GPAtlas🧭 When to suspect
Suspect chilblains (perniosis) when an otherwise well patient develops itchy or burning red-to-violaceous patches or swellings on the acral extremities:
• Classically the toes and fingers, but also the heels, ears and nose.
• Appearing several hours (typically 12–24 hours) after exposure to cold, damp conditions.
Chilblains are an abnormal inflammatory response to non-freezing cold, not a freezing injury, and are common in the UK's damp winters.
The diagnosis itself is usually obvious. The central clinical skill is deciding which kind of chilblains you are looking at:
• The great majority are simple idiopathic chilblains: self-limiting and managed with warmth.
• In secondary chilblains, cold-induced lesions are the visible tip of an underlying disorder such as chilblain lupus or another connective tissue disease.
• Secondary causes account for fewer than 7% of cases, but missing them is the principal pitfall.
| Feature | Primary (idiopathic) chilblains | Secondary chilblains – raise suspicion |
|---|---|---|
| Timing | • Cold, damp weather • Settle as the weather warms |
Persist into warm weather or occur year-round |
| Course | Self-limiting over 1–3 weeks | Persistent (> 1 month), recurrent, or ulcerating |
| Distribution | Typical acral sites, symmetrical | Atypical sites or unusually widespread |
| Systemic clues | None – patient otherwise well | Raynaud's, photosensitive rash, arthralgia, mouth ulcers, weight loss |
| Underlying cause | None | Chilblain lupus, connective tissue disease, cryoglobulinaemia, rarely leukaemia |
Consider the diagnosis particularly in patients with predisposing factors: low body weight, poor peripheral circulation, smoking, outdoor cold exposure, and a family or personal history of chilblains or Raynaud's.
Source: DermNet
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.