Materiały źródłowe

• #1 Chilblains (Pernio): Symptoms and Management — DermNet

  https://dermnetnz.org/topics/chilblains

  Chilblains are tender and/or itchy bumps on acral sites following exposure to damp, cold, non-freezing conditions causing a localised form of vasculitis. […] Chilblains are usually diagnosed clinically. Investigations are sometimes required to exclude differential diagnoses or look for causes of secondary chilblains. […] Skin biopsy of primary idiopathic chilblains shows a superficial and deep lymphocytic vasculitis, lymphocytes around the eccrine sweat glands, subepidermal oedema, with or without interface changes. […] The Mayo Clinic has developed diagnostic criteria for chilblains: Major criterion (required) localised redness and swelling of acral sites lasting at least 24 hours. […] Chilblains are classified as idiopathic (primary) if there is no associated cause, and secondary if a cause can be identified. […] Investigations for secondary causes of chilblains may include: Full blood count, ANA, rheumatoid factor, antiphospholipid antibodies, Complement levels, Protein electrophoresis, Cold agglutinins and, in children, cryoglobulins.

• #2 Chilblains – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097

  Chilblains (CHILL-blayns) is a condition that causes inflamed swollen patches and blistering on the hands and feet. It’s caused by exposure to damp air that’s cold but not freezing. Symptoms may show up a few hours after being in the cold. […] Seek medical care for chilblains if you: Have symptoms that are long lasting or go away then flare. […] The exact cause of chilblains is unknown. They may be an unusual reaction of your body to cold followed by rewarming. […] Chilblains symptoms that are long-lasting and develop after repeated exposure to cold and damp conditions can cause scarring and thin skin. […] To prevent chilblains: Avoid or limit your exposure to the cold.

• #3

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Chilblains

  Diagnostics […] Diagnosis based on clinical history and physical examination […] Symptoms usually start 12-24 hours after exposure to cold […] Causes itching, burning, pain in affected area […] Typically occur on the toes or dorsum of fingers […] Can occur on ears, nose, face, thighs, and buttocks […] No systemic involvement […] Formation of single or multiple dusky red to purple macules, papules, plaques, or nodules […] The lesions may blister or ulcerate […] Laboratory tests only if suspect concomitant disease […] CBC +Diff […] ANA, antiphospholipid antibodies […] Rheumatoid factor […] Complement, cryoglobulins […] Skin biopsy if atypical presentation

• #4 Chilblains

  https://www.nhs.uk/conditions/chilblains/

  Chilblains usually appear a few hours after you’ve been in the cold. […] You may need to see a GP if they do not go away. […] A GP will check your symptoms to see if you have chilblains. […] They may need to refer you for further tests with a specialist if they’re not sure why you’re getting chilblains. […] Rarely, the GP will prescribe a medicine that can help your chilblains clear up.

• #5 Chilblains

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3255185/

  A 26-year-old woman presented with a three-year history of painful and itching skin lesions on both feet that worsened during the winter and improved during the summer. Based on the relation of cold temperature to her skin lesions, we considered a diagnosis of chilblains. Results of laboratory analyses including a complete blood count, antinuclear antibodies, cryoglobulins, cryofibrinogen, cold agglutinins, antiphospholipid antibodies and serum protein electrophoresis were normal. […] Chilblains, also called perniosis, are an inflammatory skin condition related to an abnormal vascular response to the cold. It typically presents as tender, pruritic red or bluish lesions located symmetrically on the dorsal aspect of the fingers, toes, ears and nose. […] Because it remains a diagnosis of exclusion, a minimal workup for chilblains includes a complete blood count, antiphospholipid antibody panel, cryoglobulins, cryofibrinogen, cold agglutinins, antinuclear antibodies and serum protein electrophoresis. In treatment-resistant or chronic chilblains, further testing, including a biopsy, may be indicated to rule out other inflammatory processes. Histology usually shows intense papillary dermal edema, superficial and deep perivascular lymphocytic infiltrates and edema of vessel walls.

