Chilblains: Difference between revisions
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==Background== | ==Background== | ||
*Also known as perniones (sing. pernio), chill burns, and perniosis | |||
*Mild but uncomfortable inflammatory lesions of skin | *Mild but uncomfortable inflammatory lesions of skin | ||
**Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures | **Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures | ||
**Symptoms precipitated by acute exposure to cold | **Symptoms precipitated by acute exposure to cold | ||
*Primarily a disease of women and children | *Primarily a disease of women and children | ||
*Associated with [[systemic lupus erythematosus|lupus]], antiphospholipid antibodies, and Raynaud phenomenon | |||
*Rare in U.S.; common in United Kingdom | *Rare in U.S.; common in United Kingdom | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Wintertenen.jpg|thumb|Example 1]] | |||
[[File:Chilblains from excessively icing the feet.jpg|thumb|Example 2]] | |||
*Hands, ears, lower legs, feet most commonly affected | *Hands, ears, lower legs, feet most commonly affected | ||
*Symptoms | *Symptoms | ||
**Tingling, numbness, pruritus, burning paresthesias | **[[paresthesia|Tingling]], [[numbness]], [[pruritus]], burning paresthesias | ||
**Cutaneous manifestations appear up to 12hr after acute exposure | **[[rash|Cutaneous manifestations]] appear up to 12hr after acute exposure | ||
***Localized edema, erythema, cyanosis, plaques, nodules | ***Localized edema, erythema, cyanosis, plaques, nodules | ||
***May progress in rare cases to ulcerations, vesicles, and bullae | ***May progress in rare cases to ulcerations, vesicles, and bullae | ||
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{{Cold injuries DDX}} | {{Cold injuries DDX}} | ||
== | ==Evaluation== | ||
* | *Clinical diagnosis | ||
==Treatment<ref>Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331</ref>== | ==Treatment<ref>Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331</ref>== | ||
*Affected skin should be rewarmed, gently bandaged, and elevated | *Affected skin should be rewarmed, gently bandaged, and elevated | ||
*Prophylactic and therapeutic treatment options: | *Prophylactic and therapeutic treatment options: | ||
**Nifedipine 20mg PO TID | **[[Nifedipine]] 20mg PO TID | ||
**Pentoxifylline 400mg PO TID | **[[Pentoxifylline]] 400mg PO TID | ||
**Limaprost 20mcg TID | **Limaprost 20mcg TID | ||
*Topical corticosteroids and oral | *[[Topical corticosteroids]] and oral [[steroids]] burst have been shown to be useful | ||
==Disposition== | ==Disposition== | ||
*Discharge if no frostbite or other serious pathology | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Environmental]] | ||
Latest revision as of 18:31, 4 January 2021
Background
- Also known as perniones (sing. pernio), chill burns, and perniosis
- Mild but uncomfortable inflammatory lesions of skin
- Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures
- Symptoms precipitated by acute exposure to cold
- Primarily a disease of women and children
- Associated with lupus, antiphospholipid antibodies, and Raynaud phenomenon
- Rare in U.S.; common in United Kingdom
Clinical Features
- Hands, ears, lower legs, feet most commonly affected
- Symptoms
- Tingling, numbness, pruritus, burning paresthesias
- Cutaneous manifestations appear up to 12hr after acute exposure
- Localized edema, erythema, cyanosis, plaques, nodules
- May progress in rare cases to ulcerations, vesicles, and bullae
- Rewarming may result in formation of tender blue nodules which may persist for days
Differential Diagnosis
Cold injuries
- Generalized
- Freezing
- Non-freezing
Evaluation
- Clinical diagnosis
Treatment[1]
- Affected skin should be rewarmed, gently bandaged, and elevated
- Prophylactic and therapeutic treatment options:
- Nifedipine 20mg PO TID
- Pentoxifylline 400mg PO TID
- Limaprost 20mcg TID
- Topical corticosteroids and oral steroids burst have been shown to be useful
Disposition
- Discharge if no frostbite or other serious pathology
See Also
References
- ↑ Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331