Picture of the Month

Case Report: Six-Year-Old Girl With Recurrent Episodes of Blue Toes

“…1 This condition was first described in 1894 by Corlett. 2 The precise incidence of this condition in children is unknown but appears to be extremely rare, less than 1 in a million. Pernio most commonly affects young women between the ages of 15 and 30 years, but it can affect older individuals or children.…”

“…4 The precise etiology of pernio is unknown; both abnormal nerve control of the blood vessel diameter and nerve sensitivity to cold exposure have been suspected as being contributing factors. 2 Histopathology of pernio lesions most often lacks inflammation or signs of vascular injury, which makes vasculitis less likely, and instead shows invasion of the underlying plexus with lymphocytes. 5 A variety of conditions have been described in association with pernio.…”

Modigliani's “fillette en bleu”: a case of juvenile dermatomyositis?

“…4 Children, especially those with sensitive skin, are more susceptible than adults to sunburn and cold injuries. 5,6 The girl's pale blue eyes and the mahogany touch of her hair indicate that her skin may have been type I. Although sunburn rarely affects the hands, chilblains and frostbite typically occur on the face and hands and could develop even after moderate cold exposure in individuals with certain predisposing conditions, including collagen diseases.…”

Childhood Pernio and Cryoproteins

“…It is believed to be far more common in Europe than North America, and there are few reports from North America (1–4). Most series report adult patients (4–6), but isolated cases have been reported in children (7–9). One report states that pernio “is common in women and children,” but it describes only a single case (9).…”

“…Others suspect a low‐grade vasculitis of cutaneous vessels, although signs of acute vascular injury, such as fibrin deposition, inflammatory cells in the vessel wall, or thrombosis, are usually absent (1,2,6). Perivascular cuffing and some endothelial swelling are usually found (5,8). Some affected persons are felt to have collagen vascular disease, especially lupus erythematosis (6).…”