• #6 Chilblains (Pernio): What Is It, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21817-chilblains-pernio

  Chilblains are inflamed, painful skin patches. […] Chilblains, also known as pernio, are small patches of inflamed skin. […] Chilblains are typically red, bluish or purplish. […] Anyone can get chilblains, but people with a low body mass index (BMI) have a higher risk of developing them. […] How are chilblains diagnosed? […] Often, your healthcare provider can diagnose chilblains by looking at your skin. But they may sometimes recommend blood tests or a skin biopsy. […] How are chilblains treated? […] Often, chilblains go away on their own as long as you avoid the cold and/or damp weather conditions. […] If chilblains keep coming back, your healthcare provider may give you a medication to prevent chilblains from developing as frequently. […] See your healthcare provider right away if you have: Chilblains that dont go away after three weeks. […] Some conditions that affect your blood vessels cause symptoms similar to chilblains. […] Your healthcare provider can offer specific ways to take care of your skin.

• #7 Chilblains | Diagnosis, Causes & Treatments

  https://www.mattraden.co.uk/conditions/chilblains

  Chilblains cause small, inflamed red patches on the feet (and hands) after you move from very cold temperatures into the warmth. […] Signs and symptoms of chilblains include: Pain and throbbing at the toes (and fingers), Red or purple discolouration in patches, Inflammation and swelling, Itchiness and sensitivity around the toes, Changes in skin texture, with the skin becoming dry, scaly or hardened, Severe chilblains may blister, become eroded, or may even ulcerate. […] With chilblains, it is the rapid change from vasoconstriction (narrow vessels) to vasodilation, where the blood starts rushing through, this can cause damage to the vessels and result in blood leaking to the surrounding tissues – so the affected area (often the toes) becomes inflamed, red and tender. […] While in the case of chilblains, the damage has already been done and you’ll need to focus on caring for your feet at home and preventing another episode of chilblains in the future, for many of our patients, they may have underlying problems that either make it much easier to develop chilblains (like poor circulation associated with diabetes), or put them at risk of skin damage once they have chilblains. […] Remember, in the case of chilblains, prevention is 100% the best cure – and preventing chilblains can be done by just following very simple principles.

• #8 Chilblains (Pernio): What Is It, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21817-chilblains-pernio

  Chilblains are inflamed, painful skin patches. […] Chilblains, also known as pernio, are small patches of inflamed skin. […] Chilblains are typically red, bluish or purplish. […] Anyone can get chilblains, but people with a low body mass index (BMI) have a higher risk of developing them. […] How are chilblains diagnosed? […] Often, your healthcare provider can diagnose chilblains by looking at your skin. But they may sometimes recommend blood tests or a skin biopsy. […] How are chilblains treated? […] Often, chilblains go away on their own as long as you avoid the cold and/or damp weather conditions. […] If chilblains keep coming back, your healthcare provider may give you a medication to prevent chilblains from developing as frequently. […] See your healthcare provider right away if you have: Chilblains that dont go away after three weeks. […] Some conditions that affect your blood vessels cause symptoms similar to chilblains. […] Your healthcare provider can offer specific ways to take care of your skin.

• #9 SciELO Brazil – Chilblains in Turkey: a case-control study Chilblains in Turkey: a case-control study

  https://www.scielo.br/j/abd/a/Pd8dxY6SNV5KnW3NN7GKkGD/?lang=en

  Chilblains are rather common in winter months in our country. […] Determination of demographical and clinical characteristics of patients presenting with chilblains in Diyarbakir, Turkey. Evaluation of body mass index (BMI) as risk factor for development of chilblains. […] Diagnosis of chilblains requires wariness, as history of cold exposure may not be evident. […] Low BMI may be a risk factor contributing to development of chilblains in persons exposed to cold weather conditions. […] Diagnosis of chilblains requires wariness, as history of cold exposure may not be evident. Detailed investigation should be undertaken in patients presenting with chronic lesions or symptoms of underlying systemic disease.

