Chilblains/Pernio

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Chilblains is a term that is likely derived from Old English: chill (cold) and "blegen" (sore). It is also known as pernio.

Today, we discussed a case in a patient with smoldering multiple myeloma--and Chillblains can be associated with paraproteinemia and several other disorders including autoimmune disease, viral hepatitis, or malignancy. The relationship however is not necessarily known to be causative--and the significance of the presence of cold agglutinins, cryoglobulins, or antiphospholipid antibodies identified in subsets of these patients is unclear.

 Illness script for Chilblains/Pernio: In patients with a predisposition with exposure to cold, abnormal or exaggerated vasoconstriction or vasospasm response leads to hypoxemia and an inflammatory response resulting in a clinical picture with a dorsal acral and symmetric distribution of edematous and erythematous to violaceous macules, papules, and nodules which can ulcerate and become tender.

Note: pernio/chilblains can take a chronic or acute course:

  • acute cases appearing in 12-24 hours of cold exposure and lasting for several weeks
  • chronic cases manifesting as recurrent acute episodes the persist for weeks or months, but often improve in warm months of the year.