Chilblains in Adult
Chilblains is most common in children and young to middle-aged women. Lesions are typically self-limited but may be recurrent. Chronic pernio is characterized by persistent lesions after repeated exposure to the cold. Blistering, pustules, crusting, and ulceration can occur in severe cases. Chilblains results from an abnormal inflammatory and vascular response to cold temperatures, especially when the environment is also humid.
Equestrian perniosis is a rare variant that usually affects the thighs and buttocks of (most often female) horseback riders. It may affect individuals in other recreational scenarios involving cold exposure and tight-fitting clothing, such as motorcycle riders or outdoor enthusiasts. Histology is generally consistent with that of classic perniosis.
Pernio can be a primary disorder or secondary to other conditions, such as connective tissue disease, monoclonal gammopathy, cryoproteinemia, chronic myelomonocytic leukemia, and viral infections, although the causative mechanisms have yet to be established. Compared with primary pernio, secondary pernio tends to be associated with photosensitivity and persistence beyond cold seasons.
T69.1XXA – Chilblains, initial encounter
37869000 – Chilblains
Differential Diagnosis & Pitfalls
- Dyshidrotic dermatitis
- Raynaud phenomenon – Has a much shorter duration than chilblains and is characterized by well-demarcated cutaneous pallor and cyanosis followed by erythema.
- COVID toes (see COVID-19) – Pseudo-chilblains on the acral surfaces, including erythema, edema, vesiculation, and purpura of the hands and feet (more commonly the feet). Lesions may be painful, itchy, or asymptomatic.
- Erythema multiforme minor
- Leukocytoclastic vasculitis
- Polyarteritis nodosa – Typically has linear and tender nodules compared to chilblains. In very rare cases, a biopsy may be necessary to distinguish chilblains from polyarteritis nodosa.
- First-degree burns
- Bruising secondary to trauma
- Cold panniculitis
- Cocaine levamisole toxicity
- Systemic lupus erythematosus
- Lupus chilblains
- Antiphospholipid antibody syndrome