Saturday, January 01, 2011
Chilblains is a recurrent, localized erythema and swelling of
the hands, feet, ears, and face. The reaction is an abnormal
reaction to cold that occurs most frequently in women, children,
and the elderly. Lesions tend to become worse in the elderly, and
improve spontaneously in younger patients. The therapeutic strategy
is to correct the conditions that result in chronic cold exposure
and to employ therapeutic agents that increase peripheral
The calcium channel blocker nifedipine 10 mg three times daily
or 20 mg twice daily is very effective in both increasing the rate
of resolution of pernio lesions and in preventing their appearance.
This efficacy is due to the vasodilatory effect of this medication.
While mild symptoms of peripheral edema and hypotension may occur,
these symptoms rarely require discontinuation of the medication
when used at low doses. Monitor blood pressure at the start of
treatment and at return visits.
- Keeping both the affected extremities and the core body warm
are essential in preventing pernio. Patients should wear thick
socks and shoes. For perniosis of the hands, gloves are
recommended. The ambient temperature must be kept warm. These
environmental changes are most critical in preventing
- Keep feet dry. Moisture enhances cold injury.
- Nicotinamide 500 mg three times daily may be useful alone or in
addition to calcium channel blockers.
- Hexylnicotinate 2% cream applied three times daily may be
useful for patients intolerant of or unwilling to take oral
- Amlodipine 2.5-5 mg once daily may be used as an alternative
calcium channel blocker. The long half-life and consequent once
daily dosing of this drug is beneficial when chronic therapy is
- Erythematous doses of ultraviolet light to affected areas 2 to
3 times a week at the start of winter may be preventive.
- Pernio-like lesions occur in both discoid and systemic lupus
erythematosus, as well as in sarcoidosis. The possibility of lupus
should be excluded by appropriate laboratory tests and biopsy.
- Cryoglobulinemia, cryofibrinogenemia and other hypercoagulable
states should be considered, especially in atypical or refractory
cases. Most cases of classic perniosis are not associated with such
conditions but are environmentally triggered.
- Chilblains may be accompanied by other clinical manifestations
of cold sensitivity, such as acrocyanosis and/or