chilblains

Last edited 05/2022 and last reviewed 05/2023

Chilblains (also known as pernio) are localized cutaneous inflammatory lesions of the extremities 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 in children, anorexia nervosa in adolescents, and lupus erythematosus in adults (1,3).

They are caused by localized vasoconstriction which results in tissue anoxemia and inflammation leading to 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 (1)
    • 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: feet, hands, legs, and thighs
    • single or multiple, erythematous, purplish, edematous lesions with vesicles
      • may have yellowish or brownish discoloration associated with peeling
    • symptoms - intense pruritus, burning, or pain, often worsened by subsequent warmth
    • lesions are usually self-limited
      • 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
    • repeated exposure to the cold resulting in persistence of lesions, with subsequent scarring and atrophy (1)
    • 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
      • 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, primary Raynaud’s phenomenon 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), a calcium channel blocker, has shown to be beneficial in severe pernio (1).

Reference:

Related pages:

epidemiology

risk factors

clinical features

differential diagnosis

management

chapping

cold injuries

non freezing cold injuries (NFCI)

Covid toe (toes)