J Clin Neurol.  2016 Jan;12(1):75-78. 10.3988/jcn.2016.12.1.75.

Dermatological Manifestations of Postural Tachycardia Syndrome Are Common and Diverse

• Huang H
• Deb A
• Culbertson C
• Morgenshtern K
• DePold Hohler A

• KMID: 2364922
• DOI: http://doi.org/10.3988/jcn.2016.12.1.75

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, fibromyalgia, 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
The 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. The 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
The results suggest that dermatological manifestations in POTS vary but are highly prevalent, and are therefore of important diagnostic and therapeutic significance for physicians and patients alike to gain a better understanding thereof. Further research exploring the underlying pathophysiology, incidence, and treatment strategies is necessary.

Keyword

postural tachycardia syndrome; Raynaud's phenomenon; livedo reticularis; varicose veins; dermatological manifestations; dysautonomia

MeSH Terms

Arm
Exanthema
Fibromyalgia
Headache Disorders
Humans
Incidence
Leg
Livedo Reticularis
Neurology
Orthostatic Intolerance
Postural Orthostatic Tachycardia Syndrome*
Primary Dysautonomias
Tachycardia
Varicose Veins

Figure

• 

  Fig. 1 Response rates for core dermatological symptoms. A: Bar graph displays the frequency of positive responses (i.e., "strongly agree" or "agree"). B: Box-and-whisker plots display the median and interquartile range for each symptom. Q1: first quartile, Q3: third quartile.

• 

  Fig. 2 Response rates for associated features of rash among subjects positive for "rash". Box-and-whisker plots display the median and interquartile range for each location. "Antihistamine"=no response to antihistamine medication.

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  Fig. 3 Response rates for locations of rash among subjects positive for "rash". Box-and-whisker plots display the median and interquartile range for each location.

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