Chilblains

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
• Rare in U.S.; common in United Kingdom

Clinical Features

Example 1

Example 2

• 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
  • Accidental hypothermia
  • Therapeutic hypothermia
• Freezing
  • Frostbite
• Non-freezing
  • Trench foot
  • Chilblains (Pernio)
  • Cold panniculitis
  • Cold urticaria
  • Polar thigh

Evaluation

• Clinical diagnosis

Treatment

• 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

• Cold injuries