Pernio Workup

Updated: Feb 20, 2020
  • Author: Michele S Maroon, MD; Chief Editor: William D James, MD  more...
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Laboratory Studies

The following laboratory tests may be needed:

  • CBC count and sedimentation rate: These should be obtained to rule out associated leukemia.

  • Antiphospholipid antibody panel: Review of patients presenting with pernio shows an increased incidence of antiphospholipid antibody syndrome.

  • Cryoglobulins, cryofibrinogen, and cold agglutinin testing: These generally are absent but should be considered as part of the laboratory evaluation in a patient with chronic pernio. Because of occasional false-negative cryoprecipitate screening results, consider hepatitis C antibody screening or even rheumatoid factor (RF) as a marker for cryoglobulinemia in select cases.

  • Antinuclear antibody (ANA): Pernio lesions can occur in the setting of lupus erythematosus.

  • Serum protein electrophoresis (SPEP) and quantitative immunoglobulins: Dysproteinemias and macroglobulinemia, causing increased serum viscosity, may be associated with pernio.


Histologic Findings

Pernio can often be diagnosed on the basis of clinical findings. Biopsy may be indicated to rule out other inflammatory processes in difficult chronic cases. Punch biopsy is adequate. There is variable epidermal spongiosis or necrosis. Intense papillary dermal edema is present. A superficial and deep perivascular lymphocytic infiltrate is seen, with the described "fluffy edema" of vessel walls. Lymphocytic vasculitis may be present.