM, "Reduced body mass index is associated with increased angiotensin II in young women with postural tachycardia syndrome", Clin Sci (Lond), 113, pp.449~457 (2007)
- Stewart JM, "Angiotensin II type 1 receptor blockade corrects cutaneous nitric oxide deficit in postural tachycardia syndrome", Am J Physiol Heart Circ Physiol, 294, pp.H466~H473 (2008)
- Stewart JM, "Defects in cutaneous angiotensin-converting enzyme 2 and angiotensin-(1-7)production in postural tachycardia syndrome", Hypertension, 53, pp.767~774 (2009)
- Greaves M, "Chronic urticaria", J Allergy Clin Immunol, 105, pp.664~672 (2000)
- Shibao C, "Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders", Hypertension, 45, pp.385~390 (2005)
- Sharma M, "H1-antihistamines for chronic spontaneous urticaria", Cochrane Database Syst Rev, 11, pp.CD006137~ (2014)
- Shelley WB, "Adrenergic urticaria: a new form of stressinduced hives", Lancet, 2, pp.1031~1033 (1985)
- Haustein UF, "Adrenergic urticaria and adrenergic pruritus", Acta Derm Venereol, 70, pp.82~84 (1990)
- Chapman EM, "On the occurrence of dyspnea, dizziness and precordial distress ccasioned by the pooling of blood in varicose veins", J Clin Invest, 21, pp.393~399 (1942)
- National Clinical Guideline Centre (UK), "Varicose Veins in the Legs:The Diagnosis and Management of Varicose Veins", National Institute for Health and Care Excellence (UK), ~ (2013)