chilblain

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Chilblain
Classification and external resources
ICD-10	T69.1
ICD-9	991.5
DiseasesDB	31219
eMedicine	derm/322

Chilblains (also known as pernio and perniosis^[1]:25) is a medical condition that is often confused with frostbite and trench foot. Chilblains are acral ulcers (that is, ulcers affecting the extremities) that occur when a predisposed individual is exposed to cold and humidity. The cold exposure damages capillary beds in the skin, which in turn can cause redness, itching, blisters, and inflammation.^[2] Chilblains are often idiopathic in origin but can be manifestations of serious medical conditions that need to be investigated. Chilblains can be prevented by keeping the feet and hands warm in cold weather. Smoking cessation and consultation with a dermatologist are advised. A history of chilblains is suggestive of a connective tissue disease.

Symptoms

• Ulceration of the digits and toes
• Red nose
• Skin redness
• Toe skin inflammation
• Finger skin inflammation
• Earlobe inflammation

Duration

With treatment, chilblains usually heal within 7–14 days.

Treatments

• Keep area warm
• Nifedipine may be used in more severe or recurrent cases.^[3] Its vasodilation helps reduce pain, facilitate healing and prevent recurrences.^[4]
• Diltiazem, a newer calcium channel blocker, may also be used.^[5]

Prevention

Exposure

• Avoid rapid changes in temperature.
• Wear gloves or socks.
• Use warm footwear.
• Keep hands and feet warm.
• Avoid tight fitting socks/shoes
• Place cotton wool between the toes to improve circulation

Dietary

• Healthy diet
• Exercise to improve circulation
• High doses of vitamin K^{[citation needed]}
• Avoid alcohol before going out in snow

History

The medieval Bald's Leechbook recommended that chilblains be treated with a mix of eggs, wine, and fennel root.^[6]

See also

• Erythrocyanosis crurum
• Equestrian perniosis
• Trench foot
• Frostbite

References

1. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
2. ^ Cold Stress: Chilblains. National Institute for Occupational Safety and Health. Retrieved January 6, 2009.
3. ^ Rustin M, Newton J, Smith N, Dowd P (1989). "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 120 (2): 267–75. PMID 2647123. 
4. ^ Simon T, Soep J, Hollister J (2005). "Pernio in pediatrics". Pediatrics 116 (3): e472–5. doi:10.1542/peds.2004-2681. PMID 16140694. http://pediatrics.aappublications.org/cgi/content/full/116/3/e472. 
5. ^ Patra AK, Das AL, Ramadasan P. (2003). "Diltiazem vs. nifedipine in chilblains: A clinical trial". Indian J Dermatol Venereol Leprol 69: 209–11. PMID 17642888 : 17642888. http://www.ijdvl.com/text.asp?2003/69/3/209/999. 
6. ^ 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

External links

• DermAtlas -1683395337
• Cold stress, National Institute for Occupational Safety and Health
• Chillblains, Chillblains: Causes, Treatment and Personal Experiences