Chilblains Explained

Chilblains
Synonyms:	Pernio, perniones, perniosis^[1]
Field:	Internal medicine, podiatry

Chilblains, also known as pernio, is a medical condition in which damage occurs to capillary beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue, resulting in redness, itching, inflammation, and possibly blisters.^[2]

It occurs most frequently when predisposed individuals, predominantly women,^[3] are exposed to cold and humidity. Ulcerated chilblains are referred to as kibes. Temperature-related chilblains can be prevented by keeping the feet and hands warm in cold weather and avoiding exposing these areas to extreme temperature changes. Once the diagnosis of chilblains is made, first-line treatment includes avoiding cold, damp environments and wearing gloves and warm socks.^[3]

Chilblains can be idiopathic (spontaneous and unrelated to another disease), but similar symptoms may also be a manifestation of another serious medical condition that must be investigated. Related medical conditions include Raynaud syndrome, erythromelalgia, frostbite, and trench foot, as well as connective tissue diseases such as lupus or vasculitis. 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.

Signs and symptoms

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

• Blistering of affected area
• Burning and itching sensation in extremities
• Dermatitis in extremities
• Ulceration (severe cases only)
• Erythema (blanchable redness of the skin)
• Pain in affected area
• Skin discoloration, red to dark blue

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

Prevention

Exposure

• Keep affected area warm, and avoid any extreme temperature changes (including very hot water).
• Keep affected area dry.^[4]
• Wear warm shoes, socks and gloves.
• Wear a hat and a scarf to protect the ears and the nose.
• Avoid tight fitting socks/shoes.

Other

• Exercise at least four times a week to improve circulation.
• Quit smoking, as it damages circulation.^[5]

Treatment

• Nifedipine and amlodipine, which are vasodilators in the class of drugs known as calcium channel blockers, may help in some cases.^[6] Vasodilation may reduce pain, facilitate healing, and prevent recurrences.^[7] It is typically available in an oral pill but can be compounded into a topical formula.
• Diltiazem, a vasodilator, may help.^[8]
• Apply a mixture of friar's balsam and a weak iodine solution.^[9]

Etymology

The word is a compound of Modern English chill ‘cold’ and the archaic word blain (now used only in the word in question), meaning ‘swelling’, ‘blister’ or ‘sore’ and derived from Old English bleġen, bleġene, having the same meaning.^[10]

History

The medieval Bald's Leechbook recommended treating chilblains with a mixture of eggs, wine, and fennel root.^[11] A modern-day home remedy is to put garlic on the chilblains.^[12] While neither of these remedies has been supported by scientific research, vasodilating, rubiefacient and warming herbal remedies, both topical and internal are prescribed and efficacious.

COVID-19

Chilblain-like symptoms have also been linked to COVID-19.^{[13] [14] [15]} COVID toes, as they are commonly known,^{[16] [17] [18]} have mostly been reported in older children and adolescents,^[19] who often have not had other symptoms of COVID-19.^[20] The symptoms are usually mild and disappear without treatment. Their cause is debated: it is uncertain whether COVID toes are a delayed consequence of the viral infection itself or are, at least partially, connected to environmental factors during the COVID-19 pandemic.^[21] They may share some of the microscopic features of chilblains caused by lupus. 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.

In a study at the dermatology department of Saint-Louis Hospital in Paris, researchers found that most of their study participants carried high levels of autoantibodies, proteins generated by the immune system that inadvertently attack the body's own tissues. Compared with healthy individuals, the participants showed high activity of proteins called type 1 interferons, which switch on pathogen-fighting genes in immune cells.^[22]

