EM is a disorder of small nerve fibers that leads to painful flushing and burning paresthesias of distal extremities and is typically associated with heat or physical activity and relieved with cooling measures. It is typically familial and related to mutations in the SCN9A gene. A mutation has not been identified in sporadic cases, and no curative therapy exists to date. A 31-year-old male with small fiber neuropathy for ten years presented with painful erythema and a sensation of warmth and burning affecting the chest, ears and feet, that has progressed to his hands over the past three years. Warm environments, exercise, or heat precipitate episodes. Additionally, episodes are associated with positional orientation of his upper extremities that is relieved with arm raising. Furthermore, his episodes affect isolated patches of skin on his knees and trunk. His symptoms improve with cooling and raising his arms above his head.