Clinical Characteristics, Etiologic Associations, Laboratory Findings, Treatment, and Proposal of Diagnostic Criteria of Pernio (Chilblains) in a Series of 104 Patients at Mayo Clinic, 2000 to 2011

Cappel, Jonathan A.; Wetter, David A.

doi:10.1016/j.mayocp.2013.09.020

Cited by 95 publications

(128 citation statements)

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“…Three of the 5 patients in our cohort also had primary Raynaud's phenomenon, which may have contributed to their altered vasospastic response on vascular testing. However, a previously published cohort of 104 patients with pernio found that 18 (17%) had coexistent Raynaud's phenomenon [1]. In addition, a previous study found that 5 of 39 patients with pernio also had coexistent Raynaud's phenomenon [7].…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion criteria for a diagnosis of pernio (i.e. localized erythema and swelling involving acral sites that persisted for >24 h, with a final diagnosis rendered by a dermatologist) were as previously described by Cappel and Wetter [1]. Four patients were identified from a previously published cohort of 104 patients by Cappel and Wetter [1], and 1 patient was identified by a diagnosis of pernio and the requisite testing as documented in the institutional database as having been seen after that initial report.…”

Section: Methodsmentioning

confidence: 99%

“…Pernio (chilblains) is a vascular condition marked by an inflammatory process, and affected patients present with localized pruritic, erythematous and swollen lesions that occur in response to damp conditions and cold but not freezing temperatures [1]. Lesions first appear 12- 24 h after exposure and are generally confined to the extremities, ears and face [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although the etiology is unknown, one theory is that cold-induced vasospasm leads to hypoxemia, with a subsequent secondary inflammatory response [4]. Some patients with pernio also have coexistent Raynaud's phenomenon [1], and we therefore hypothesized that vasospasm could be the inciting event leading to the clinical manifestations of pernio. However, studies are lacking to document the potential pathogenic role of vasospasm in pernio through noninvasive vascular testing.…”

Section: Introductionmentioning

confidence: 99%

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Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis

Shahi¹,

Wetter²,

Cappel³

et al. 2015

Dermatology

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Background/Aims: Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. We sought to determine whether cold-induced vasospasm has a role in the development of pernio. Methods: We retrospectively reviewed 5 patients with pernio who were seen at our institution between January 1, 2000 and December 31, 2011, and had undergone a noninvasive arterial vascular study of the upper extremities that corresponded to a site of clinical involvement of pernio and who had also undergone vasospastic testing and ice water immersion as part of the noninvasive arterial vascular study protocol. Results: Vascular testing in all patients (mean age 37.8 years; 4 women) demonstrated vasospasm with ice water immersion. Conclusion: Our findings suggest that vasospasm likely has a role in the pathophysiology of pernio and may also provide a rationale for the pharmacological treatment of vasospasm in patients with pernio.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis

Shahi¹,

Wetter²,

Cappel³

et al. 2015

Dermatology

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“…Chilblain, also known as pernio, manifests with tender violaceous to blue macules, papules and plaques across acral sites 1. Most cases are attributed to exposure to cold, moist environmental conditions.…”

Section: Introductionmentioning

confidence: 99%

Chilblain-like leukaemia cutis

Tran

McEwen²,

Fraga

2016

BMJ Case Reports

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Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic

et al. 2021

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n early 2020, dermatologists in Europe noticed a sharp increase in chilblains, an inflammatory dermatosis that generally affects the dorsal feet or hands during periods of damp and cold, but not freezing, conditions, associated with the COVID-19 pandemic. [1][2][3][4][5][6][7][8] Few patients with chilblains tested positive for SARS-CoV-2 or its antibodies, although access to testing was limited. [1][2][3][4] Subsequent reports of series with complete viral and antibody testing indicated low frequencies of tests with positive results. [5][6][7][8] The underlying causes of an increase in chilblains related to the pandemic are controversial. 5,[7][8][9][10] Published cases of presumed secondary chilblains in the setting of confirmed COVID-19 infection indicate that COVID-19associated symptoms preceded chilblains by up to 30 days. 2,11 On noticing an increase in chilblains after the shelter-athome order was initiated in 6 Bay Area counties in California on March 16, 2020 (and statewide on March 18, 2020), we conducted a retrospective cohort study to test the hypothesis that increased cases of chilblains appeared in the same locations as increased cases of COVID-19 over time. Methods Setting and DesignKaiser Permanente Northern California provides comprehensive, integrated care to 4.4 million people, with all clinical information entered into an electronic medical record. The health care system operates 23 medical centers that are located to serve defined urban, suburban, and exurban population centers. Northern California is known for its microclimates. The IMPORTANCE Beginning in March 2020, case reports and case series linked the COVID-19 pandemic with an increased occurrence of chilblains, but this association has not been evaluated in an epidemiologic study.OBJECTIVE To assess whether a correlation exists between COVID-19 incidence and chilblains incidence. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted within the Kaiser Permanente Northern California system from January 1, 2016, to December 31, 2020; health plan members of all ages were included.EXPOSURE COVID-19 incidence in 207 location-months, representing 23 geographic locations in northern California across 9 months. MAIN OUTCOME AND MEASURESChilblains incidence was the main outcome. The association of chilblains incidence with COVID-19 incidence across the 207 location-months was measured using the Spearman rank correlation coefficient. RESULTSOf 780 patients with chilblains reported during the pandemic, 464 were female (59.5%); mean (SD) age was 36.8 (21.8) years. COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P = .01). However, only 17 of 456 (3.7%) patients with chilblains tested during the pandemic were positive for SARS-CoV-2, and only 9 of 456 (2.0%) were positive for SARS-CoV-2 within 6 weeks of the chilblains diagnosis. Test results of 1 of 97 (1.0%) patients were positive for SARS-CoV-2 IgG antibodies. Latinx patients were disproportionately affected by C...

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Clinical Characteristics, Etiologic Associations, Laboratory Findings, Treatment, and Proposal of Diagnostic Criteria of Pernio (Chilblains) in a Series of 104 Patients at Mayo Clinic, 2000 to 2011

Cited by 95 publications

References 10 publications

Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis

Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis

Chilblain-like leukaemia cutis

Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic

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