Classification
Megavitamin-B6 syndrome is characterized mainly by degeneration of dorsal root ganglion axons and cell bodies, although it also affects the trigeminal ganglia. It is classified as a sensory ganglionopathy due to involvement of these ganglia. In electrodiagnostic testing,
it has characteristic non-length-dependent abnormalities of sensory action potentials that occur globally, rather than distally decreasing of sensory nerve action potential amplitudes. Megavitamin-B6 syndrome is predominately a large fiber neuropathy characterized by sensory loss of joint position, vibration and ataxia. Although it has characteristics of small fiber neuropathy in severe cases where there is impairment of pain, temperature, and autonomic functions. Treatment
The primary treatment for megavitamin-B6 syndrome is to stop taking supplemental vitamin B6. Physical therapy, including vestibular rehabilitation, has been used in attempts to improve recovery following cessation of vitamin B6 supplementation. Medications such as amitriptyline have been used to help with neuropathic pain.In experimental tests using animal subjects, neurotrophic factors, specifically neurotrophin-3, were shown to potentially reverse the neuropathy caused from the vitamin B6 toxicity. With rats and mice, improvement has also been seen with 4-methylcatechol, a specific chicory extract, coffee and trigonelline. Prognosis
Other than with extremely high doses of vitamin B6, neurologic dysfunction improves following cessation of vitamin B6 supplementation and usually, but not always, resolves within six months.
Painful fat herniation is foot pain caused by the herniation of fat through the thin fascial layers of the weight-bearing parts of the heel. The herniation results in small bumps called piezogenic pedal papules or piezogenic papules. Though piezogenic papules are most commonly found on the heel, they can also be found on the wrist and palm.Piezogenic papules are relatively common; in one population-based study, the prevalence was found to be 76%. They occur more frequently in runners, triathletes, and individuals exposed to long periods of standing. They are also common in individuals with connective tissue disorders, especially Ehlers–Danlos syndrome. However, due to their preponderance in the general population, the presence of piezogenic papules alone does not automatically indicate the presence of Ehlers–Danlos syndrome. In most cases, piezogenic papules are of little clinical significance. See also
Skin lesion
Tennis toe
List of cutaneous conditions

References


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