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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Related Studies

Ontology: Chilblains (C0008058)

Definition (NCI) A rare condition characterized by skin inflammation, blister formation, swelling and ulcerations in the extremities. It occurs in persons exposed to cold temperatures.
Definition (MSH) Recurrent localized itching, swelling and painful erythema on the fingers, toes or ears, produced by exposure to cold.
Concepts Disease or Syndrome (T047)
MSH D002647
ICD9 991.5
ICD10 T69.1
SnomedCT 157719006, 269421007, 37869000
English Effects of chilblains, chilblains (diagnosis), chilblains, erythema pernio, Chillblains, Chilblains [Disease/Finding], chillblains, chilblained, chilblain, chilblain disorder, perniosis, Perniosis, Idiopathic, Perniosis, Idiopathic Perniosis, Idiopathic Pernioses, Pernioses, Idiopathic, Pernioses, Pernio, Pernios, Erythema pernio, Chilblain, Chilblains (disorder), cold; adverse effect, chilblains, erythema; pernio, adverse effect; cold, chilblains, pernio; erythema, pernio, Chilblains
Dutch pernio, winterhanden, erytheem; pernio, koude; ongewenst gevolg, winterhanden en -voeten, ongewenst gevolg; koude, winterhanden en -voeten, pernio; erytheem, koubulten, Hand en -voet, winter-, Handen en -voeten, winter-, Winterhand en -voet, Winterhanden en -voeten
French Engelure, Engelures
German Frostbeule, Frostbeulen, Pernio
Portuguese Frieiras, Congelamento (chilblains), Eritema Pérnio, Perniose, Geladura, Psicose infantil, Pérnio
Spanish Sabañón, Sabañones, Sabanones, eritema pernio, perniosis, sabañones (trastorno), sabañones, Perniosis, Eritema Pernio
Japanese 凍瘡, ﾄｳｿｳ
Swedish Köldknölar
Czech oznobenina, Omrzliny, Omrznutí
Finnish Kylmänkyhmyt
Russian OZNOBLENIE, OBMOROZHENIE, OTMOROZHENIE I-OI STEPENI, ОБМОРОЖЕНИЕ, ОЗНОБЛЕНИЕ, ОТМОРОЖЕНИЕ I-ОЙ СТЕПЕНИ
Korean 동창
Polish Odmroziny
Hungarian Fagyási sérülés, Pernio
Norwegian Frostknuter, Pernio, Perniose, Idiopatisk perniose
Italian Geloni
Derived from the NIH UMLS (Unified Medical Language System)

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