Materiały źródłowe

• #1 Pernio – StatPearls – NCBI Bookshelf

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

  Pernio is mostly thought to be idiopathic; however, while several forms of secondary pernio exist, they are incredibly rare, and the direct association has not clinically correlated with extensive studies due to the rarity. The most common form of secondary pernio is the association with systemic lupus erythematosus and the subsequent development of chilblain lupus erythematosus (CHLE). […] The pathophysiology and pathogenesis of pernio remain still largely unknown due to the rarity of the condition. However, the thinking is that there is some association with vasospasm as the primary pathophysiologic finding, particularly when the patient becomes exposed to cold, damp conditions for a prolonged period. In a small study by the Mayo Clinic, researchers exposed five patients with known pernio to ice-water immersions and analyzed the patients’ vascular response. They found that all of the patients demonstrated vasospasm when exposed to the ice water bath, potentially discovering a target for pharmacologic therapy in patients with pernio.

• #2 Pernio (Chilblains) | Thoracic Key

  https://thoracickey.com/pernio-chilblains/

  Pernio, commonly known as chilblains, is a cold-induced localized inflammatory condition presenting as skin lesions predominantly on unprotected acral areas. […] The first response to cold exposure is vasoconstriction in the dermis and subcutaneous tissue. Heat loss is minimized by shutting down distal capillary beds and diminishing blood supply to the acral portions of the extremities to maintain central body temperature. Stasis and shunting of blood flow away from the superficial vessels occurs secondary to arteriolar constriction, venular relaxation, and cold-associated increased blood viscosity. The result of these changes is superficial tissue anoxia and ischemia. […] Humidity has an important role in the pathophysiology of pernio because it enhances air conductivity, promoting heat loss from the skin.

• #3 Chilblains – Pathophysiology, Risk factors, and Diagnosis. –

  https://diseasesdic.com/chilblains-pathophysiology-risk-factors-and-diagnosis/

  The pathophysiology and pathogenesis of pernio remain still largely unknown due to the rarity of the condition. However, the thinking is that there is some association with vasospasm as the primary pathophysiologic finding, particularly when the patient becomes exposed to cold, damp conditions for a prolonged period. […] In a small study by the Mayo Clinic, researchers exposed five patients with known pernio to ice-water immersions and analyzed the patients vascular response. They found that all of the patients demonstrated vasospasm when exposed to the ice water bath, potentially discovering a target for pharmacologic therapy in patients with pernio. […] Chilblains are the result of an abnormal reaction to the cold. […] When the skin is cold, blood vessels near its surface get narrower. If the skin is then exposed to heat, the blood vessels become wider. […] If this happens too quickly, blood vessels near the surface of the skin cant always handle the increased blood flow. […] This can cause blood to leak into the surrounding tissue, which may cause the swelling and itchiness associated with chilblains.

• #4 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. […] Cold causes constriction of small arteries and veins but a protective physiological reflex intermittently dilates the blood vessels to prevent skin ischaemia. Persistent or prolonged vasoconstriction due to an abnormal vascular reaction to cold may result in hypoxaemia and inflammation to produce 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. […] Chilblains are classified as idiopathic (primary) if there is no associated cause, and secondary if a cause can be identified.

• #5 Chilblains: Causes, Symptoms. and Treatment

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

  Chilblains are caused by an abnormal skin reaction to cold. They tend to occur on 'extremities’ that easily become cold – that is, your toes, fingers, nose and earlobes. However, other areas of skin sometimes develop chilblains when they become cold. For example, your heels, lower legs and thighs (especially in horse riders). […] The tiny blood vessels under the skin narrow (constrict) when the skin becomes cold. The blood supply to areas of skin may then become very slow. As the skin re-warms there is some leakage of fluid from the blood vessels into the tissues. In some way this causes areas of inflammation and swelling, leading to chilblains. […] The speed (rate) of temperature change may play a part. Some people get chilblains if they warm up cold skin too quickly. For example, with a hot water bottle or by sitting very close to a fire.

