Chilblains

Aka: Chilblains, Pernio, Perniosis

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II. Definitions

  1. Pernio (Chilblains)
    1. Non-freezing injury after cold, wet exposure followed within 24 hours by inflammatory lesions on the hands and feet

III. Pathophysiology

  1. Skin Reaction to Cold, damp conditions
  2. Vascular acrosyndrome on same spectrum as Raynaud Syndrome

IV. Risk Factors

  1. Young women
  2. Body Mass Index <25 kg/m2
  3. Systemic Lupus Erythematosus
  4. Raynaud Syndrome
  5. SARS-CoV2

V. Symptoms

  1. Onset
    1. Lesions following cold exposure within 24 hours
  2. Location:
    1. Inflammatory lesions of hands and feet
  3. Associated symptoms
    1. Lesions itch, burn (or other Paresthesias) or are painful
  4. Course
    1. Onset within 1-5 hours of cold exposure
    2. Develops over hours or days and slowly subsides over weeks

VI. Symptoms

  1. Pruritic, tender rash on hands and feet
  2. Purple to erythematous Papules with variable edema

VII. Signs

  1. Rash on hands and feet
  2. Multiple tender, erythematous, purplish Papules or Nodules
  3. May progress to bullae or ulceration

VIII. Lab: Skin biopsy

  1. Blood vessel wall thickening
  2. Perivascular lymphocytic infiltrates
  3. Edema of papillary Dermis

IX. Management

  1. Rest
  2. Warmth (and avoid further cold exposure)
  3. Antipruritics
  4. Analgesics
  5. Specific measures that may reduce pain, speed healing and prevent progression
    1. Topical Corticosteroids
    2. Nifedipine 20 mg orally three times daily
      1. Rustin (1989) Br J Dermatol 120(2):267-75 [PubMed]

X. Complications

  1. Chronic, relapsing course may occur with repeat cold exposure

XI. Prognosis: Course

  1. Lesions may persist for weeks to months and ultimately resolve spontaneously
  2. Scarring may occur

XII. Prevention

  1. Adequate clothing and home heating
  2. Short course of UV light at the beginning of winter
  3. Tobacco Cessation

XIII. References

  1. Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16
  2. Rathjen (2019) Am Fam Physician 100(11): 680-6 [PubMed]

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