erythema pernio

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Chilblains (also known as pernio) are localized cutaneous inflammatory lesions of the extremeties precipitated by cold (dry cold) or high humidity (damp cold). Controversy exist about which factor (dry cold or damp cold) plays a major role in causing pernio (1)

It occurs frequently in young women (between the ages of 15 and 30 years) but can also arise in older individuals or children (1).

Chilblain may be idiopathic or may be secondary to other systemic diseases e.g - cryopathies and lupus erythematosus (3).

They are caused by localized vasoconstriction which results in tissue anoxemia and inflammation causing vascular damage (1).

Chilblain can be divided into

  • acute pernio
    • appears several hours after cold exposure
      • skin lesion fully develop within 12 to 24 hours
    • seen commonly in schoolchildren and young adults under the age of 20 years
      • highest incidence in adolescent females
    • can occur in mildly cold settings such as logging, kayaking, snowmaking, 46 winter horseback riding, and hiking
    • characteristic locations include: feet, hands, legs, and thighs
    • in severe cases - single or multiple, erythematous, purplish, edematous lesions form, with vesicles
    • symptoms - intense pruritus,burning, or pain, often worsened by subsequent warmth
    • lesions are usually self limiting
      • resolves within a few days to 3 weeks
      • residual hyperpigmentation may be seen occasionally
      • pain often persist during healing
    • subsequent mild cold exposure may trigger paresthesias, edema, and skin scaling
  • chronic pernio
    • usually progresses over several winters after repeated episodes of acute pernio
    • lesions occurring over several seasons may become oedematous, with permanent discoloration and subcutaneous nodule formation
      • nodules are firm and painful, ultimately rupturing, which provides pain relief and leaves a shallow ulcer with pigmented atrophic skin
      • these ulcers may grow larger and coalesce, remaining open, which leads to permanently swollen extremities, scaly pigmented skin, and unremitting pain aggravated by light pressure (1,2,3)

Differential diagnosis includes lupus erythematosus and emboli.

Management of the condition involves drying and gently massaging the affected skin.

  • active warming above 30 ° C should be avoided since it considerably worsens the pain
  • nifedipine (20 mg, 3 times daily) has shown to be beneficial in severe perniosis (4)

Reference:

Last reviewed 02/2021

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