Pernio, also known as perniosis or chilblains, is the result of nonfreezing cold exposure in susceptible individuals. Pernio appears within 24 hours of cold exposure, most frequently on the face, ears, hands, feet, and pretibial areas. A large range of lesions may be seen, with localized edema, erythema, cyanosis, plaques, and blue nodules occasionally progressing to more severe lesions including vesicles, bullae, and ulcerations. The lesions persist for up to 2 weeks and may become chronic. They are typically very pruritic and associated with burning paresthesias. Following rewarming, pernio often takes the form of blue nodules, which are quite tender. In the setting of recent cold exposure, pernio might be confused with the more severe syndrome of trench foot. If the history of cold exposure is not elicited, the differential diagnosis is potentially very broad.
Pernio. Pernio or chilblains with localized erythema, cyanosis, and nodules. (Photo contributor: Ken Zafren, MD.)
Pernio. Pernio of the hand with localized erythema and painful nodules. (Photo contributor: Alison Jarman, MD.)
Management and Disposition
Management is supportive. The skin should be warmed, washed, and dried. Affected extremities can be dressed in soft, dry, sterile dressings and elevated. Nifedipine (20-60 mg daily) may be helpful in chronic cases.
Healing may be followed by hyperpigmentation.
Recurrences are possible following milder cold exposure.
Chilblains may be more frequent in young women, especially in association with Raynaud phenomenon, and may also be associated with underlying dermatologic or vascular disease.