• #6 Pernio: Practice Essentials, Pathophysiology, Etiology

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

  Pernio is due to an abnormal vascular response to cold exposure, and it is most frequent when damp or humid conditions coincide. […] The direct cause of pernio is cold exposure; specifically, exposure to both mild nonfreezing cold and humidity seems to be required. […] Chronic pernio may be secondary to various systemic diseases as follows: […] Chilblain lupus erythematosus (CHLE): Violaceous „pernio” plaques appear prominent over dorsal interphalangeal joints, often with positive antinuclear antibody (ANA) or rheumatoid factor (RF). Histologic and immunofluorescent evidence of lupus is present in the skin lesions. […] Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis.

• #7 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

  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. […] The exact pathogenesis of chilblains is unknown. The process is generally described as a vasculopathy whereby there is disruption of normal neurovascular responses to dermal temperature changes. It has been suggested that patients with chilblains have persistent or prolonged cold-induced vasoconstriction leading to hypoxemia and a subsequent secondary inflammatory reaction.

• #8 Perniosis chilblains

  https://www.pcds.org.uk/clinical-guidance/perniosis

  Chilblains are caused by the vasoconstriction of the deep cutaneous arterioles along with concomitant dilatation of the smaller, superficial vessels. […] Most cases are primary (idiopathic), however, some cases are secondary to an underlying condition. […] When an underlying cause is suspected (eg more severe and persistent symptoms, ulceration and necrosis, other significant skin changes) it is important to investigate for possible haematological malignancy, connective tissue disorders or cryoglobulinaemia. […] Nifedipine is effective in the treatment and prevention of chilblains.

• #9 Chilblains – Symptoms and causes – Mayo Clinic

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

  Chilblains causes inflamed, swollen skin, which appears several hours after exposure to cold but not freezing air. […] The exact cause of chilblains is unknown. They may be an unusual reaction of your body to cold followed by rewarming. Rewarming of cold skin can cause small blood vessels under the skin to expand more quickly than nearby larger blood vessels can handle.

• #10 Take the Chill Out of Chilblains and Toe-tally Enjoy the Cooler Seasons! – Acupuncture & Wellness Clinic

  https://awclinic.com/take-the-chill-out-of-chilblains-and-toe-tally-enjoy-the-cooler-seasons/

  Chilblains, also known as perniosis, are localized inflammatory lesions that typically occur on the fingers, toes, ears, and nose in response to prolonged exposure to cold and damp environments. […] The underlying mechanism of chilblains begins with vasoconstriction, which is the narrowing of blood vessels in response to cold temperatures. This physiological response is an attempt to conserve body heat by redirecting blood flow away from the extremities. However, when these areas are suddenly re-warmed, the body experiences a rapid vasodilation, where blood vessels expand to restore normal blood flow. This abrupt change can overwhelm the local capillary network, leading to increased permeability of the blood vessels. […] As a result, blood plasma and inflammatory mediators leak into the surrounding tissues, causing localized inflammation. The accumulation of fluid results in the characteristic symptoms of chilblains: redness, swelling, and pain. […] Chilblains are more common in the winter months and can affect individuals of all ages, although they are often seen in women and those with a family history of the condition. Risk factors include a history of cold exposure, poor circulation, and certain medical conditions that affect blood flow.

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

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

  Chilblains form after on-and-off or prolonged exposure to cold or damp air. The cold air causes blood vessels near your skins surface to tighten or constrict. This leads to less oxygen and inflammation in the exposed areas. […] Researchers dont know exactly why this reaction happens. Some experts believe pernio develops because of: […] Genetics […] Hormonal changes […] Underlying conditions, like connective tissue diseases.

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

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

  Chilblains, also known as perniosis, or pernio, can happen when parts of your body are exposed to damp and cold, but not freezing weather. […] Scientists consider them an abnormal response to the cold. […] Chilblains can form when parts of your body are exposed for too long in damp, cold weather. Chilly air narrows the blood vessels near the surface of your uncovered skin. This cuts oxygen flow and leads to swelling. If your skin is then exposed to heat, the blood vessels will widen again. But if this happens too fast, those vessels cant manage the sudden increase in blood flow. The extra blood can seep into nearby tissue. This can trigger itchiness and inflammation. […] Researchers dont know why some people are more likely to get chilblains than others. They think genetics or hormonal changes might play a part.

