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Pernio (Chilblains)

Opinion statement

Pernio is a vasospastic disorder that affects unprotected skin regions of individuals exposed to nonfreezing, damp cold. It may be idiopathic or associated with other systemic diseases, particularly cryopathies and lupus erythematosus. Acute pernio manifests several hours following exposure, whereas chronic pernio may persist even after the cold season has long ended. The pathophysiology is complex and related to patient and environmental factors. Pernio is diagnosed by clinical features. There are no characteristic histopathologic features that confirm the diagnosis, but biopsy of affected areas may exclude the presence of other disorders. Sequelae include superinfection, depigmentation, and scarring. Treatment involves rewarming of the whole body and avoidance of further exposure to cold. The use of the dihydropyridine calcium channel blocker nifedipine promotes faster healing and prevents recurrence.

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References

  1. Encyclopaedia Britannica, or A Dictionary of Arts, Sciences, and Miscellaneous Literature, edn 6. Edinburgh: Archibald Constable and Company; 1823.

  2. Jordaan HF: The diagnosis and management of perniosis (chilblains). SA Fam Pract 2007, 49:28–29.

    Google Scholar 

  3. Maroon MS, Hensley D: Pernio. Available at http://www.emedicine.com/derm/topic322.htm. Accessed December 17, 2007.

  4. Carpentier PH: Definition and epidemiology of vascular acrosyndromes. Rev Prat 1998, 48:1641–1646.

    PubMed  CAS  Google Scholar 

  5. Goette DK: Chilblains (perniosis). J Am Acad Dermatol 1990, 23:257–262.

    PubMed  CAS  Article  Google Scholar 

  6. Jacob JR, Weisman MH, Rosenblatt SI, et al.: Chronic pernio. A historical perspective of cold-induced vascular disease. Arch Intern Med 1986, 146:1589–1592.

    PubMed  Article  CAS  Google Scholar 

  7. Purdue GF, Hunt JL: Cold injury: a collective review. J Burn Care Rehabil 1986, 7:417–421.

    PubMed  Article  Google Scholar 

  8. Wessagowit P, Asawanonda P, Noppakun N: Papular perniosis mimicking erythema multiforme: the first case report in Thailand. Int J Dermatol 2000, 39:527–529.

    PubMed  Article  CAS  Google Scholar 

  9. Weston WL, Morelli JG: Childhood pernio and cryoproteins. Pediatr Dermatol 2000, 17:97–99.

    PubMed  Article  CAS  Google Scholar 

  10. Lynn RB: Chilblains. Surg Gynecol Obstet 1954, 99:720–726.

    PubMed  CAS  Google Scholar 

  11. Olin JW, Arrabi W: Vascular diseases related to extremes in environmental temperature. In Peripheral Vascular Disease, edn 2. Edited by Young JR, Olin JW, Bartholomew JR. St. Louis: Mosby-Year Book; 1996:611–613.

    Google Scholar 

  12. DeGroot DW, Castellani JW, Williams JO, et al.: Epidemiology of US Army cold weather injuries, 1980–1999. Aviat Space Environ Med 2003, 74:564–570.

    PubMed  Google Scholar 

  13. Winner A, Cooper-Willis E: Chilblains in service women. Lancet 1946, 1:663.

    Article  Google Scholar 

  14. Elias PM, Jackson SM: What does normal skin do? In Cutaneous Medicine and Surgery, an Integrated Program in Dermatology. Edited by Arndt KA, LeBoit PE, Robinson JK, Wintroub BU. Philadelphia: WB Saunders Co.; 1996:46–57.

    Google Scholar 

  15. Eero L: The skin in the cold. Int J Circumpolar Health 2002, 61:277–286.

    Google Scholar 

  16. Eubanks RG: Heat and cold injuries. J Arkansas Med Soc 1974, 71:53–58.

    PubMed  CAS  Google Scholar 

  17. Kulka JP: Vasomotor microcirculatory insufficiency: observations on nonfreezing cold injury of the mouse ear. Angiology 1961, 12:491–506.

