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Pernio Differential Diagnoses

  • Author: Michele S Maroon, MD; Chief Editor: William D James, MD  more...
 
Updated: Feb 08, 2016
 
 

Diagnostic Considerations

Also consider the following:

  • Acrocyanosis
  • Aicardi-Goutieres syndrome
  • Emboli (septic or cholesterol)
  • Erythromelalgia
  • Ischemia
  • Nakajo-Nishimura syndrome
  • Purple toe syndrome secondary to coumarin
  • Raynaud phenomenon
  • Trauma

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Michele S Maroon, MD Program Director, Department of Dermatology, Geisinger Medical Center

Michele S Maroon, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

David Hensley, MD Mullanax Dermatology Associates, Arlington Memorial Hospital

David Hensley, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Pennsylvania Medical Society, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

References
  1. Shahi V, Wetter DA, Cappel JA, Davis MD, Spittell PC. Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis. Dermatology. 2015 Sep. 231 (3):274-9. [Medline].

  2. Singh GK, Datta A, Grewal RS, Suresh MS, Vaishampayan SS. Pattern of chilblains in a high altitude region of Ladakh, India. Med J Armed Forces India. 2015 Jul. 71 (3):265-9. [Medline].

  3. Chan Y, Tang WY, Lam WY, et al. A cluster of chilblains in Hong Kong. Hong Kong Med J. 2008 Jun. 14(3):185-91. [Medline].

  4. Prakash S, Weisman MH. Idiopathic chilblains. Am J Med. 2009 Dec. 122(12):1152-5. [Medline].

  5. Almahameed A, Pinto DS. Pernio (chilblains). Curr Treat Options Cardiovasc Med. 2008 Apr. 10(2):128-35. [Medline].

  6. Kelly JW, Dowling JP. Pernio. A possible association with chronic myelomonocytic leukemia. Arch Dermatol. 1985 Aug. 121(8):1048-52. [Medline].

  7. White KP, Rothe MJ, Milanese A, Grant-Kels JM. Perniosis in association with anorexia nervosa. Pediatr Dermatol. 1994 Mar. 11(1):1-5. [Medline].

  8. Akkurt ZM, Ucmak D, Yildiz K, Yürüker SK, Celik HÖ. Chilblains in Turkey: a case-control study. An Bras Dermatol. 2014 Jan-Feb. 89 (1):44-50. [Medline].

  9. Rustin MH, Foreman JC, Dowd PM. Anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud's phenomenon and worsening of chilblains. J R Soc Med. 1990 Aug. 83(8):495-6. [Medline].

  10. Kearby R, Bowyer S, Scharrer J, Sharathkumar A. Case Report: Six-Year-old Girl With Recurrent Episodes of Blue Toes. Clin Pediatr (Phila). 2010 Jan 28. [Medline].

  11. Su WP, Perniciaro C, Rogers RS 3rd, White JW Jr. Chilblain lupus erythematosus (lupus pernio): clinical review of the Mayo Clinic experience and proposal of diagnostic criteria. Cutis. 1994 Dec. 54(6):395-9. [Medline].

  12. Viguier M, Pinquier L, Cavelier-Balloy B, et al. Clinical and histopathologic features and immunologic variables in patients with severe chilblains. A study of the relationship to lupus erythematosus. Medicine (Baltimore). 2001 May. 80(3):180-8. [Medline].

  13. Reinertsen JL. Unusual pernio-like reaction to sulindac. Arthritis Rheum. 1981 Sep. 24(9):1215. [Medline].

  14. Langtry JA, Diffey BL. A double-blind study of ultraviolet phototherapy in the prophylaxis of chilblains. Acta Derm Venereol. 1989. 69(4):320-2. [Medline].

  15. Verma P. Topical Nitroglycerine in Perniosis/Chilblains. Skinmed. 2015 May-Jun. 13 (3):176-7. [Medline].

  16. Dowd PM, Rustin MH, Lanigan S. Nifedipine in the treatment of chilblains. Br Med J (Clin Res Ed). 1986 Oct 11. 293(6552):923-4. [Medline].

  17. Rustin MH, Newton JA, Smith NP, Dowd PM. 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. 1989 Feb. 120(2):267-75. [Medline].

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Erythematous macules on distal toes of a 6-month-old girl with pernio.
Close-up of erythematous macules and plaques on distal plantar toes.
A 63-year-old man with pernio presenting as acral violaceous plaques with bullae.
Close-up of great toe bulla.
 
 
 
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