Medical Care

Prophylactic warming of acral areas, achieved by heat and appropriate clothing, best prevents pernio.

Ultraviolet light, given at the beginning of the cold, damp season, has been touted as preventing outbreaks of pernio in prone individuals. Pathogenesis was loosely based on damaging the minute vessels and minimizing their ability to vasoconstrict with subsequent cold exposure. However, in at least one double-blind study, ultraviolet therapy was of no value in prophylaxis of pernio.^[15]

Avoidance of nicotine may help alleviate pernio.^[4]

Consultations

Consult a dermatologist for diagnosis and evaluation of associated disease.

Diet

Thin body habitus may be associated with heightened cutaneous vasoreactivity; the healthcare provider needs to be aware of this population at risk.

Activity

Prophylactic warming of acral areas with minimization of cold exposure may prevent disease recurrence.

Prevention

Avoid exposure to cold.

Cease smoking.

Medication

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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Prakash S, Weisman MH. Idiopathic chilblains. Am J Med. 2009 Dec. 122(12):1152-5. [QxMD MEDLINE Link].
Almahameed A, Pinto DS. Pernio (chilblains). Curr Treat Options Cardiovasc Med. 2008 Apr. 10(2):128-35. [QxMD MEDLINE Link].
Kelly JW, Dowling JP. Pernio. A possible association with chronic myelomonocytic leukemia. Arch Dermatol. 1985 Aug. 121(8):1048-52. [QxMD MEDLINE Link].
White KP, Rothe MJ, Milanese A, Grant-Kels JM. Perniosis in association with anorexia nervosa. Pediatr Dermatol. 1994 Mar. 11(1):1-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Reinertsen JL. Unusual pernio-like reaction to sulindac. Arthritis Rheum. 1981 Sep. 24(9):1215. [QxMD MEDLINE Link].
Boesjes CM, van Rhijn BD, van Dijk MR, Sigurdsson V. Posttraumatic unilateral perniosis: A case report. JAAD Case Rep. 2019 Oct. 5 (10):909-911. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Langtry JA, Diffey BL. A double-blind study of ultraviolet phototherapy in the prophylaxis of chilblains. Acta Derm Venereol. 1989. 69(4):320-2. [QxMD MEDLINE Link].
Verma P. Topical Nitroglycerine in Perniosis/Chilblains. Skinmed. 2015 May-Jun. 13 (3):176-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

Media Gallery

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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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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.