• #10 Pernio – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549842/

  Pernio also referred to as chilblains, is a rare inflammatory condition. The diagnosis is largely clinical and based on a thorough history and physical exam. […] A thorough history and physical exam are crucial for evaluating and diagnosing pernio. In general, asking questions regarding the timing of lesions, recent exposures to cold, and improvement of symptoms with removal of cold exposure help narrow the differential to pernio or at least one of the other vasospastic disease processes. […] The primary disorder that merits consideration when diagnosing pernio is chilblain lupus erythematosus (CHLE). CHLE is a rare dermatology condition often confused with other forms of pernio or vasculitic processes. […] The prognosis of pernio is overall excellent since lesions are rarely severe, and most cases of pernio can be resolved relatively easily without prolonged sequelae.

• #11 Chilblains: Causes, Symptoms. and Treatment

  https://patient.info/foot-care/chilblains

  Chilblains are lumps on the skin which come up as an abnormal reaction to the cold. They are usually red or purplish. […] Chilblains can be diagnosed from their typical appearance together with the background of having been exposed to cold.

• #12 Chilblains: Symptoms, complications, and treatment

  https://www.medicalnewstoday.com/articles/172191

  Diagnosing chilblains is straightforward. If symptoms are present and the patient has been exposed to cold, a doctor will diagnose chilblains. […] The doctor will want to rule out other conditions such as lupus, Raynauds phenomenon, erythromelalgia, and ischemia. If the diagnosis is in doubt, in rare cases, a skin biopsy may be taken.

• #13 Chilblains (Pernio)

  https://lakecountyin.gov/departments/health/nursing-clinic/diseases-and-conditions/enviro-health-conditions/chilblains-pernio

  Chilblains typically present with the following symptoms: […] Diagnosing chilblains involves assessing clinical signs and symptoms: […] Reviewing recent exposure to cold and damp conditions, as well as any relevant medical conditions or lifestyle factors. […] Inspecting the affected areas for signs of redness, swelling, itching, and discoloration. […] Distinguishing chilblains from other conditions that may present with similar symptoms, such as frostbite, eczema, or vasculitis.

• #14 Chilblains: Causes, Symptoms, and Treatments | Manly Cove Podiatry

  https://manlycovepodiatry.com/guide-to-chilblains/

  Diagnosing chilblains typically involves a physical examination and a review of the patients medical history. Heres what to expect during the diagnosis process: […] Accurate diagnosis is essential to differentiate chilblains from other conditions with similar symptoms and to develop an effective treatment plan.

• #15 Chilblains

  https://www.mymlc.com/health-information/diseases-and-conditions/c/chilblains/?section=Symptoms

  Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin that occur in response to repeated exposure to cold but not freezing air. […] You generally won’t need to see your doctor for chilblains. If you do visit your doctor, he or she will be able to diagnose your skin condition by looking at it and talking with you about any recent cold exposure. The exam might also include checking your circulation. […] He or she may do further tests, such as a skin biopsy, to rule out other causes for your signs and symptoms.

• #16 Chilblains (Pernio): Symptoms and Management — DermNet

  https://dermnetnz.org/topics/chilblains

  Chilblains are tender and/or itchy bumps on acral sites following exposure to damp, cold, non-freezing conditions causing a localised form of vasculitis. […] Chilblains are usually diagnosed clinically. Investigations are sometimes required to exclude differential diagnoses or look for causes of secondary chilblains. […] Skin biopsy of primary idiopathic chilblains shows a superficial and deep lymphocytic vasculitis, lymphocytes around the eccrine sweat glands, subepidermal oedema, with or without interface changes. […] The Mayo Clinic has developed diagnostic criteria for chilblains: Major criterion (required) localised redness and swelling of acral sites lasting at least 24 hours. […] Chilblains are classified as idiopathic (primary) if there is no associated cause, and secondary if a cause can be identified. […] Investigations for secondary causes of chilblains may include: Full blood count, ANA, rheumatoid factor, antiphospholipid antibodies, Complement levels, Protein electrophoresis, Cold agglutinins and, in children, cryoglobulins.