    PubMed  Article  CAS  Google Scholar 

  18. Lewis T: Observations upon the reactions of the vessels of the human skin to cold. Heart 1930, 15:177–208.

    Google Scholar 

  19. Daanen HAM, Van de Linde FJG, Romet T, Ducharme MB: The effect of body temperature on the hunting response of the middle finger skin temperature. Eur J Appl Physiol 1997, 76:538–543.

    Article  CAS  Google Scholar 

  20. Daanen HAM, Ducharme MB: Finger cold-induced vasodilatation during mild hypothermia, hyperthermia and at thermoneutrality. Aviat Space Environ Med 1999, 70:1206–1210.

    PubMed  CAS  Google Scholar 

  21. Hanson HJ, Goldman RF Cold injury in man: a review of its etiology and discussion of its prediction. Mil Med 1969, 134:1307–1316.

    PubMed  CAS  Google Scholar 

  22. Winter kibes in horsey women. Lancet 1980, 2:1345.

  23. Price RD, Murdoch DR: Perniosis (chilblains) of the thigh: report of five cases, including four following river crossings. High Alt Med Biol 2001, 2:535–538.

    PubMed  Article  CAS  Google Scholar 

  24. Goodfield M: Cold-induced skin disorders. Practitioner 1989, 233:1616–1620.

    PubMed  CAS  Google Scholar 

  25. Rintamaki H: Predisposing factors and prevention of frostbite. Int J Circumpolar Health 2000, 59:114–121.

    PubMed  CAS  Google Scholar 

  26. Hassi J, Makinen TM: Frostbite: occurrence, risk factors and consequences. Int J Circumpolar Health 2000, 59:92–98.

    PubMed  CAS  Google Scholar 

  27. Hamlet MP: Prevention and treatment of cold injury. Int J Circumpolar Health 2000, 59:108–113.

    PubMed  CAS  Google Scholar 

  28. Viguier M, Pinquier L, Cavelier-Balloy B, et al.: Clinical and histopathologic features and immunologic variables in patients with severe chilblains. A study of the relationship to lupus erythematosus. Medicine (Baltimore) 2001, 80:180–188.

    Article  CAS  Google Scholar 

  29. AlMahameed A, Olin JW: Pernio (chilblains). In Vascular Medicine: A Companion to Braunwald’s Heart Disease. Edited by Creager MA, Dzau VJ, Loscalzo J. Philadelphia: Elsevier; 2006:723-728.

    Google Scholar 

  30. Cribier B, Djeridi N, Peltre B, et al.: A histologic and immunohistochemical study of chilblains. J Am Acad Dermatol 2001, 45:924–929.

    PubMed  Article  CAS  Google Scholar 

  31. Herman EW, Kezis JS, Silvers DN: A distinctive variant of pernio. Clinical and histopathologic study of nine cases. Arch Dermatol 1981, 117:26–28.

    PubMed  Article  CAS  Google Scholar 

  32. Wall LM, Smith NP: Perniosis: a histopathological review. Clin Exp Dermatol 1981, 6:263–271.

    PubMed  Article  CAS  Google Scholar 

  33. Corbett D, Benson P: Military dermatology. In Textbook of Military Medicine. Part III. Diseases of the Environment. Edited by Zajtchuk R, Bellamy RF. Washington, DC: Office of the Surgeon General; 1994.

    Google Scholar 

  34. Inoue G, Miura T: Microgeodic disease affecting the hands and feet of children. J Pediatr Orthop 1991, 11:59–63.

    PubMed  CAS  Google Scholar 

  35. Page EH, Shear NH: Temperature-dependent skin disorders. J Am Acad Dermatol 1988, 18:1003–1019.

    PubMed  CAS  Google Scholar 

  36. Beacham BE, Cooper PH, Buchanan CS, et al.: Equestrian cold panniculitis in women. Arch Dermatol 1980, 116:1025–1027.

    PubMed  Article  CAS  Google Scholar 

  37. De Silva BD, McLaren K, Doherty VR: Equestrian perniosis associated with cold agglutinins: a novel finding. Clin Exp Dermatol 2000, 25:285–288.