• #13 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, or perniosis, is a localized skin inflammatory disorder of the acral areas, typically observed after exposure to a cool/cold and damp environment. […] Chilblains typically affect the dorsal feet or hands causing inflammatory skin lesions that are often painful, and their pathogenesis remains only partly understood. It is likely of microvascular origin, but a number of patient-related and environmental factors appear to contribute to the observed vascular damage. […] The present systematic review, meta-analysis, and meta-regression investigated the population characteristics, symptoms, and predisposing factors of chilblains in otherwise healthy adults who were exposed to cool/cold environments. […] The meta-analytic results showed that the pooled proportion (percent (95% CI)) of patients with chilblains that tested positive for different histopathological and serologic features were as follows: 81% for perivascular lymphocytic infiltrate, 67% for basal epidermal-cell layer vacuolation, 66% for papillary dermal edema, and 57% for perieccrine lymphocytic infiltrate.

• #14 Perniosis (chilblains) pathology

  https://dermnetnz.org/topics/perniosis-pathology

  Perniosis or chilblains are a localised form of vasculitis presenting with reddish purple bumps in reaction to cold exposure. Blistering and ulceration may occur. […] This is thought by some authors to represent the one true lymphocytic vasculitis, as there may be well established fibrinoid change and thrombosis can occur. […] Frank lymphocytic vasculitis and interface changes are more common in chilblain lupus than in idiopathic chilblains.

• #15 Pernio (Chilblains) | Thoracic Key

  https://thoracickey.com/pernio-chilblains/

  The increased incidence of pernio among relatives of affected patients suggests the possibility of genetic predisposition. […] A number of conditions have been associated with pernio. […] The characteristic histopathological features of pernio are usually seen in the dermis and subcutaneous tissue, but are not pathognomonic. These consist of edema of the papillodermis, vasculitis characterized by perivascular infiltration of the arterioles and venules of the dermis and subcutaneous fat by mononuclear and lymphocytic cells, thickening and edema of blood vessel walls, fat necrosis, and chronic inflammatory reaction with giant cell formation. […] Repeated episodes of vasospasm or prolonged vasospasm may cause tissue anoxia, thus causing the identical histopathological picture that occurs in pernio.

• #16 Chilblains in immune-mediated inflammatory diseases: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9383735/

  Chilblains can be primary, or secondary to a number of conditions such as infections, including COVID-19, and immune-mediated inflammatory disorders (IMIDs) with SLE being the commonest. […] The pathogenesis of CHLE is not well understood. Vasoconstriction provoked by exposure to cold leads to the occlusion of the capillary bed and a circulation slowdown with the presence of aggregates of red blood cells visible on capillaroscopy. […] Antibodies to Ro/SSA may be demonstrated in a subset of CHLE patients. […] However, in patients with SLE, Bouaziz et al. did not find association with anti-Ro antibodies. […] Full-thickness skin grafts from unaffected regions resulted in persistent improvement in two reported cases, implying that local factors might be crucial in the pathophysiology. […] Familial chilblain lupus (FCL) can arise due to loss-of-function mutations in TREX1, or less commonly SAMHD1, or gain-of-function mutations in TMEM173 (which encodes stimulator of interferon genes, STING).

• #17 Chilblain lupus with nail involvement: a case report

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-81232022000300231

  Chilblain lupus is a rare form of presentation of cutaneous lupus erythematosus (CLE). […] The pathophysiology is not fully understood, but it is autoimmune and is related to altered microcirculation, stasis, and vascular occlusion precipitated by low temperatures. […] Familial cases have been described in which chilblain lupus is known as a genodermatosis with an autosomal dominant inheritance pattern. […] Causal genes that encode intracellular nucleases such as TREX1, SAMHD1, and STING are included, which produce the activation of type 1 interferon, which, in turn, leads to the immune recognition of non-metabolized nucleic acids. […] The histopathology of chilblain lupus consists of epidermal atrophy, interface vacuolization, papillary edema, and perivascular mononuclear infiltrate in the dermis.