• #17 Chilblains

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20155443

  To diagnose chilblains, your health care provider will look at the affected skin and talk with you about your symptoms and any recent cold exposure. […] To rule out other conditions, you may need blood tests. Or your health care provider may take a small sample of the affected skin to have it examined under a microscope in a laboratory. This test is called a skin biopsy.

• #18 Chilblains: Symptoms, Pictures, Causes, Treatment, More

  https://www.healthline.com/health/chilblains

  Chilblains can resemble other conditions. […] A doctor can usually diagnose chilblains during a basic physical examination. They may also ask you some questions about any recent exposure to unusually cold or wet weather. […] In rare cases, they may decide to perform a biopsy of the affected area. This involves taking a small sample of tissue and viewing it under a microscope for signs of an underlying condition, like skin cancer. […] If you’ve had chilblains before, you’ll likely recognize them on your own. But if you’ve never had them before, it’s best to check in with a doctor to make sure something else isn’t causing your symptoms. Similar conditions include cold urticaria (a form of hives) and vasculitis (any condition that causes inflamed blood vessels). […] If having chilblains is new for you, the doctor might want to rule out potentially related conditions, like a circulation issue or lupus.

• #19 Chilblains in Southern California: two case reports and a review of the literature | springermedizin.de

  https://www.springermedizin.de/chilblains-in-southern-california-two-case-reports-and-a-review-/9651020

  The diagnosis can usually be made clinically by the appearance of typical lesions during the cold damp seasons. Idiopathic chilblains is, however, a diagnosis of exclusion, and an underlying CTD, or a mimic, such as vasculitis or cutaneous leukemia must be considered. A thorough history and physical examination should be performed to evaluate for the presence of systemic disease. Initial laboratory evaluation should include: a complete blood count, ANA and antiphospholipid antibody profiles, cryoglobulins, and serum protein electrophoresis. Biopsy should be considered for treatment-resistant cases. Typical lesions in a person with a known CTD or Raynauds can help to make the diagnosis of secondary chilblains. […] The treatment of chilblains is focused on keeping the affected area warm, and occasionally using vasodilator agents such as calcium-channel blockers.

• #20 Population Characteristics, Symptoms, and Risk Factors of Idiopathic Chilblains: A Systematic Review, Meta-Analysis, and Meta-Regression

  https://www.mdpi.com/2079-7737/11/11/1651

  Chilblains/perniosis is a non-freezing cold injury, most commonly idiopathic, and it affects the dorsal feet or hands, fingers, feet, and toes, causing painful inflammatory skin lesions. […] The present systematic review investigated the population characteristics, symptoms, and predisposing factors of chilblains in otherwise healthy adults who are exposed to cool/cold environments. […] The population characteristics, symptoms, and predisposing factors of chilblains revealed in this analysis should be incorporated in medical care to improve the condition’s diagnosis and management. […] To improve diagnosis and management, it is vital to focus entirely on chilblains and consider the histopathological features that characterize this disorder. […] The histological identification of four histopathological features (perivascular lymphocytic infiltrate, basal epidermal-cell layer vacuolation, papillary dermal edema, and perieccrine lymphocytic infiltrate) are likely to characterize chilblains patients and may, therefore, be useful in differentiating idiopathic chilblains from other causes of acral skin lesions.

• #21 Pernio Differential Diagnoses

  https://emedicine.medscape.com/article/1087946-differential

  The following should also be considered in the differential diagnosis of pernio: Achenbach syndrome, Acrocyanosis, Aicardi-Goutieres syndrome, Blue toe syndrome, Cryofibrinogenemia, Emboli (septic or cholesterol), Ischemia, Nakajo-Nishimura syndrome, Purple toe syndrome secondary to coumarin, Trauma.

