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Chilblains
Aka: Chilblains, Pernio, Perniosis
- See Also
- Skin Reactions to Cold
- Frostbite
- Hypothermia
- Definitions
- Pernio (Chilblains)
- Non-freezing injury after cold, wet exposure followed within 24 hours by inflammatory lesions on the hands and feet
- Pathophysiology
- Skin Reaction to Cold, damp conditions
- Risk Factors
- Young women
- Body Mass Index <25 kg/m2
- Systemic Lupus Erythematosus
- Symptoms
- Onset
- Lesions following cold exposure within 24 hours
- Location:
- Inflammatory lesions of hands and feet
- Associated symptoms
- Lesions itch, burn (or other Paresthesias) or are painful
- Course
- Onset within 1-5 hours of cold exposure
- Develops over hours or days and slowly subsides over weeks
- Symptoms
- Pruritic, tender rash on hands and feet
- Purple to erythematous Papules with variable edema
- Signs
- Rash on hands and feet
- Multiple tender, erythematous, purplish Papules or Nodules
- May progress to bullae or ulceration
- Lab: Skin biopsy
- Blood vessel wall thickening
- Perivascular lymphocytic infiltrates
- Edema of papillary Dermis
- Management
- Rest
- Warmth (and avoid further cold exposure)
- Antipruritics
- Analgesics
- Specific measures that may reduce pain, speed healing and prevent progression
- Topical Corticosteroids
- Nifedipine 20 mg orally three times daily
- Rustin (1989) Br J Dermatol 120(2):267-75 [PubMed]
- Complications
- Chronic, relapsing course may occur with repeat cold exposure
- Prognosis: Course
- Lesions may persist for weeks to months and ultimately resolve spontaneously
- Scarring may occur
- Prevention
- Adequate clothing and home heating
- Short course of UV light at the beginning of winter
- Tobacco Cessation
- References
- Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16
- Rathjen (2019) Am Fam Physician 100(11): 680-6 [PubMed]