• #18 Pernio and Chillblains: Symptoms and Treatment | Rencic Dermatology

  https://www.rencicderm.com/conditions/pernio-chillblains

  Hormonal factors: Chilblains are more common in females, suggesting a potential hormonal influence on their development. […] Damp living conditions: Exposure to dampness and moisture can exacerbate chilblain symptoms, especially when combined with cold temperatures. […] Treatment options for pernio (chilblains) focus on relieving symptoms, facilitating healing, and preventing complications. Firstly, it’s crucial to keep the affected areas warm and shield them from further cold exposure to promote circulation and alleviate discomfort. […] Medical evaluation is essential to address any underlying conditions contributing to chilblains, such as circulatory disorders or autoimmune diseases. […] Furthermore, practicing gradual rewarming techniques after cold exposure and keeping the skin well-moisturized are beneficial.

• #18 Pernio and Chillblains: Symptoms and Treatment | Rencic Dermatology

  https://www.rencicderm.com/conditions/pernio-chillblains

  Pernio and chilblains are painful reactions of the skin’s small blood vessels to cold temperatures. They typically appear several hours after cold exposure, especially in humid climates. […] Initially, they present as small, itchy, red areas that become increasingly painful and dark blue. […] Commonly affecting the toes but also extending to the fingers and areas of pressure on the feet, such as bunions or tight shoe areas, chilblains can significantly impact one’s comfort and well-being. […] Cold weather exposure: Pernio typically occurs during colder months when temperatures drop, especially in individuals with poor cold tolerance. […] Poor circulation: Reduced blood flow to the extremities, often due to factors like genetics, cardiovascular conditions, or lifestyle habits, can increase susceptibility to chilblains.

• #19 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. […] It occurs most frequently when predisposed individuals, predominantly women, are exposed to cold and humidity. […] 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. […] In a study at the dermatology department of Saint-Louis Hospital in Paris, researchers found that most of their study participants carried high levels of autoantibodies, proteins generated by the immune system that inadvertently attack the body’s own tissues. Compared with healthy individuals, the participants showed high activity of proteins called type 1 interferons, which switch on pathogen-fighting genes in immune cells.

• #20 Chilblains – Drugs, Targets, Patents – Synapse

  https://synapse.patsnap.com/disease/c2c614ac4b93497b9e9846e18be238d8

  Chilblains, also known as perniosis, is a non-freezing cold injury causing painful inflammatory skin lesions. […] Their pathogenesis remains only partly understood. […] It is vital to focus entirely on chilblains and consider the patient-related and environmental factors that characterize this disorder. […] Given the essential role of type I interferon (I-IFN) in protective immunity against SARS-CoV-2 and the association of chilblains with inherited type I interferonopathies, we hypothesized that excessive I-IFN responses to SARS-CoV-2 might underlie the occurrence of chilblains in this context. […] Genetic mutations that lead to the aberrant activation of cGAS/STING in humans are known to cause severe infant onset Aicardi-Goutires Syndrome (AGS) and genetic forms of chilblain lupus, demonstrating the relevance of the pathway in human diseases. […] Given that the pathophysiology and presentation of these genetic diseases have significant similarities with idiopathic complex diseases such as SLE, CLE, and DM, these diseases represent highly compelling opportunities for treatment with a cGAS inhibitor.

• #21 Chilblains in immune-mediated inflammatory diseases: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9383735/

  Enhanced 1 IFN responses may therefore also be important in COVID-19-associated chilblains in which there are also high levels of type 1 interferon (IFN) as part of the antiviral response. […] Histological studies suggest that chilblain-type lesions are associated with microthrombi. […] A causative link between chilblains and COVID-19 remains inconclusive, especially since cold exposure does not appear to be a precipitating factor.