• #22 Chilblain Lupus (SLE pernio) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/chilblain-lupus-sle-pernio/

  Most patients present with discoid lupus erythematosus (DLE) lesions elsewhere, especially the face and head, making the condition easier to diagnose. DLE typically precedes the development of chilblains. However, isolated lesions make the diagnosis difficult unless the index of suspicion is high. […] The differential diagnosis for acral violaceous plaques precipitated by cold include cold-induced syndromes, such as cryoglobulinemic vasculitis, cold agglutinin disease, cryofibrinogenemia and hematologic disorders. […] To help establish a proper diagnosis of chilblain lupus, diagnostic criteria from the Mayo Clinic were proposed. Both major and minor criteria need to be present to diagnose chilblain lupus. […] Histopathologic findings in chilblain lupus are consistent with discoid lupus and most show hyperkeratosis, vacuolated basement membrane, and predominantly lymphocytic perivascular and periadnexal infiltrate.

• #23 Chilblains vs Raynaud’s: Differences, Symptoms, Causes, Treatment

  https://www.medicinenet.com/difference_between_chilblains_and_raynauds/article.htm

  A thorough medical evaluation including lab tests may be necessary to reach a definitive diagnosis. This may particularly be important when there are other signs and symptoms present besides the typical signs of Raynauds or chilblains. […] It is generally diagnosed by a doctor based on the signs and symptoms. Your doctor may ask about your occupation and whether you participate in certain sports (such as skiing) and have a family history of chilblains. […] The doctor diagnoses Raynauds based on medical history, physical examination, and certain tests. Medical tests help ascertain the cause of Raynauds (primary or secondary) and rule out any coexisting health conditions. […] Additional tests, including blood tests or skin biopsy, may be needed in some cases to rule out any underlying health conditions.

• #24 The Difference Between Chilblains, Raynaud’s Disease & Raynaud’s Phenomenon | Hurst Podiatry

  https://www.hurstpodiatry.com.au/blog/chilblains-vs-raynauds-disease-vs-raynauds-phenomenon/

  Chilblains occur when small blood vessels in the skin respond abnormally to cold exposure, particularly when exposed skin is rapidly warmed. This abnormal response leads to inflammation and damage in the affected areas, typically the toes and fingers. […] Chilblains and Raynauds Disease are related in that chilblains can often be a byproduct or complication of Raynauds Disease. […] Chilblains are typically diagnosed based on clinical symptoms and medical history. Healthcare professionals often follow these steps: Physical Examination: Doctors perform a thorough physical examination to assess the appearance of the affected skin, looking for characteristic signs such as red or purple patches, itching, swelling, and, in some cases, small blisters or ulcers. […] The diagnosis of Raynauds Disease and Raynauds Phenomenon also relies on clinical evaluation and may involve the following steps: Medical History: A detailed medical history is crucial, including information about the frequency, duration, and triggers of episodes, as well as any underlying medical conditions.

• #25 Differential diagnosis – Primary Care Notebook

  https://primarycarenotebook.com/pages/general-information/chilblains/differential-diagnosis

  Differential diagnosis of chilblains include: […] Raynaud’s phenomenon (3) […] frostbite (1) […] acrocyanosis (2) […] conditions which cause erythematous, nodular, and ulcerative lesions (3) […] leukocytoclastic vasculitis (3) […] arterial insufficiency (3).

• #26 Chilblain lupus: Symptoms, causes, treatments, and more

  https://www.medicalnewstoday.com/articles/chilblain-lupus

  Chilblain lupus erythematosus (CHLE) is a rare type of cutaneous lupus erythematosus (CLE). […] This article also looks at how doctors diagnose the condition, treatment options, possible complications, and more. […] Doctors use major and minor criteria to diagnose CHLE. A person must have both major criteria and at least one minor criterion to receive a diagnosis. […] CHLE symptoms can resemble pernio, or chilblains. However, while chilblains typically do not develop into another condition, CHLE can progress to systemic lupus erythematosus (SLE), so an early and accurate diagnosis is crucial. […] Treatment for CHLE can include medications and lifestyle changes. […] If symptoms do not respond to lifestyle changes or a person develops an infection, they may require medication. […] Possible medical treatments include: antibiotics, systemic calcium channel blockers, topical or systemic (whole body) steroids, mycophenolate mofetil, antimalarials such as hydroxychloroquine, tacrolimus.

