Abstract
A 68-year-old woman presents with pain in the 4th and 5th toes of her right foot. Her toes are tender and cold to touch with purple discoloration. Capillary refill time is prolonged in both digits but feet pulses are preserved bilaterally.
This is pernio (chilblains)
Pernio (or chilblains) is a vasospastic condition causing localised, tender bumps that tend to appear on extremities, most commonly fingers, toes or ears, following exposure to non-freezing or damp conditions. It can be idiopathic or associated with vasculopathies such as lupus erythematous (Al Mahameed and Pinto, 2008).
It typically presents with itching or burning pain, localised swelling and purple/red discolouration.
The pathophysiology is unknown; however, risk factors include female gender, low body mass index and smoking (Prakash and Weisman, 2009).
The diagnosis is typically clinical but can be confirmed with more invasive testing, including skin biopsy. However, if an underlying vasculopathy is being considered, further blood tests, such as full blood count, anti-nuclear antibody, rheumatoid factor, antiphospholipid antibodies and complement levels, should be included.
Pernio is usually managed conservatively in mild cases. In more severe cases, calcium channel blockers, such as oral Nifedipine, are recommended as a first-line pharmacological treatment (Pratt et al., 2021). For symptomatic management of itchiness, steroid creams can be used though there is currently no evidence supporting a specific cream composition over another. Local anaesthetic creams can also be used for the same purpose on unbroken chilblains.
Pernio is typically a self-resolving condition, with an overall excellent prognosis (Whitman and Cran, 2022). The lesions are rarely severe and patients do not usually have any long-term physical sequelae.
