Chilblains, also known as pernio, is a medical condition in which damage occurs to
capillary
A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...
beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue resulting in redness, itching,
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
, and possibly
blister
A blister is a small pocket of body fluid (lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled w ...
s. It occurs most frequently when predisposed individuals, predominantly women, 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.
Chilblains can be
idiopathic
An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. From Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approximately "a disease of its own kin ...
(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
Raynaud syndrome, also known as Raynaud's phenomenon, eponymously named after the physician Auguste Gabriel Maurice Raynaud, who first described it in his doctoral thesis in 1862, is a medical condition in which the spasm of small arteries cau ...
,
erythromelalgia
Erythromelalgia or Mitchell's disease (after Silas Weir Mitchell) is a rare vascular peripheral pain disorder in which blood vessels, usually in the lower extremities or hands, are episodically blocked (frequently on and off daily), then become ...
,
frostbite
Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the h ...
, and
trench foot, as well as
connective tissue disease
A connective tissue disease (collagenosis) is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds toget ...
s such as
lupus
Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...
or
vasculitis
Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused ...
. In infants affected by
Aicardi–Goutières syndrome
Aicardi–Goutières syndrome (AGS), which is completely distinct from the similarly named Aicardi syndrome, is a rare, usually early onset childhood, inflammatory disorder most typically affecting the brain and the skin (neurodevelopmental disor ...
(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
toe
Toes are the digits (fingers) of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plant ...
s,
finger
A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers (Pentadactyly). Chambers 1 ...
s,
earlobe
The human earlobe (''lobulus auriculae''), the lower portion of the outer ear, is composed of tough areolar and adipose connective tissues, lacking the firmness and elasticity of the rest of the auricle (the external structure of the ear). In ...
s,
nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...
.
*
Blister
A blister is a small pocket of body fluid (lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled w ...
ing of affected area
* Burning and
itch
Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasant ...
ing sensation in extremities
*
Dermatitis in extremities
*
Ulceration
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...
(severe cases only)
*
Erythema
Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not assoc ...
(
blanchable redness of the skin)
*
Pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
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.
* 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.
Treatment
* Nifedipine
Nifedipine (3,5-dimethyl 2,6-dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate), sold under the brand name Adalat and Procardia, among others, is a calcium channel blocker medication used to manage angina, high blood pressure, R ...
and amlodipine
Amlodipine, sold under the brand name Norvasc among others, is a calcium channel blocker medication used to treat high blood pressure and coronary artery disease. It is taken by mouth.
Common side effects include swelling, feeling tired, ab ...
, which are vasodilator
Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstricti ...
s in the class of drugs known as calcium channel blocker
Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...
s, may help in some cases. Vasodilation
Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstriction ...
may reduce pain, facilitate healing, and prevent recurrences. It is typically available in an oral pill but can be compounded into a topical formula.
* Diltiazem
Diltiazem, sold under the brand name Cardizem among others, is a calcium channel blocker medication used to treat high blood pressure, angina, and certain heart arrhythmias. It may also be used in hyperthyroidism if beta blockers cannot be us ...
, a vasodilator, may help.
* Apply a mixture of friar's balsam
Tincture of benzoin is a pungent solution of benzoin resin in ethanol. A similar preparation called Friar's Balsam or Compound Benzoin Tincture contains, in addition, Cape aloes or Barbados aloes and storax resin. Friar's balsam was invented by ...
and a weak iodine solution.
History
The medieval ''Bald's Leechbook
''Bald's Leechbook'' (also known as ''Medicinale Anglicum'') is an Old English medical text probably compiled in the ninth century, possibly under the influence of Alfred the Great's educational reforms.Nokes, Richard Scott ‘The several compil ...
'' recommended treating chilblains with a mixture of eggs, wine, and fennel
Fennel (''Foeniculum vulgare'') is a flowering plant species in the carrot family. It is a hardy, perennial herb with yellow flowers and feathery leaves. It is indigenous to the shores of the Mediterranean but has become widely naturalized ...
root. A modern-day home remedy is to put garlic on the chilblains. While neither of these remedies has been supported by scientific research, vasodialating, rubifacient and warming herbal remedies, both topical and internal are prescribed and efficacious.
COVID-19
Chilblain-like symptoms have also been linked to COVID-19. COVID toes, as they are commonly known, have mostly been reported in older children and adolescents, who often have not had other symptoms of COVID-19. 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. 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.
See also
* Equestrian perniosis
* Erythrocyanosis crurum
* Raynaud's disease
Raynaud syndrome, also known as Raynaud's phenomenon, eponymously named after the physician Auguste Gabriel Maurice Raynaud, who first described it in his doctoral thesis in 1862, is a medical condition in which the spasm of small arteries cau ...
References
External links
*
Cold stress
National Institute for Occupational Safety and Health
{{Authority control
Foot diseases
Skin conditions resulting from physical factors
Effects of external causes
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