• #22 Perniosis-like lesions after vaccination with mRNA against COVID-19 | Medicina Clínica (English Edition)

  https://www.elsevier.es/en-revista-medicina-clinica-english-edition–462-avance-resumen-perniosis-like-lesions-after-vaccination-with-S2387020622000584?esCovid=Dr56DrLjUdaMjzAgze452SzSInMN&rfr=truhgiz&y=kEzTXsahn8atJufRpNPuIGh67s1

  Numerous cases of COVID-19-associated chilblain-like lesions were reported during the last year, especially in the paediatric population and in adults with severe disease, with viral particles being described in the lesions. However, recent studies suggest that there is no such relationship and that, therefore, chilblain-like lesions would not be a specific marker of infection in healthy subjects without other symptoms of active infection. […] Also, during the last few months of the pandemic, vaccination has been linked to the occurrence of chilblain-like lesions. The aetiological mechanism for this relationship has not yet been described, although it is well known that mRNA vaccines are capable of inducing potent type I interferon-mediated reactions and can trigger inflammatory responses involving cytokines.

• #23 Trends and Associations of Chilblains Prevalence with Connective Tissu | CCID

  https://www.dovepress.com/trends-and-associations-of-chilblains-prevalence-with-connective-tissu-peer-reviewed-fulltext-article-CCID

  Chilblains, also known as perniosis, are inflammatory skin lesions that have long been associated with exposure to low temperatures. […] Their association with connective tissue disorders (CTDs) such as systemic lupus erythematosus (SLE), systemic sclerosis, scleroderma, dermatomyositis, and Sjogrens syndrome has been studied, suggesting a potential but rare link. […] The majority of chilblains cases are considered idiopathic. However, previous research has linked chilblains to various CTDs such as antiphospholipid syndrome, rheumatoid arthritis, SLE, cryofibrinogenemia, as well as blood dyscrasias and Raynauds disease. […] The observed correlation of 11.43% between chilblains and CTDs in this study is consistent with other findings suggesting a possible connection, although it underscores how rare this association is.

• #24 Chilblain lupus with nail involvement: a case report

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-81232022000300231

  The presence of eccrine periadnexal distribution of lymphocytic infiltrate is observed in the idiopathic form (not related to lupus) and helps in their differentiation. […] The typical clinical lesions are painful erythematous-violaceous macules, plaques, and nodules, usually in exposed areas, such as the back of the hand and the pads of the fingers or toes, and rarely on the tip of the nose or the ears. […] There may be central erosions or ulcers. […] Infrequently, hyperkeratosis with fissures can be observed on the soles and palms. […] Cases of nail involvement with dystrophy or loss of the nail plate have been described, indicating chronic changes, as observed in the clinical case described here. […] Moreover, patients with chilblain lupus may present with hypergammaglobulinemia (2/3 of cases), and high-titers of rheumatoid factor, ANA, and anti-Ro antibodies. […] There is a relationship with an increase in red blood cells, and this could cause blood viscosity and stasis; magnetic resonance angiography studies have shown decreased perfusion in the phalanges in these cases.

• #25 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

  There are no pathognomonic histological findings for idiopathic chilblains, but many studies describe superficial and deep perivascular lymphocytic infiltrates, with vessel wall and papillary dermal edema. It has been suggested that idiopathic chilblains may be distinguished from secondary lesions seen in lupus by the presence of spongiosis, perieccrine inflammation, and dermal edema in idiopathic lesions, whereas vacuolation of basal cells is more commonly seen in lupus erythematosus lesions. […] Pathogenesis is probably similar to that of idiopathic chilblains, involving an exaggerated vasoconstrictive response with subsequent hypoxemia and inflammation. However, hyperviscosity may play more of a role in the development of secondary lesions. Hypergammaglobulinemia and autoantibodies, frequently seen with CTD, may play a role in the development of these lesions, but their exact pathophysiological relevance is not known.

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

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

  Certain medical conditions might have a link to chilblains, though such connections are rare. They include: Connective tissue diseases like systemic lupus erythematosus (SLE). SLE is the most common condition that seems to relate to chilblains. […] The word „chilblains” is a blend of the two Old English words „chill” (meaning cold) and „blegen” (sore).