See also

• Equestrian perniosis
• Erythrocyanosis crurum
• Raynaud's disease

External links

• • Cold stress, National Institute for Occupational Safety and Health

Notes and References

1. Book: James . William D. . Elston . Dirk M. . Treat . James R. . Rosenbach . Misha A. . Neuhaus . Isaac M. . Andrews' Diseases of the Skin . 2020 . Elsevier . 9780323547536 . 13th . Dermatoses Resulting From Physical Factors. 18–45.
2. https://www.cdc.gov/niosh/topics/coldstress/ Cold Stress: Chilblains
3. Beuscher . Tara L. . Andrews . Sarah E. . What Are COVID Toes? A Case Study . Journal of Wound, Ostomy & Continence Nursing . November 2020 . 47 . 6 . 619–621 . 10.1097/WON.0000000000000711. 33201148 . 226988942 .
4. Web site: Chilblains.org – #1 Online Source for Treatments, Prevention, Relief Advice. Chilblains.org. 2014-09-02. 2014-11-24. https://web.archive.org/web/20141124054002/http://chilblains.org/. dead.
5. Web site: 1 December 2010 . By the way, doctor: What can I do about chilblains? . Harvard Health . 31 May 2020.
6. Rustin . M.H.A. . Newton . Julia A. . Smith . N.P. . Dowd . Pauline M. . 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 . 2006 . 2647123 . 10.1111/j.1365-2133.1989.tb07792.x. 13230013 .
7. Simon . T. D. . Soep . JB . Hollister . JR . Pernio in Pediatrics . Pediatrics . 116 . 3 . e472–5 . 2005 . 16140694 . 10.1542/peds.2004-2681. 2091725 .
8. Patra . AK . Das . AL . Ramadasan . P . Diltiazem vs. nifedipine in chilblains: A clinical trial . 17642888 . 2003 . 209–11 . 3 . 69 . Indian Journal of Dermatology, Venereology and Leprology .
9. Web site: What are chilblains (pernio)? What causes chilblains?. Medical News Today. 20 December 2017.
10. https://en.wiktionary.org/wiki/chilblain Retrieved at 8.45 on Wednesday 20/12/23.
11. Robert Lacey and Danny Danziger August: The Year 1000: What Life Was Like at the Turn of the First Millennium Little, Brown, 2000
12. Web site: Remedios caseros para sabañones. saludplena.com. es. 29 December 2016.
13. Wollina U, Karadağ AS, Rowland-Payne C, Chiriac A, Lotti T. 2020. Cutaneous signs in COVID-19 Patients: a review. Dermatologic Therapy. 33. 5. e13549. 10.1111/dth.13549. 7273098. 32390279. free.
14. Young S, Fernandez AP. 2020. Skin manifestations of COVID-19. Cleveland Clinic Journal of Medicine. 10.3949/ccjm.87a.ccc031. 32409442. free.
15. 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. 10.3390/dermatopathology7010002. 7583593. 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.. free.
16. 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. 47. 5. 330–334. 10.1053/j.seminoncol.2020.05.012. 7245293. 32736881. free.
17. 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. 10.1186/s13047-020-00408-w. 7309429. 32576291. free.
18. Rocha. Kelvin Oliveira. Zanuncio. Virgínia Vinha. Freitas. Brunnella Alcântara Chagas de. Lima. Luciana Moreira. "COVID toes": A meta-analysis of case and observational studies on clinical, histopathological, and laboratory findings. Pediatric Dermatology. 2021. 38. 5. 1143–1149. en. 10.1111/pde.14805. 34515379. 8646534. 1525-1470. free.
19. Walker DM, Tolentino VR. June 2020. COVID-19: The impact on pediatric emergency care. Pediatric Emergency Medicine Practice. 17. Suppl 6-1. 1–27. 32496723.
20. 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. 24. 5. 504–517. 10.1177/1203475420937978. 32741218. free.
21. https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-unusual-symptoms/faq-20487367 Unusual coronavirus (COVID-19) symptoms: What are they?
22. Web site: Nicoletta Lanese. 2021-10-07. We might finally know what causes 'COVID toes'. 2022-01-08. livescience.com. en.