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Chilblains

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 
 
 

Chilblains -  also known as pernio and perniosis — is a medical condition that occurs when a ‘predisposed individual’ is exposed to cold and humidity. 

It seems to affect those with ‘poor circulation’ and those who are unused to the conditions. 

It also affects those who are a bit sweaty naturally, for example those with sweaty feet or those who have become sweaty from exercise.  The water they exude evaporates and ends up making the person far colder than they might otherwise have been.

cold but dry .......

Water, when it evaporates, creates a significant cooling effect, and even if the conditions might only be simply ‘cold’ and not ‘freezing’, damp weather, a wind and damp extremities create an effect close to freezing.  The near freezing of the extremities damages tissue and also damages the small capillary blood vessels.  Whilst the cold is there it has a numbing effect, but once the person is placed in the warmth, the feeling comes back and chilblains then become very painful.

It is actually as close to frostbite as you are likely to get, without it actually being frostbite.

Symptoms

 

Chilblains (Perniosis/Pernio) is characterized by painful red-to-purple papular lesions involving the extremities,  or the parts exposed, such as fingers or toes.  It has baffled not a few physicians in the USA because it can occur even in apparently warm climates – it is the combination of cold and wetness with evaporation that is key …….

Unfamiliarity of physicians with chilblains (perniosis) gives rise to unnecessary hospital admissions with expensive laboratory and radiologic evaluations and, at times, hazardous therapy. Seven cases of chilblains were seen in San Francisco from November 1986 through January 1987. The patients presented with pruritic, at times painful, purple acral patches or plaques on the fingers, toes, and nose after exposure to a cool or a cold, damp environment. PMID:  2212122

It can occur in places other than the fingers or toes [equestrian chilblain does not affect the horse, as one might initially assume, but the rider]:

Herein, we describe two cases and review 14 cases of equestrian chilblain or 'equestrian cold panniculitis' in the literature. The first, a 23-year-old healthy female horse trainer, presented with burning nodular swelling on her lateral thighs. The second was a 34-year-old healthy woman with recurrent nodular eruption on the lateral thighs after horseback riding in the winter. Physical examination of both patients revealed erythematous to violaceous nodules with eczema craquelé-like changes. PMID: 23432072

The really interesting aspect about this form of chilblains is that it might be the horse that is sweaty, not the rider, but the cold and then the wet clothes and evaporation from them, along with perhaps rubbing create the same symptoms.

We describe 2 adult patients using ice-pack therapy for chronic back pain who developed erythematous, purpuric plaques at the site of ice-pack application. Histopathologic findings from both patients were similar and showed overlapping features of perniosis and cold panniculitis that closely resembled the pattern seen in cutaneous lupus erythematosus…...PMID: 24026341

scarves, hats, layered socks, good stout boots - excellent

Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue (the fatty layer under the skin). 

Using ice packs for back pain is barmy anyway, as it almost halts any form of healing, but it is clear that for a chilblain to form it does have to be very close to freezing.

Causes

Getting wet, getting cold, being sweaty, then exposing yourself to a wind that evaporates away the water and chills you down to almost freezing.

warm boots, woolly socks, gloves, scarf, excellent ...... hmmm but no hat

BACKGROUND: Extreme sub-zero temperature in winters (15 °C to -25 °C), high velocity winds and wind-chill factor pose risk to those who resides at the high altitude environment to develop cold related injuries like chilblains and frostbite. The aim of this study was to study the patterns of chilblains in high altitude region like Ladakh.

METHODS: The study was conducted at Dermatology outpatient department of Military Hospital, Leh from 1 Sep 2009 to 31 May 2010. Patients, satisfying clinical criteria for the diagnosis of chilblains were included into the study. Detailed history and thorough clinical examination was conducted. Complete blood count and Urine routine examination was carried out in every patient. Anti Nuclear Factor tests were carried out in only those who had history suggestive of connective tissue disease.

RESULTS: Total 108 (5.75%) were diagnosed to have chilblains. Only a single case of chilblain was found in a local resident (p < 0.005). Family history of chilblains was present in 10 (9.2%) patients, there was recurrence in 12 (11.1%) and 21 patients (19.4%) were smokers. Most (63.8%) of the patients, had BMI between 20 and 22 kg/m(2) (mean = 20.03 kg/m(2); 95% CI = 19.68-20.38 and SD 1.82). 42.1% of cases of chilblains also had hyperhidrosis (p < 0.05).

CONCLUSION: In a HA area like Ladakh, the non-natives suffer maximum from chilblains. This could be explained by the protective genetic adaptability of natives to extreme cold environment and their protective life style against cold. Low body mass index (BMI) and hyperhidrosis are important associations for development of chilblains.  PMID: 26286795

Treatment

good stout boots, but ...........

Wrap up very warm and be aware of the problems of wind chill.  Protect exposed parts from both damp and cold.

Wear sock and gloves made from natural fibres that will hopefully wick away some of the perspiration if you are a sweaty soul.  Layers help.  For example, cotton socks covered by woollen socks can actually work as a form of insulation, trapping air and moisture, as long as no wind gets through the layers.

If you think you may have got wet and cold and done some damage – for example if the area feels a bit numb, DO NOT warm your extremities quickly.  Get warm slowly to let the blood flow gently back into the veins and the nerves to recover.  The purple colour is bruising – broken veins, but if the chilblains turn a bright pink this is actually a GOOD sign.  Histamine is rushing to the area in order that the healing troops of the body can hurtle there and start the repair process.  It will itch, it will be painful, your toes may glow in the dark, but you will not get gangrene and your toes will not drop off as long as you let Nature take its course.

No medication is needed, all you need to do is make sure you have a diet rich in histidine – the precursor to histamine.  Never, ever take anti-histamines. Never, never, never take immunosuppressants.

 

References and further reading

  • Med J Armed Forces India. 2015 Jul;71(3):265-9. doi: 10.1016/j.mjafi.2013.01.011. Epub 2013 May 10.  Pattern of chilblains in a high altitude region of Ladakh, India.  Singh GK1, Datta A2, Grewal RS3, Suresh MS4, Vaishampayan SS5.
  • 1Graded Specialist (Dermatology & Ven), Command Hospital (Eastern Command), Kolkata 700027, India.
  • 2Commandant, MH Jalandhar, India.
  • 3Prof & Head (Dermatology), Army College of Medical Sciences, Delhi, India.
  • 4Senior Advisor (Dermatology, Ven, Lep), Command Hospital (Eastern Command), Bengaluru, India.
  • 5Commandant, MH Nasirabad, India.

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