    PubMed  Article  Google Scholar 

  38. Duffill MB: Milkers’ chilblains. N Z Med J 1993, 106:101–103.

    PubMed  CAS  Google Scholar 

  39. Fisher DA, Everett MA: Violaceous rash of dorsal fingers in a woman. Diagnosis: chilblain lupus erythematosus (perniosis). Arch Dermatol 1996, 132:459, 462.

    PubMed  Article  CAS  Google Scholar 

  40. Thomas EW: Chapping and chilblains. Practitioner 1964, 193:755–760.

    PubMed  CAS  Google Scholar 

  41. Giusti R, Tunnessen WW Jr: Picture of the month. Chilblains (pernio). Arch Pediatr Adolesc Med 1997, 151:1055–1056.

    PubMed  CAS  Google Scholar 

  42. Weismann K, Larsen FG: Pernio of the hips in young girls wearing tight-fitting jeans with a low waistband. Acta Dermato-Venereologica 2006, 86:558–559.

    PubMed  Article  Google Scholar 

  43. Parlette EC, Parlette HL 3rd: Erythrocyanotic discoloration of the toes. Cutis 2000, 65:223–224, 226.

    PubMed  CAS  Google Scholar 

  44. Spittell JA Jr, Spittell PC: Chronic pernio: another cause of blue toes. Int Angiol 1992, 11:46–50.

    PubMed  Google Scholar 

  45. Rustin MH, Newton JA, Smith NP, et al.: The treatment of chilblains with nifedipine: the results of a pilot study, a double-blind placebo-controlled randomized study and a long-term open trial. Br J Dermatol 1989, 120:267–275.

    PubMed  CAS  Article  Google Scholar 

  46. Dowd PM, Rustin MH, Lanigan S: Nifedipine in the treatment of chilblains. Br Med J (Clin Res Ed) 1986, 293:923–924.

    CAS  Google Scholar 

  47. Patra AK, Das AL, Ramadasan P: Diltiazem vs. nifedipine in chilblains: a clinical trial. Indian J Dermatol Venereal Leprol 2003, 69:209–211.

    CAS  Google Scholar 

  48. White KP, Rothe MJ, Milanese A, et al.: Perniosis in association with anorexia nervosa. Pediatr Dermatol 1994, 11:1–5.

    PubMed  Article  CAS  Google Scholar 

  49. Rustin MH, Foreman JC, Dowd PM: Anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud’s phenomenon and worsening of chilblains. J R Soc Med 1990, 83:495–496.

    PubMed  CAS  Google Scholar 

  50. Reinertsen JL: Unusual pernio-like reaction to sulindac [letter]. Arch Derm 1981, 117:1215.

    Google Scholar 

  51. Rose R, Bartholomew JR, Olin JW: Atheromatous embolization syndrome. In Vascular Surgery, edn 6. Edited by Rutherford RB. Philadelphia: WB Saunders Co.; 2004.

    Google Scholar 

  52. Solomon LM, Beerman H: Cold panniculitis. Arch Dermatol 1961, 88:897–900.

    Google Scholar 

  53. Montgomery H, O’Leary PA, Barker NW: Nodular vascular disease of the legs. JAMA 1945, 128:335.

    Google Scholar 

  54. Creager MA, Halperin JL, Coffman JD: Raynaud’s phenomenon. In Vascular Medicine: A Companion to Braunwald’s Heart Disease. Edited by Creager MA, Dzau VJ, Loscalzo J. Philadelphia: Elsevier; 2006:689–705.

    Google Scholar 

  55. Coffman JD: Acrocyanosis. In Vascular Medicine: A Companion to Braunwald’s Heart Disease. Edited by Creager MA, Dzau VJ, Loscalzo J. Philadelphia: Elsevier; 2006:707–710.

    Google Scholar 

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Correspondence to Amjad AlMahameed.

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AlMahameed, A., Pinto, D.S. Pernio (Chilblains). Curr Treat Options Cardio Med 10, 128–135 (2008). https://doi.org/10.1007/s11936-008-0014-0

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Keywords

  • Nifedipine
  • Anorexia Nervosa
  • Dermatol
  • Cold Exposure
  • Complex Regional Pain Syndrome