Chilblains in Southern California: two case reports and a review of the literature

Abstract

IntroductionChilblains or perniosis is an acrally located cutaneous eruption that occurs with exposure to cold. Chilblains can be classified into primary and secondary forms. The primary or idiopathic form is not associated with an underlying disease and is clinically indistinguishable from the secondary form. The secondary form is associated with an underlying condition such as connective tissue disease, monoclonal gammopathy, cryoglobulinemia, or chronic myelomonocytic leukemia. Histopathology cannot accurately help distinguish the primary from secondary forms of chilblains. This article will raise the awareness of chilblains by presenting two unusual case reports of chilblains in men from Southern California with discussion of the appropriate evaluation and treatment of this condition.Case presentationsCase 1A 56-year-old Caucasian man presented in January to a Southern California primary care clinic with a report of tingling and burning in both feet, followed by bluish discoloration and swelling as well as blistering. He had no unusual cold exposure prior to the onset of his symptoms. He had a history of “white attacks” in his hands consistent with Raynaud’s phenomenon. His symptoms gradually resolved over a 3-week period.Case 2A 53-year-old Caucasian man also presented to a Southern California clinic in January with a 3-week history of painful tingling in his toes, and subsequent purplish-black discoloration of the toes in both feet. His symptoms occurred 1 week after a skiing trip. He had partial improvement with warming measures. His symptoms resolved 2 weeks after his initial presentation.ConclusionsChilblains is a relatively uncommon entity in warmer climates but can present during the winter months. Primary care providers in warmer climates such as Southern California in the USA may be unfamiliar with its presentation. It can be diagnosed clinically by the appearance of typical lesions during the cold damp season. Through a thorough history, physical examination and selected laboratory evaluation, underlying connective tissue disease or a mimic such as vasculitis or cutaneous leukemia can be excluded.

Thermal Injuries in Veterinary Forensic Pathology

“…A skin biopsy may help to rule out these disorders, but the histopathology of chilblains is nonspecific. 22 In domestic animals, a chilblain syndrome was suspected as the cause of an itchy skin lesion at the tail tip of dogs that frequently became ulcerated often after automutilation. 32 As clinical differential diagnoses of local cold injuries, several disorders have to be considered, including chemical burns, toxic epidermal necrolysis, erythema multiforme, bullous autoimmune diseases, vasculitis, and ischemic or pressure necrosis.…”

Demographic findings of patients diagnosed with pernio and comparison of their vitamin B12, folate and ferritin levels with a control group

“…The average age of patients diagnosed with pernio in our hospital was 28 years. Cases have been reported in all age groups, including children 5,9 . In our study, 57.2% of the patients were female.…”

Soğuk Hasarı ve Perniosis (Mayasıl)

“…Primer veya kazara hipotermi yeterince iyi giyinmemiş veya ciddi soğuğa maruz kalan sağlıklı bireylerde meydana gelebilmektedir. Sekonder hipotermide ise başka bir hastalık nedeniyle kişi hipotermiye yatkınlık geliştirmektedir [1][2][3] . Soğuk hasarının ciddiyetine göre değişen hipotermi semptomları çok sayıda organı etkilemektedir.…”

“…Her iki durumda da rektal sıcaklık düşük seviyeyi okuyabilen bir termometre ile ölçülmelidir. Soğuk hasarında hastane öncesi genel tedavi prensipleri (1) daha fazla ısı kaybını önlemek, (2) sıcak bir zemine yerleştirerek vücut sıcaklığını artırmaya çalışmak, (3) ventriküler fibrilasyondan kaçınmak, şeklinde sıralanabilir [1][2][3] .…”

“…Genel olarak doku donması meydana gelene kadar ciddi hasar gelişmemektedir. Periferik soğuk hasarının en hafif formu ise üşüme (frostnip)'dir [1][2][3] . Vücut çeşitli mekanizmalarını devreye sokarak (vazokonstrüksiyon) çevresel soğuğa karşı vücut ısısını sabit tutmaya çalışır.…”