Chilblains in Adult
Alerts and Notices
SynopsisChilblains, also known as pernio, is characterized as erythematous / violaceous papules that present after exposure to a cold and wet environment. It is typically observed during the fall and winter in seasonal climates. Lesions usually appear over a few hours and resolve over 7-14 days. They are initially pruritic and sometimes painful. (See COVID-19 for discussion of "COVID toes.")
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
Patient Information for Chilblains in Adult
OverviewChilblains (also known as pernio) are painful, swollen bumps that appear on exposed skin (fingers, nose, toes) in cold, damp weather. A rash called "COVID toes" (pseudo-chilblains), which can occur in coronavirus disease 2019 (COVID-19), is similar in appearance; like chilblains it can appear on the fingers as well as the toes.
Who’s At Risk
- Women, people who are underweight or have poor circulation, and people with autoimmune disease have an increased risk of getting typical chilblains. Wearing clothing that exposes your skin to cold air increases the likelihood of chilblains.
- Both children and adults can have COVID toes.
Signs & Symptoms
- Red, swollen bumps appear on the feet and hands, including the toes and fingers. Sometimes the skin turns purple or rarely blue. You may see blisters or scabs. Skin can be tender to touch, painful, and red. The skin may burn or itch.
- COVID-19-related lesions of the toes or fingers can appear anytime during the year. It is unclear why COVID toes occur, but people are likely still infectious when they have skin changes of COVID-19. Frequently, COVID toes are the only symptom of COVID-19. Skin changes can last for weeks and will resolve with the illness.
- Chilblains typically appear in cold, damp weather. Chilblains due to cold weather causes the tiny blood vessels in the fingers, toes, and nose to clamp down. When these areas warm up again, the blood vessels open and there is swelling and inflammation. Chilblains last about 1 or 2 weeks after cold exposure.
- If you or family members develop red or purple lesions on your fingers or toes, contact your health care provider about testing for COVID-19.
- Acetaminophen can be helpful for tenderness. You can apply moisturizing cream to reduce itching.
- For chilblains due to cold weather, rewarm the affected areas gently without the use of direct heat.
- Wear protective gear such as gloves, scarves, and hats to prevent typical chilblains.
When to Seek Medical CareSee a doctor if:
- You suspect COVID-19 infection. Call your doctor for instructions on how to best seek medical care in your community.
- Fever, cough, diarrhea, or other flu-like symptoms develop.
- The skin blisters or breaks down.
- The condition worsens after self-care.
- You suspect an underlying condition like lupus.
- Your doctor may order COVID-19 testing.
- Your doctor may want to do blood tests for any underlying medical conditions.
- Your doctor may recommend removing a small piece of skin for further evaluation under a microscope (biopsy) if your diagnosis is in question.
- Topical corticosteroid cream helps with inflammation.
- For typical chilblains, medicine that lowers blood pressure can open the blood vessels and increase blood flow.
- If skin breaks down and becomes infected, antibiotics may be prescribed.
Chilblains in Adult