• #27 Chilblain lupus erythematosus

  https://dermnetnz.org/topics/chilblain-lupus-erythematosus

  Chilblain LE is an under-reported entity. In a 2008 review, the authors stated that 70 cases have been reported in the literature. It mainly occurs in adults but can occur at any age. […] The pathogenesis of the sporadic form of chilblain LE remains unknown. […] The Mayo Clinic diagnostic criteria for the diagnosis of chilblain LE comprises two major and four minor criteria. To diagnose chilblain LE, both major criteria and at least one minor criterion need to be demonstrated. […] Lesions persisting beyond the colder months, positive antinuclear antibody tests, and concomitant features of the American College of Rheumatology criteria for SLE distinguish chilblain LE from idiopathic chilblains. […] Chilblain LE is often associated with several immunological makers including: Anti-SSA/Ro antibodies, Hypergammaglobulinaemia, Rheumatoid factor, Anti-nuclear antibodies, Antiphospholipid antibodies, Positive latex agglutination tests. […] The majority of patients respond well to symptomatic treatment.

• #28 Pernio Differential Diagnoses

  https://emedicine.medscape.com/article/1087946-differential

  Chilblain lupus erythematosus (CHLE) must be distinguished from lupus pernio, a cutaneous manifestation of sarcoidosis. […] A biopsy may be necessary for a definitive diagnosis. […] Proposed diagnostic criteria from the Mayo clinic can be helpful in differentiating CHLE from lupus pernio and idiopathic pernio. Both major criteria and one minor criterion are needed to diagnose CHLE. […] Major criterion: Skin lesions of the acral sites induced by exposure to cold or a drop in temperature. […] Evidence of lupus erythematosus in the skin lesions as determined by histopathologic examination or direct immunofluorescence. […] Minor criterion: Coexistence of systemic lupus erythematosus or other skin lesions of discoid lupus erythematosus. […] Response to antilupus therapy. […] Negative cryoglobulin and cold agglutinin studies.

• #29 Chilblains: Causes, Symptoms, Diagnosis, Treatment, and Prevention

  https://www.webmd.com/skin-problems-and-treatments/chilblains-causes-symptoms-diagnosis-treatment-and-prevention

  Chilblains Diagnosis Your health care provider likely can diagnose chilblains just by looking at the affected area. They might want to run a blood test or a biopsy to see if the chilblains are related to another condition or to discern if its another condition with symptoms similar to chilblains. […] Many medical practitioners now think COVID toes actually were chilblains. During the pandemic, people were at home much more, perhaps not covering their feet when walking on cold surfaces or being in cold air. […] A study on whether the abrupt uptick of chilblains cases in 2020 was connected to COVID-19 found a weak link. Researchers also noted that few people in the case studies tested positive for COVID-19. The cases might have been caused by behavior changes during the pandemic and could thus have led to more chilblains diagnoses.

• #30 Chilblains – Wikipedia

  https://en.wikipedia.org/wiki/Chilblains

  Chilblains, also known as pernio, is a medical condition in which damage occurs to capillary beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue, resulting in redness, itching, inflammation, and possibly blisters. […] Once the diagnosis of chilblains is made, first-line treatment includes avoiding cold, damp environments and wearing gloves and warm socks. […] Chilblains can be idiopathic (spontaneous and unrelated to another disease), but similar symptoms may also be a manifestation of another serious medical condition that must be investigated. […] It has been suggested that in the absence of exposure to cold and damp, COVID-19 should be considered as a possible cause of chilblains.

• #31 Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic – Kaiser Permanente Division of Research

  https://divisionofresearch.kaiserpermanente.org/publications/epidemiologic-analysis-of-chilblains-cohorts-before-and-during-the-covid-19-pandemic/

  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. […] COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P=.01). […] This cohort study found that in northern California, the incidence of chilblains increased during the pandemic but was correlated weakly with the incidence of COVID-19 across 207 location-months.

• #32 Chilblains | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chilblains

  Chilblains are patches of red, swollen and itchy skin, thought to be caused by a combination of cold weather and poor circulation. […] Although the exact cause of chilblains remains unknown, it is thought to be associated with the body’s reaction to cold weather. […] Severe, ulcerating or recurring chilblains need professional attention. A qualified podiatrist can treat your chilblains and offer advice on prevention. […] If you develop chilblains without being exposed to cold weather, seek advice from your health professional as this may be a sign of another condition such COVID-19.

