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Pernio (Chilblains)
From WikEM
Contents
Background
- 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
- 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
- Trench foot
- Pernio (Chilblains)
- Cold panniculitis
- Cold urticaria
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
