Chilblains

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Chilblain
Other names: Pernio,[1] perniones,[2] perniosis,[1] kibes[3]
Wintertenen.jpg
Toes inflamed by chilblains
Pronunciation
SpecialtyEmergency medicine
SymptomsRedness, itching, blistering[4]
Usual onsetWithin a few hours[1]
Duration1 to 2 weeks[1]
CausesProlonged cold exposure[5]
Risk factorsLupus, smoking, family history, Raynaud's[1]
Diagnostic methodBased on symptoms and examination[6]
Differential diagnosisFrostbite, trench foot, leukemia cutis, cold panniculitis[5][7][8]
PreventionKeeping the hands and feet warm[1]
TreatmentCorticosteroid creams[1]

Chilblains, also known as pernio, is a type of cold injury that results in red, itchy, and tender areas of skin.[1][4] Less commonly blistering and ulceration may occur.[4] The fingers, toes, ears and cheeks are most commonly affected.[4]

Chilblains typically occurs due to prolonged exposure to cold.[5][8] The degree of cold; however, is less than freezing, which would result in frostbite.[5] Risk factors include lupus, smoking, family history, and Raynaud's.[1] The underlying mechanism involves the inflammation of small blood vessels.[1][4] Diagnosis is usually based on symptoms and examination.[6]

Prevention is generally by keeping the hands and feet warm.[1] Other measures may include avoiding caffeine and potentially taking nifedipine.[1] Treatment may involve the use of corticosteroid creams.[1] It may take a week or two for an episode to resolve.[1]

Chilblains is relatively common in regions of the world with cold climates.[8] The young and old are most commonly affected.[1] Women are more commonly affected than men.[8] The condition has been described since at least the 1st century by Pedanius Dioscorides of Anazarbus.[9]

Signs and symptoms

Chilblains from excessively icing the feet

The areas most affected are the toes, fingers, earlobes, nose.[1]

Chilblains caused by exposure to low temperatures usually heal within 7–14 days.

Diagnosis

Diagnosis is usually based on symptoms and examination.[6]

Differential diagnosis

In infants affected by Aicardi–Goutières syndrome (a rare inherited condition which affects the nervous system) chilblain-like symptoms occur together with severe neurologic disturbances and unexplained fevers.

Chilblain-like symptoms have also been linked to COVID-19.[10][11][12] COVID toes, as they are commonly known,[13][14] have mostly been reported in older children and adolescents,[15] who often have not had other symptoms of COVID-19.[16] The symptoms are usually mild and disappear without treatment.[15] Their cause is debated: it is uncertain whether COVID toes are a delayed consequence of the viral infection itself (or at least partially connected to environmental factors during the COVID-19 pandemic).[13][14][17] They may share some of the microscopic features of chilblains caused by lupus.[16] It has been suggested that in the absence of exposure to cold and damp, COVID-19 should be considered as a possible cause of chilblains.[16]

Prevention

Exposure

  • Keep affected area warm, and avoid any extreme temperature changes (including very hot water).[18][19]
  • Keep affected area dry.[20]
  • Wear warm shoes, socks and gloves.[19]
  • Wear a hat and a scarf to protect the ears and the nose.[19]
  • Avoid tight fitting socks/shoes.

Other

  • Exercise at least four times a week to improve circulation.[19]
  • Quit smoking, as it damages circulation.[18]

Treatment

Treatment for the condition depends on its cause. Below are some common treatments for chilblains caused by exposure to low temperatures, though some may also apply to other sources of the condition.

  • Soaking in warm water with Epsom salts for 15–20 minutes, 3–4 times a day.
  • A topical steroid cream may relieve itching.
  • Nifedipine, a vasodilator, may help in some cases,[21] and can be used throughout just the winter months.[1] Vasodilation may reduce pain, facilitate healing, and prevent recurrences.[22] It is typically available in an oral pill but can be compounded into a topical formula.
  • Diltiazem, a vasodilator, may help.[23]
  • Apply a mixture of friar's balsam and a weak iodine solution.[19]
  • Avoid restricting the affected area.[24]

History

The medieval Bald's Leechbook recommended treating chilblains with a mix of eggs, wine, and fennel root,[25] and a modern home remedy is to put garlic on the chilblains.[26] Neither of these remedies has been supported by scientific research.

