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| PERNIOSIS: UNBIDDEN SEASONAL FELICITATION | | | Dr. Wahied Khawar Balwan
Perniosis also known as chilblain or chill burns is incredibly usual form of sickness that is caused due to massive exposure to coolness and humidity. Chilblains’, meaning cold sore-chill (cold) and blegen (swelling), was first described in 1894 by Corlett. Fingers, toes, nose and earlobes are the most affected areas by perniosis. It is often confused with frostbite. Swelling, itching, burning sensation, bluish color, blisters and discoloration of skin of hands, feet or different extremities are the comprehensible signs shown during chilblains. Perniosis is divided into two stages, an acute stage which is completely reversible and chronic stage in which permanent tissue changes have developed, a stage which is never completely reversible. Acute stage is short, developing within 12-24 hours after exposure to the cold and getting better after one to two weeks, but chronic stage lasts for a minimum of five months to a year and cause persistent sores that can lead to scarring. The condition usually starts in early winter and vanishes in spring, but often recurs the next winter. Apart from external factors, there seems to be a personal tendency to develop lesions. Doctors can diagnose perniosis from the typical symptoms and appearance. If the diagnosis is in doubt, in rare cases, a skin biopsy may be taken.
ETIOLOGY
Perniosis is quite common and can occur at any age. It most commonly affects women, children and the elderly. Especially skinny patients may be at higher risk of getting chilblains. Several hours after the exposure to cold weather the blood vessels in toes and fingers get smaller by confine. The vascular mechanism underlying perniosis is to be persistent prolonged cold-induced vasoconstriction, without episodes of cold-induced vasodilation, leading to hypoxemia and a subsequent secondary inflammatory reaction. There may be a genetic influence in perniosis, since several generations within a family can be affected. Other etiological factors include poor nutrition, anorexia nervosa, and systemic diseases, most typically lupus erythematosus and hematological malignancy.
PATHOLOGY
Pathogenesis of perniosis has been attributed to a defective vasodilatory reflex and caused by a combination of arteriolar and venular constriction, the latter predominating on rewarming with exudation of fluid into the tissues. In perniosis patients, the initial vasoconstriction is prolonged, resulting in vasospasms. Result of this prolonged vasoconstriction is localized inflammation due to hypoxic damage. Severe cases may lead to ulceration, super infection, and scarring of the skin. Detailed investigation should be undertaken in patients presenting with chronic lesions. Physicians should monitor perniosis patients for low haemoglobin levels and note the presence and/or onset of vascular disorders and autoimmune diseases. Cold is a requirement for the development of symptoms. Perniosis seems to be more common in environments where heating is inadequate for a few months of the year and is less common in localities characterised by harsh frigid winters where adequate home heating is the norm.
Risk Factors
Clothing that is tight or exposes skin to the cold: Wearing tight-fitting clothing and shoes in cold, damp weather may make person more susceptible to perniosis and skin exposed to cold, damp conditions is more likely to develop perniosis.
Environment and Season: Perniosis is less likely in colder and drier areas because the living conditions and clothing used in these areas are more protective against cold. Risk of chilblains is higher in an area with high humidity and cold, but not freezing, temperatures. They are more common from November to April.
Poor Circulation: People with poor circulation tend to be more sensitive to changes in temperature, making them more susceptible to perniosis.
Raynaud’s Disease: People with Raynaud’s disease are more susceptible to perniosis as narrowing of blood vessels is excessive which causes the blood vessels almost to shut down.
An Autoimmune Disorder: Lupus-an autoimmune connective tissue disease is the most common autoimmune disorder associated with perniosis.
Sex: Women are more likely to get affected by perniosis than men.
Family History: People with a family history of perniosis are more at risk than others.
Treatment
Perniosis is a temporary condition. It will cure at their own after winters. The first line of treatment generally includes measures to keep hands and feet warm and dry, such as keeping indoor environment warm and dry, using gloves and socks, and changing damp gloves and socks when needed. Affected skin is cleaned with an antiseptic and gently bandaged to prevent infection and avoiding scratching. Though there are several lotions or creams that are available to treat chilblains. Topical steroid and calciumchannel blockers are beneficial for the treatment of chilblains. Elderly patients may have a prolonged course, while younger patients improve spontaneously. If the patient is diabetic or has poor circulation, healing may be impaired. So diabetic patients must have regular foot checks as they may not be able to feel their feet and could have septic chilblains without realising. Vulnerable individuals who wrap up warmly, or stay away from the cold as much as possible are much less likely to develop perniosis. Laboratory tests and skin biopsies for perniosis is not necessary, unless the condition persists.
Conclusion
Perniosis or chilblains are small, itchy swellings on the skin that occur as a reaction to cold temperatures. These lesions are bilateral, symmetrical and painful. They are distributed over the exposed parts of the body such as hands, feet, ears, and nose. Diagnosis of perniosis requires wariness, as history of cold exposure may not be evident. Perniosis patients should avoid common triggers such as cold conditions. Prevention is paramount in the management of perniosis.
‘Any error in this manuscript is silent testimony of the fact that it was a human effort’ |
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