Perniosis idiopática: reporte de un caso y revisión de la literatura / Chilblains: report of a case and literature review

Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. It is reported a case of a 59-year-old otherwise healthy woman with acute primary perniosis. She had a 3-day history of lesions on the toes brought on by cold, damp weather. On initial presentation, a biopsy sample was taken of a hallux lesion, and the patient was given a trial course of oral pentoxifylline, topical corticoid and nifedipine therapy. Follow-up at 2 weeks showed complete relief of symptoms and the biopsy results confirmed the diagnosis. Pentoxifylline therapy has been shown to be effective and should be considered the standard of care in the treatment of perniosis along with conservative environmental measures.The etiology and pathogenesis of perniosis are reviewed and discussed, as well as differential diagnoses and treatment options. (AU)

Case for diagnosis / Caso para diagnóstico

Chilblains are an inflammatory skin condition that develops following exposure to the cold. They consist of pruritic and/or painful erythematous-to-violaceous acral lesions and are the result of an abnormal vascular response to exposure to the cold. This benign condition is common in southern Brazil, particularly in Rio Grande do Sul where climatic conditions, together with cultural and economic aspects, facilitate the development of these sores.

Eritema pérnio é uma condição inflamatória da pele que ocorre após exposição ao frio e se manifesta com lesões eritêmato-violáceas, pruriginosas e dolorosas nas extremidades. Ocorre devido a uma resposta vascular alterada à exposição ao frio. Esta condição benigna é frequente na região sul do Brasil, especialmente no Rio Grande do Sul, onde as características clínicas, associadas a aspectos culturais e econômicos, promovem o desenvolvimento do eritema pérnio.

Eritema pérnio na faixa etária pediátrica / Chilblains in pediatrics

Os autores apresentam 5 casos com eritema pérnio da população de 5079 pacientes acompanhados na Unidade de Reumatologia Pediátrica doInstituto da Criança por um período consecutivo de 25 anos. Destes, 4 eram primários e um secundário ao lúpus eritematoso sistêmico juvenil. Todos apresentaram lesões cutâneas com acometimento de extremidades associadas às baixas temperaturas ambientais. O tratamento principal foi orientação de aquecimento das extremidades, utilização de luvas e meias e uso de nifedipina nos casos refratários.

The authors show 5 cases with chilblains from the populations of 5079 patients followed in the Pediatric Rheumatology Unity of the Instituto da Criança for a consecutive a period of 25 years. From these, 4 were primary and one was secondary to juvenile systemic lupus erytematosus. All of them had cutaneous lesions with involvement of extremities, associated at low environmental temperature. The main treatment was the orientation with warming of the extremities, utilization of gloves and socks, and nifedipine in the refractory cases...

Perniosis: clinical and epidemiological study in Iraqi patients

Perniosis [chilblains] is a common skin problem. This condition results from abnormal reaction to cold which is usually seen during the cold months of year. The aim of the present study is to shed a light on different clinical and epidemiological aspects of perniosis in Iraq. A total of 40 patients with perniosis were seen between January to march 2008 in the department of dermatology and venereology of Baghdad Teaching Hospital. A detailed history was taken from each patient regarding age, sex, occupation, duration of attack, family history, smoking, drug history, medical history, relieving and aggrevating factors and previous treatment modality. Full examination was done to each patient to assess the distribution and extent and morphology of the lesions and to see if there other skin diseases. Biopsies was done for 6 patients for histopathological study. A total of 40 patients were assessed. Their ages ranged from 5-60 years with a mean age of 22 SD +/- 6.2, 31 females and 9 males [3.5:1]. Main sites of involvemnt were; toes 39%, fingers 22%, heals 10% and nose 2.5%. Main types of lesions were; erythematous cyanotic swellings 82%, vesicular lesions 23%, ulcerations 10% and erythema multiforme like lesions 15%. Family history was positive in 22.5% of patients. Perniosis occur mainly in females between 10-20 years. Most common sites of involvement are toes and fingers genetic susceptibility is an important factor in the development of the disease. Majority of patients are healthy without any medical or dermatological diseases. Majority are non smokers and did not have any history of drug intake

Chilblains at Abbottabad, a moderately cold weather station

Chilblains are quite often seen in various parts, in particular cold weather areas of Pakistan. Unfortunately, no studies have so far been carried out in Pakistan, to determine epidemiological aspects of chilblains. The objective of this study was to see the epidemiological patterns of chilblains at a moderately cold weather station. The study was conducted at Dermatology out patient department of Combined Military Hospital, Abbottabad from 1 Dec 2004 to 31 Mar 2005. All the patients fulfilling clinical criteria for the diagnosis of chilblains were registered. Every patient was interviewed in detail followed by thorough physical examination. Complete Blood Count, Urine Routine Examination and Anti Nuclear Factor were carried out in only those patients, having the disease of more than 3 years duration. A pre-designed proforma was filled separately for each patient. Out of 111 patients, 67 [60.4%] males and 44 [39.6%] females were registered with the diagnosis of chilblains. Fifty nine [53.2%] patients were locals and 52 [46.8%] were non locals. Out door workers were 75 [67.6%]. Onset in majority of the patients [42.3%] was in the age group 11-20 years. Family history of chilblains was present in 25 [22.5%] patients and 8 patients [7.2%] were smokers. The disease of longer duration was more common in females and locals. At moderately cold weather areas, out door workers and young adolescents are more likely to develop Chilblains. The disease of longer duration is more common among females and local residents. On the other hand, first episode or the disease of shorter duration is more common among non locals at moderately cold weather stations because of poor acclimatization and inadequate protection

Eritema pernio en dos gemelas de ocho meses de vida / Chillblains in two tween sisters eigth months old

Se comunican 2 pacientes gemelas, de ocho meses de vida, que presentan lesiones maculares eritematovioláceas localizadas en el dorso y regiones laterales de los pies, con edema de los dedos. Se realizan los estudios histopatológicos que son compatibles con eritema pernio, entidad que se diagnostica con poca frecuencia en lactantes

Perniosis: Estudio clinico e histologico de 5 casos / Perniosis: Histological and Clinical study of 5 cases

Incluimos en este trabajo 5 casos de perniosis(2 superficiales,2 profundas,1 mixta)observados durante el invierno de 1990 en nuestro servicio. Clinicamente se presentaron como maculas o pequenias placas dolorosas de coloracion rojo-violacea localizada en miembros inferiores(4 casos) y cara (1 caso). La histologia revelo la tipica angeitis linfocitaria con edema de la pared vascular. Referimos otras variantes histologicas y consideramos sus principales diagnosticos diferenciales