• #33 From Chilblains (Pernio) to Coeliac Disease—Should We Still Consider It Random?

  https://www.mdpi.com/2227-9067/9/12/1972

  Coeliac disease (CD) is a gluten-triggered, immune-mediated inflammatory disease occurring in genetically predisposed individuals, causing a variety of gastrointestinal and extraintestinal symptoms. […] In the workup of chilblains (pernio) in children, an active case finding for coeliac disease should be conducted with coeliac-specific serology testing. […] Our patient is a nine-year-old female who initially presented to a rheumatologist and dermatologist due to complaints of feeling coldness in her legs and fingers, with inflammatory lesions of the skin on the distal parts of the toes and fingers. […] After the examination of the rheumatologist and dermatologist, a diagnosis of pernio (chilblains) was proposed. […] The patient was subsequently referred to our gastroenterology department. An additional laboratory workup was recommended with repeated anti-tTG, which was four times the upper limit of normal and endomysial antibodies (EMA), which were also positive, based on which an upper endoscopy was indicated, according to current guidelines.

• #34 From Chilblains (Pernio) to Coeliac Disease—Should We Still Consider It Random?

  https://www.mdpi.com/2227-9067/9/12/1972

  Finally, CD was diagnosed according to the ESPGHAN criteria (positive coeliac-specific serology—positive anti-tTG and EMA antibodies and Marsh IIIC—total villous atrophy on small bowel biopsy). […] The question of whether pernio and coeliac disease are pathogenically related remains open. […] However, keeping in mind the possibility of the spontaneous resolution of chilblains, it is difficult to draw a definite conclusion. Further studies are needed to help us better understand the possible association between these two entities. […] In the workup of chilblains (pernio) in children, an active case finding for coeliac disease should be conducted with coeliac-specific serology testing.

• #35 Chilblains in Southern California: two case reports and a review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-8-381

  The diagnosis can usually be made clinically by the appearance of typical lesions during the cold damp seasons. Idiopathic chilblains is, however, a diagnosis of exclusion, and an underlying CTD, or a mimic, such as vasculitis or cutaneous leukemia must be considered. A thorough history and physical examination should be performed to evaluate for the presence of systemic disease. Initial laboratory evaluation should include: a complete blood count, ANA and antiphospholipid antibody profiles, cryoglobulins, and serum protein electrophoresis. […] In this series, we present two cases of chilblains seen in the winter months in Southern California. One case is purely idiopathic, whereas the other is more consistent with a secondary phenomenon related to the patients history of Raynauds and an underlying undifferentiated CTD. In both cases, lesions responded well to warming measures alone. This condition needs to be recognized even in typically warmer climates, and screening for an underlying systemic disease should be done, especially in treatment-resistant cases.

• #35 Chilblains in Southern California: two case reports and a review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-8-381

  Chilblains or perniosis is an acrally located cutaneous eruption that occurs with exposure to cold. Chilblains can be classified into primary and secondary forms. The primary or idiopathic form is not associated with an underlying disease and is clinically indistinguishable from the secondary form. The secondary form is associated with an underlying condition such as connective tissue disease, monoclonal gammopathy, cryoglobulinemia, or chronic myelomonocytic leukemia. Histopathology cannot accurately help distinguish the primary from secondary forms of chilblains. […] It can be diagnosed clinically by the appearance of typical lesions during the cold damp season. Through a thorough history, physical examination and selected laboratory evaluation, underlying connective tissue disease or a mimic such as vasculitis or cutaneous leukemia can be excluded.

• #36 Chilblains – Symptoms, Diagnosis And Treatment | 24-7Medcare

  https://24-7medcare.com.au/skin-conditions/chilblains/

  Chilblains are usually diagnosed after a thorough questioning and physical examination from a GP. Generally, no further assessments will be required. Although, depending on your presentation, your GP may opt for skin biopsies and/or blood tests to rule out other conditions. […] After getting a diagnosis from a GP, the next step will be to figure out how to treat chilblains. Usually, only lifestyle modifications will be required, although additional treatments may be required if symptoms are not settling.

