injuries poisoning
Nonfreezing Tissue Injuries
Chilblains (pernio)
Localized areas of erythema, swelling, pain, and pruritus result from repeated exposure to damp nonfreezing cold; the mechanism is unclear. Blistering or ulceration may occur. Chilblains most commonly affects the fingers and pretibial area and is self-limited. Occasionally, symptoms recur. Younger women are most commonly affected, some of whom may have Raynaud Syndrome or underlying autoimmune disorders (eg, systemic or cutaneous lupus erythematosus). In this photo of chilblains, the middle phalanx has areas of localized erythema and appears swollen. © Springer Science+Business Media This image shows swelling and blistering on the pads of the toes resulting from repeated cold exposure without freezing. Image courtesy of Karen McKoy, MD. This image shows the swelling and erythema of chilblains. Image courtesy of Karen McKoy, MD. Endothelial and neuronal damage results in vasospasm and exaggerated sympathetic response when exposed to cold.Nifedipine20 mg orally 3 times a day, limaprost 20 mcg orally 3 times a day (not available in the US), or corticosteroids (oral, eg,prednisolone0.25 mg/kg twice a day, plus topical corticosteroids) may be effective for refractory pernio. Sympatholytic drugs and avoidance ofnicotinemay also help. 