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Pernio Medication

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

Medication Summary

The use of topical and systemic steroids, vasodilators,[10, 15, 16, 17] intravenous calcium followed by intramuscular vitamin K, and ultraviolet B radiation has been anecdotally reported in the literature. In most cases of pernio, the value of these agents is questionable and often disputed.

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Calcium channel blockers

Class Summary

Peripheral arterial vasodilators may be effective in the treatment and prevention of pernio.

Nifedipine (Procardia)

 

Nifedipine relaxes coronary smooth muscle and produces coronary vasodilation, which, in turn, improves myocardial oxygen delivery. Small studies have shown this drug to be effective in reducing symptoms associated with severe recurrent pernio. Nifedipine is currently considered the drug of choice.

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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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