• #37 LP-204 Chilblain lupus erythematosus-a rare encounter | Lupus Science & Medicine

  https://lupus.bmj.com/content/10/Suppl_1/A113.3

  Chilblain lupus erythematosus(CHLE) or Perniosis is a rare and chronic form of lupus involving the toes, fingers, nose, and ears precipitated by cold exposure. […] Diagnosing a patient requires two major and at least one minor criterion. […] Chilblain lupus erythematosus is a rare and chronic disease mainly affecting women. Although it is not as severe as Systemic Lupus Erythematosus(SLE), it may be the sentinel sign of a range of underlying auto-immune diseases. Physicians should be vigilant in dealing with CHLE as their symptoms may be subtle and mimic other similar pathologies.

• #38 Chilblain Lupus (SLE pernio) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/chilblain-lupus-sle-pernio/

  The diagnosis of chilblain lupus can be difficult. It is important to rule out other cold induced syndromes prior to initiating therapy. Chilblain lupus is persistent, thus once lesions have developed they may take 4 to 6 months to resolve. Allowing a longer time for observation before switching therapeutic modalities is warranted. […] The goal of any therapy for chilblain lupus is to minimize new lesion development and expedite healing of older lesions. Mainstay therapies for the majority of CLE subsets include topical therapies and antimalarials.

• #39 The Difference Between Chilblains, Raynaud’s Disease & Raynaud’s Phenomenon | Hurst Podiatry

  https://www.hurstpodiatry.com.au/blog/chilblains-vs-raynauds-disease-vs-raynauds-phenomenon/

  Effective treatment strategies for these vascular conditions involve a multidimensional approach, tailored to the individuals specific condition and needs. […] The prognosis for Chilblains is generally favourable. Most cases resolve within a few weeks with proper care. […] Raynauds Disease is typically a chronic condition, but with the right treatment and lifestyle modifications, individuals can effectively manage their symptoms. […] The prognosis for Raynauds Phenomenon is closely tied to the underlying conditions causing it. Managing the primary diseases, such as autoimmune disorders or connective tissue disorders, is essential.

• #40 Chilblains (Pernio) Causes, Symptoms, and Treatment

  https://www.verywellhealth.com/chilblains-5219587

  In severe cases, a healthcare provider may prescribe topical or oral medications to improve blood flow and relieve inflammation. These include: […] While chilblains will often go away on its own without treatment, you should seek care if: […] Chilblains is a condition in which swelling, itchiness, and discoloration of the skin occur after exposure to cold temperatures. It usually happens after hours of exposure, often causing tiny bumps and blisters that take anywhere from one to three weeks to heal. […] Chilblains is generally harmless but can become chronic or recurrent in some people or lead to complications like skin ulcers. Chilblains generally clears on its own but may require a mild topical steroid and oral or topical vasodilators for people with severe or chronic symptoms.

• #41 Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care | British Journal of General Practice

  https://bjgp.org/content/67/656/e187

  GPs prescribe topical corticosteroids to patients with chronic chilblains despite poor evidence for their effectiveness. […] The aim of this study was to assess the proposed superiority of the topical application of betamethasone valerate 0.1% cream twice a day for 6 weeks compared with placebo cream in patients with chronic chilblains in a primary care setting. […] In this study, topical betamethasone was not superior to placebo in the treatment of chronic chilblains. Topical betamethasone should not be used for chronic chilblains without new evidence. […] The prescription of topical steroids for patients with chilblains finds support in one study. The current randomised, placebo-controlled trial does not confirm the conclusions of this study. Topical betamethasone should not be used in the treatment of chronic chilblains without new evidence. […] The effectiveness of betamethasone valerate 0.1% cream in the treatment of chronic chilblains in primary care is to be called into question. Topical steroids should not be used in the treatment of chronic chilblains without new evidence.

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