Perniosis or Chilblains: Symptoms, Treatment, Diagnosis

 

Perniosis is painful, inflamed skin patches that often develop after exposure to cold but not freezing air. They generally, repair without treatment. Chilblains are most common in females, but any can be affected by them.

Overview:

Chilblains, also known as pernio, are painful and inflamed skin patches that develop after exposure to cold but not freezing air. They typically appear on fingers or toes, but can also develop on the legs or ears. Chilblains are more common in women and individuals with a low body mass index (BMI), and those living in damp or nonfreezing climates. They usually heal within one to three weeks, but may recur annually. Treatment may include medications to soothe pain or itching and preventive measures such as keeping the affected areas warm and moisturized. To reduce the risk of chilblains, it's important to avoid cold, damp environments and exercise regularly to improve blood circulation. If chilblains persist for more than three weeks or if there are other concerning symptoms, it's important to seek medical attention.

What are chilblains (pernio)?

Chilblains also referred to as pernio, are small areas of skin inflammation that occur after exposure to cold or damp air, but not freezing air. Typically, chilblains appear on your fingers or toes, although they can also develop on your ears or legs.

Chilblains, also known as pernio or perniosis, are blue or red and can cause itchiness, tenderness, or pain.

How common are chilblains?

Chilblains are not extremely common, but they can occur in individuals who are exposed to cold or damp conditions. They are more prevalent in certain populations, such as women and those with a low body mass index (BMI), as well as in individuals living in damp or nonfreezing climates. While not widespread, chilblains can affect a significant number of people, especially in specific demographic groups and environmental conditions.

Who is at risk of developing chilblains?

Everybody can get chilblains, but women and individuals with a low BMI (body mass index) have a higher risk of developing them. You are also prone to get chilblains if you:

1. Smoke
2. Live in a nonfreezing or damp climate
3. Wear tight mittens or gloves, tight shoes, or clothing in cold, damp weather
4. Babies may develop chilblains in damp or cold weather if not dressed appropriately, including covering their faces.

Your risks of developing chilblains also elevate if you have:

• Peripheral arterial disease (PAD)
• Lupus erythematosus
• Raynaud’s phenomenon
• Bone marrow disorders, for example myelomonocytic (CMML)

What does Pernio look like?

Pernio typically appears as small, inflamed, and painful patches of skin. These patches are often red or bluish and may feel itchy, tender, or painful. They can develop on the fingers, toes, legs, or ears, and may also a on theppear nose or ears.

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How long do chilblains last?

Chilblains typically take one to three weeks to heal, assuming you avoid cold or damp weather and wear appropriate clothing. If you are at high risk, chilblains may return each year during weather changes. Your healthcare provider can prescribe treatments to prevent frequent chilblains.

Symptoms:

What are the symptoms of chilblains?

Chilblains are painful, swollen patches of skin. Although chilblains can appear anywhere, they usually develop on your toes or fingers. They may also show up on your nose or ears. Sometimes, these skin patches look shiny.

You may also have:

• Burning sensation
• Blisters
• Skin color changes with blue or red patches
• Itching

Causes:

What causes chilblains (pernio)?

Chilblains, also known as pernio, are caused by an abnormal skin reaction to cold temperatures. When the skin is exposed to cold, especially when damp, blood vessels near it's surface may narrow and then suddenly expand again, leading to inflammation. Chilblains can cause damage to the small blood vessels in the skin, leading to the characteristic symptoms of swelling, itching, and redness. It's important to take precautions to protect your skin from cold temperatures and to seek medical advice if you experience these symptoms.

The accurate reason why chilblain reaction occurs is still unknown, but some health experts consider pernio develops due to:

• Hormonal changes
• Genetics
• Primary diseases, including peripheral arterial disease or connective tissue disorders

Diagnosis:

How are chilblains diagnosed?

Your healthcare provider can diagnose chilblain by examining your skin. They may suggest skin biopsy or blood tests. These tests assist your healthcare provider in finding out if you have a condition that elevates your risk for chilblains or have another condition that takes off chilblains.

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Treatment:

How are chilblains treated?

As long as you avoid the damp or cold weather, often chilblains go away indepedently. If you still experience chilblain signs after two or three weeks, you should consult with your healthcare provider for treatment. 

Medications:

Your healthcare providers can prescribe medicines. These medicines may soothe your itching or pain. Your provider may prescribe you:

1. Topical medications: These medicines include

Topical steroid such as betamethasone valerate (Valisone®, Beta-Val®) or nitroglycerin (Nitro-Bid®), Nitrol®)

2. Oral medications: These include

Pentoxifylline (Trental®, Pentoxil®), that will improve blood circulation.

Nifedipine (Adalat®) will assist in dilating your blood vessels

Management:

What can I do to manage chilblains (pernio)?

To manage chilblains (pernio), you can take several steps to lessen the symptoms and prevent further distress. Here are some strategies you can consider:

• Keep the affected areas warm: Protect the affected areas from cold temperatures and moisture. Wear warm, dry socks and gloves, and use heating pads or warm packs to keep the skin warm.
• Moisturize: Apply moisturizing lotions or creams to the affected areas to help soothe dry, irritated skin.
• Avoid scratching: Avoid scratching the affected areas of the skin, as this can worsen the pain and potentially cause infection.
• Seek out medical advice: If the symptoms persist or worsen, it's crucial to consult your healthcare provider for personalized advice and treatment options.

Prevention:

How can I prevent developing chilblains?

To prevent developing chilblains, you can take several measures to protect your skin from cold temperatures and minimize the risk of this condition. Here are some strategies to consider:

• Keep warm: Dress in layers and wear warm, dry clothing, especially in cold and damp conditions. Pay particular attention to keeping your extremities, such as hands and feet, well-insulated.
• Avoid sudden temperature changes: Avoid exposure to quick temperature changes, as this can elevate the risk of chilblains. When coming in from the cold, allow your body to gradually adjust to warmer temperatures.
• Keep skin dry: Moisture can exacerbate the risk of chilblains, so it's important to keep your skin dry, especially in cold and damp conditions. Change out of wet clothing promptly and ensure your footwear is waterproof.
• Protect extremities: Wear gloves, warm socks, and appropriate footwear to protect your hands and feet from the cold.
• Stay active: Engage in physical activity to promote circulation and keep your body warm.

Complications:

Do chilblains lead to complications?

Generally, chilblains do not lead to complications or long-term health problems. It’s crucial to keep any affected skin areas clean so that you don’t get a skin infection. 

When should I see my healthcare provider?

Most of the time chilblains heal without any treatment. Visit your healthcare provider instantly if you have the following conditions:

• Diabetes and develop chilblains on your feet.
• Chilblains that don’t go away after three weeks
• Pus coming out of your skin.
• Fever or chills

What other conditions share similarities with perniosis?

Certain conditions that impact blood vessels can present symptoms akin to perniosis, and some of these conditions may be serious. Seeking a healthcare provider's assessment and treatment is advisable.

These conditions are:

• Chilblain lupus
• Cellulitis
• Frostbite
• Vasculitis
• Blood clots (embolism) in your feet or legs
• Contact dermatitis
• Raynaud’s phenomenon

Conclusion:

Chilblains are sore, red patches of skin that happen after being in the cold. Anyone can get them, but they're more common in women. If you have a low BMI or live in a cold, damp place, you're more likely to get chilblains. Usually, they go away on their own. If they keep coming back, your doctor might give you medicine to stop them from happening so much. For most people, chilblains don't cause long-term health problems.