II. Pathophysiology

  1. Skin Reaction to Cold, damp conditions

III. Symptoms

  1. Onset
    1. Lesions following cold exposure
  2. Location:
    1. Inflammatory lesions of hands and feet
  3. Associated symptoms
    1. Lesions itch, burn 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

IV. Symptoms

  1. Pruritic, tender rash on hands and feet

V. Signs

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

VI. Lab: Skin biopsy

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

VII. Management

  1. Rest
  2. Warmth (and avoid further cold exposure)
  3. Antipruritics
  4. Analgesics
  5. Topical Corticosteroids
  6. Nifedipine 20 mg orally three times daily
    1. Rustin (1989) Br J Dermatol 120(2):267-75 [PubMed]

VIII. Complications

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

IX. Prevention

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

X. References

  1. Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16

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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
Korean 동창
Polish Odmroziny
Hungarian Fagyási sérülés, Pernio
Norwegian Frostknuter, Pernio, Perniose, Idiopatisk perniose
Italian Geloni