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. 2021 Mar 11;7(4):471-477.
doi: 10.1016/j.ijwd.2021.03.003. eCollection 2021 Sep.

Cutaneous manifestations of orthostatic intolerance syndromes

Caroline T Starling  1 , Quoc-Bao D Nguyen  2 , Ian J Butler  3 , Mohammed T Numan  3 , Adelaide A Hebert  2   3
Affiliations

Cutaneous manifestations of orthostatic intolerance syndromes

Caroline T Starling et al. Int J Womens Dermatol. .

Abstract

Dysautonomia refers to a group of autonomic nervous system disorders that affect nearly 70 million people worldwide. One subset of dysautonomia includes syndromes of orthostatic intolerance (OI), which primarily affect adolescents and women of childbearing age. Due to the variability in disease presentation, the average time from symptom onset to diagnosis of dysautonomia is 6 years. In general, there is a paucity of dermatological research articles describing patients with dysautonomia. The objective of this review is to summarize the existing literature on cutaneous manifestations in dysautonomia, with an emphasis on syndromes of OI. A PubMed database of the English-language literature (1970-2020) was searched using the terms "dysautonomia", "orthostatic intolerance", "cutaneous", "skin", "hyperhidrosis", "hypohidrosis", "sweat", and other synonyms. Results showed that cutaneous manifestations of orthostatic intolerance are common and varied, with one paper citing up to 85% of patients with OI having at least one cutaneous symptom. Recognition of dermatological complaints may lead to an earlier diagnosis of orthostatic intolerance, as well as other comorbid conditions.

Keywords: Cutaneous manifestations; Dysautonomia; Hyperhidrosis; Orthostatic intolerance.

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Figures

Fig 1
Fig. 1
Flow chart of approach to screening for orthostatic intolerance syndromes in the dermatology office.
Fig 2
Fig. 2
Twenty-year-old female patient with a history of hyperhidrosis, Ehlers-Danlos/joint hypermobility syndrome, and dysautonomia demonstrating joint hypermobility of the right wrist with flexion of the thumb to the forearm.
Fig 3
Fig. 3
Hyperhidrosis of the palms in a 30-year-old female patient with dysautonomia.
Fig 4
Fig. 4
Fourteen-year-old female patient with dysautonomia with (A) acrocyanosis and prolonged blanching of the right dorsal foot after finger-tip pressure while sitting and (B) acrocyanosis and blanching of the toes while standing.
Fig 5
Fig. 5
Fourteen-year-old male patient with tachycardia and dysautonomia presenting with livedoid pattern on the (A) hands and forearms and (B) thighs.
See this image and copyright information in PMC

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