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

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

  The pathophysiology of chilblain lupus is not entirely known. Hyperviscosity due to immunologic abnormalities together with vasoconstriction or microvascular injury due to cold temperatures is thought to play a role. Patients with chilblain lupus commonly have a positive rheumatoid factor and speckled antinuclear antibody (ANA) pattern, supporting an immune-mediated etiology. Cryoglobulins and cryoprecipitates are negative in 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. Depending on the age of the lesion biopsied, an atrophic epidermis and thickened basement membrane may be noted. Direct immunofluorescence will show granular basement membrane deposition of IgM, C3 and/or IgG.

• #28 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

  The prevalence of histopathological features related to chilblains was significantly explained by the between-study heterogeneity, in terms of smoking, type of occupation, and study size, whereby it was increased by smoking or ex-smoking, frequent occupational exposure to water, and large study sample, and it was decreased by indoor work. […] The percent of body surface area being affected by chilblains is higher in studies assessing more outdoor workers and people performing physically strenuous occupations. This is likely explained by an increased exposure to cool/cold and damp conditions of these individuals, which is hypothesized to induce vasospasm and, in turn, hypoxemia, followed by an inflammatory response leading to the clinical manifestations of chilblains.

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

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

  Chilblains is a rare inflammatory condition induced by the cold affecting accral skin (meaning the skin of hands, feet, nose, and ears). […] While most cases are idiopathic (of unknown origin), scientists generally agree that chilblains is the result of an extreme and inappropriate inflammatory response. […] However, in some people, the vasoconstriction may be excessive and prolonged, depriving tissues of oxygen. When this happens, the body will respond with extreme inflammation to force the blood vessels open. This can cause microscopic tears that allow blood to seep from capillaries into surrounding tissues, leading to chilblains. […] Chilblains also tends to be seasonal, occurring more frequently in winter and less frequently in summer. […] 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.

• #30 Chilblains – Wikipedia

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

  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. […] In acral chilblain-like lesions, a diffuse dense lymphoid infiltrate of the superficial and deep dermis, as well as hypodermis, with a prevalent perivascular pattern and signs of endothelial activation, are observed.

• #31 Chilblains – Pernio – Chill burns

  https://www.firstderm.com/chilblains-pernio/

  Chilblains are a medical condition occurring in predisposed individual when exposed to cold and humidity, causing tissue damage. […] The pathophysiology behind chilblains is due to an abnormal reaction to cold temperatures, which causes the most superficial blood vessels to constrict, resulting in blood leakage into the surrounding tissue. This leads to the swelling and itchiness associated with chilblains. It is argued, however, that chilblains related to COVID-19 may be a result of microthrombi formation in the peripheral small vessels, not allowing sufficient circulation to the toes. A different mechanism giving the same symptoms and presentation as the cold provoked chilblains. In support of this theory, there are many new studies demonstrating how complement associated microvascular injury and thrombosis are the base of both pulmonary and skin manifestations of severe Corona virus infection. This opens new research possibilities, as experimentation treatments with Low molecular Heparin (first line treatment in coagulopathies) shows strong association with decreased mortality in patients affected by COVID-19 disease.

• #32 Trends and Associations of Chilblains Prevalence with Connective Tissu | CCID

  https://www.dovepress.com/trends-and-associations-of-chilblains-prevalence-with-connective-tissu-peer-reviewed-fulltext-article-CCID

  Specifically, SLE emerged as the most common CTD linked to chilblains, particularly among younger women, reaffirming the known demographic overlap between chilblains and SLE. […] The study revealed an uncommon association with the notably low co-occurrence rate (0.033%) of chilblains in COVID-19 positive patients. […] Further investigation is warranted to explore this potential link, given that the exact mechanism connecting COVID-19 and chilblains remains elusive. […] The study also highlighted a rare co-occurrence of chilblains in COVID-19 positive patients, indicating a potential but not fully understood association.

• #33 Pernio (Chilblains) – MD Searchlight

  https://mdsearchlight.com/health/pernio-chilblains/

  Nifedipine, a type of medicine known as a calcium channel blocker, which widens blood vessels (vasodilatory effects), might also be helpful in treating pernio. Its thought to help reduce inflammation and repair skin damage, and some small studies have even found that it could help prevent more symptoms from developing in the future.

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