See also

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 "Chilblains". DermNet NZ. Retrieved 1 December 2020. CS1 maint: discouraged parameter (link)
  2. Killian, H. (2012). Cold and Frost Injuries — Rewarming Damages Biological, Angiological, and Clinical Aspects: Biological, Angiological, and Clinical Aspects. Springer Science & Business Media. p. PT43. ISBN 978-3-642-67051-0.
  3. Bolognia, Jean L.; Jorizzo, Joseph L.; Schaffer, Julie V. (2012). Dermatology E-Book. Elsevier Health Sciences. p. 1493. ISBN 978-0-7020-5182-1.
  4. 4.0 4.1 4.2 4.3 4.4 "Cold Related Illnesses". www.cdc.gov. 21 February 2020. Retrieved 1 December 2020. CS1 maint: discouraged parameter (link)
  5. 5.0 5.1 5.2 5.3 Stanley, James C.; Veith, Frank; Wakefield, Thomas W. (2014). Current Therapy in Vascular and Endovascular Surgery E-Book. Elsevier Health Sciences. p. 701. ISBN 978-1-4557-5962-0.
  6. 6.0 6.1 6.2 Wigley, Fredrick M.; Herrick, Ariane L.; Flavahan, Nicholas A. (2014). Raynaud’s Phenomenon: A Guide to Pathogenesis and Treatment. Springer. p. 168. ISBN 978-1-4939-1526-2.
  7. Patterson, James W. (2019). Weedon's Skin Pathology E-Book. Elsevier Health Sciences. p. 290. ISBN 978-0-7020-7583-4.
  8. 8.0 8.1 8.2 8.3 Bonamigo, Renan Rangel; Dornelles, Sergio Ivan Torres (2018). Dermatology in Public Health Environments: A Comprehensive Textbook. Springer. p. 27. ISBN 978-3-319-33919-1.
  9. Cartwright, Anthony C.; Armstrong, N. Anthony (2020). A History of the Medicines We Take: From Ancient Times to Present Day. Pen and Sword History. p. PT274. ISBN 978-1-5267-2404-5.
  10. Wollina U, Karadağ AS, Rowland-Payne C, Chiriac A, Lotti T (2020). "Cutaneous signs in COVID-19 Patients: a review". Dermatologic Therapy: e13549. doi:10.1111/dth.13549. PMC 7273098. PMID 32390279.
  11. Young S, Fernandez AP (2020). "Skin manifestations of COVID-19". Cleveland Clinic Journal of Medicine. doi:10.3949/ccjm.87a.ccc031. PMID 32409442.
  12. Kaya G, Kaya A, Saurat JH (June 2020). "Clinical and histopathological features and potential pathological mechanisms of skin lesions in COVID-19: review of the literature". Dermatopathology. 7 (1): 3–16. doi:10.3390/dermatopathology7010002. PMID 32608380. In acral chilblain-like lesions, a diffuse dense lymphoid infiltrate of the superficial and deep dermis, as well as hypodermis, with a prevalent perivascular pattern and signs of endothelial activation, are observed.
  13. 13.0 13.1 Massey PR, Jones KM (May 2020). "Going viral: A brief history of chilblain-like skin lesions ("COVID toes") amidst the COVID-19 pandemic". Seminars in Oncology. doi:10.1053/j.seminoncol.2020.05.012. PMID 32736881.
  14. 14.0 14.1 Bristow IR, Borthwick AM (June 2020). "The mystery of the COVID toes – turning evidence-based medicine on its head". Journal of Foot and Ankle Research. 13 (1): 38. doi:10.1186/s13047-020-00408-w. PMC 7309429. PMID 32576291.
  15. 15.0 15.1 Walker DM, Tolentino VR (June 2020). "COVID-19: The impact on pediatric emergency care". Pediatric Emergency Medicine Practice. 17 (Suppl 6-1): 1–27. PMID 32496723.
  16. 16.0 16.1 16.2 Ladha MA, Luca N, Constantinescu C, Naert K, Ramien ML (August 2020). "Approach to chilblains during the COVID-19 pandemic". Journal of Cutaneous Medicine and Surgery: 1203475420937978. doi:10.1177/1203475420937978. PMID 32741218.
  17. Unusual coronavirus (COVID-19) symptoms: What are they?
  18. 18.0 18.1 Harvard.edu. https://www.health.harvard.edu/newsletter_article/what-can-i-do-about-chilblains. Retrieved 31 May 2020. Missing or empty |title= (help)CS1 maint: discouraged parameter (link)
  19. 19.0 19.1 19.2 19.3 19.4 "What are chilblains (pernio)? What causes chilblains?". Medical News Today.
  20. "Chilblains.org – #1 Online Source for Treatments, Prevention, Relief Advice". Chilblains.org.
  21. Rustin, M.H.A.; Newton, Julia A.; Smith, N.P.; Dowd, Pauline M. (2006). "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". British Journal of Dermatology. 120 (2): 267–75. doi:10.1111/j.1365-2133.1989.tb07792.x. PMID 2647123.
  22. Simon, T. D.; Soep, JB; Hollister, JR (2005). "Pernio in Pediatrics". Pediatrics. 116 (3): e472–5. doi:10.1542/peds.2004-2681. PMID 16140694.
  23. Patra, AK; Das, AL; Ramadasan, P (2003). "Diltiazem vs. nifedipine in chilblains: A clinical trial". Indian Journal of Dermatology, Venereology and Leprology. 69 (3): 209–11. PMID 17642888.
  24. "Chilblains.com.au – Information, Treatment and Prevention". Archived from the original on 2016-03-05. Retrieved 2019-11-06.
  25. Robert Lacey and Danny Danziger August: The Year 1000: What Life Was Like at the Turn of the First Millennium Little, Brown, 2000 ISBN 0316511579[page needed]
  26. "Remedios caseros para sabañones". saludplena.com (in Spanish). Retrieved 29 December 2016. CS1 maint: discouraged parameter (link) CS1 maint: unrecognized language (link)

External links

Classification
External resources