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PERNIO (CHILBLAINS)
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What is it?

“Pernio” (also known as “chilblains”) is a condition characterized by skin changes (described below) that occur in response to cold temperatures. The fingers and toes are the most commonly affected areas of the body. The ears, nose, soles of the feet, buttocks, calves and thighs may also be affected. The exact cause of pernio remains unclear but an abnormal response of blood vessels to cold exposure is thought to play a significant role. Although it can affect anyone, it is more common in young and middle-aged females. The condition usually occurs during the winter in cold, damp environments. It may occur as a single episode or as a recurrent problem. In acute cases, symptoms usually appear within 12 to 24 hours and resolve within 3 weeks. Possible complications include the development of blistering, ulceration, or infection.

 

Risk factors

• Exposure to humid, damp, and cold environments

• Excessively tight clothing or shoes

• Being underweight

• Female gender

• Having been diagnosed with Raynaud’s disease or systemic lupus erythematosus (SLE)

• Having poor circulation

 

Symptoms

Symptoms of pernio may include:

• Itching

• Blistering

• Swelling

• Red to dark blue-colored, patchy rash

• Burning sensation

 

Sports Medicine Evaluation

A sports medicine physician will review symptoms and ask about the medical history to assess for associated conditions. A full skin examination in addition to a general medical exam will be performed. Although a skin biopsy is not necessary for diagnosis, it may be useful in certain circumstances. There is no blood test that confirms the diagnosis.

 

Treatment

• Minimize cold exposure

• Keep the affected area dry (dry bandaging)

• Re-warming but avoiding extreme temperature changes (including hot water)

• Elevation

• Anti-inflammatory medications

• Topical steroid cream

• Medications that cause blood vessels to widen, such as nifedipine or diltiazem, can be prescribed for recurrent cases

• Antibiotic cream for secondary infections

 

Injury Prevention

• Avoiding rapid changes in temperature

• Wearing protective clothing (hat, scarf, shoes, gloves, socks)

• Avoiding tight-fitting socks and shoes

• Avoiding tobacco use

 

Return to Play

Depending on symptom severity and sport, return to activity is possible within days to weeks. In athletes who are involved in sports requiring exposure to cold environments adjustments in clothing, training, and competition may be necessary. In cases of chronic pernio, preventive medications could be considered.

AMSSM Member Authors
Dusty Marie Narducci, MD

References
Prakash S, Weisman MH. Idiopathic chilblains. Am J Med 2009; 122:1152.
Kroshinsky D, (April 16, 2016). PErnio (chilblains). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on May 27, 2017.)

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