chilblain

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chilblain

 [chil´blān]
one of the mildest forms of cold injury, characterized by recurrent localized itching, swelling, painful erythema, and sometimes blistering and ulceration upon exposure to cold and dampness; it occurs chiefly on the fingers, toes, ears, and face, but may involve other areas of the body. (This condition should not be confused with frostbite, another type of skin damage caused by exposure to cold.) The basic cause of chilblain is sensitivity to cold, sometimes due to circulatory disturbances that can be partially corrected by exercise and proper diet; severe cases require medical attention. Extreme heat or cold applications should not be applied directly to chilblains. Called also pernio.

chil·blain

(chil'blān), Avoid the misspelling chillblain.
Erythema, itching, and burning, especially of the dorsa of the fingers and toes, and of the heels, nose, and ears caused by vascular constriction on exposure to extreme cold (usually associated with high humidity); lesions can be single or multiple, and can become blistered and ulcerated.
[chill + A.S. blegen, a blain]

chilblain

/chil·blain/ (chil´blān) a recurrent localized itching, swelling, and painful erythema of the fingers, toes, or ears, caused by mild frostbite and dampness. Called also chilblains .

chilblain

(chĭl′blān′)
n.
An inflammation followed by itchy irritation on the hands, feet, or ears, resulting from exposure to moist cold.

chil′blained′ adj.

chilblain

[chil′blān]
Etymology: AS, cele, cold, bleyn, blister
redness and swelling of the skin caused by excessive exposure to cold. Burning, itching, blistering, and ulceration that are similar to those characteristic of a thermal burn may occur. Treatment includes protection against cold and injury, gentle warming, and avoidance of tobacco. Also called pernio. Compare frostbite.
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Chilblain
A dermatopathy due to cold, damp climates, i.e., in the UK; presumed due to prolonged arteriolar constriction
At risk groups Infants, elderly, alcoholics
Management Proper clothing, smoking cessation, corticosteroids

chil·blain

(chil'blān)
Erythema, itching, and burning, especially of the dorsa of the fingers and toes, and of the heels, nose, and ears caused by vascular constriction on exposure to extreme cold (usually associated with high humidity); lesions can be single or multiple, and can become blistered and ulcerated.
Synonym(s): erythema pernio.
[chill + A.S. blegen, a blain]

chilblain

Raised, red, round itchy swelling of the skin of the fingers and toes occurring in cold weather. This and other related disorders, are included in the term ‘perniosis’.

chilblain

; perniosis cold-induced skin lesion characterized by marked inflammation, affecting peripheral tissues (fingers, toes, heel, lower legs, nose, tips of ears) especially in areas of skin exposed to cold draughts, in susceptible people; presents in four phases (Table 1); treatment is tailored to the phase of presentation; patients at risk of chilblain are advised to keep feet and legs warm (wear soft, multilayered leg clothing, roomy shoes with thermal insoles), avoid draughts and never immerse cold feet in hot water; systemic beta-blockers should be avoided, especially in winter
Table 1: Characteristic stages and treatments of chilblain
Presentation (phase) of chillingTreatment
Initial cold phase
Affected areas of skin are very cold, pale and cyanosedTopical application of rubefacients, e.g. iodine or methyl salicylate ointments
Acute inflammatory chilblains
Affected areas become acutely inflamed, tender, itchy and burning with associated local oedema or blistering (i.e. hyperaemic)Topical application of cooling lotions, e.g. hamamelis water, Burow's solution
Chronic inflammatory chilblains
Affected areas show chronic inflammationTopical application of rubefacients, e.g. weak iodine, methyl salicylate ointments
Gentle soft-tissue massage (see iodine)
Broken chilblains; ulcerative chilblains
The skin overlying the area of chilling undergoes breakdown as the result of the severity of the initially chilling and subsequent acute inflammatory response; the chilled areas weep serous fluid and are at risk of infectionTopical applications of antiseptic rubefacient medicaments, e.g. weak iodine or Betadine solution
Regular dressings and review until areas healed
References in periodicals archive ?
Cuando se pierde este patron ciclico y las lesiones se vuelven ulceradas, sobreinfectadas o cicatrizadas -como puede ocurrir en la perniosis cronica o secundaria- el diagnostico se hace mas dificil, por lo que se requiere una biopsia de piel y pruebas de laboratorio para descartar una criopatia o enfermedad del tejido conjuntivo (4).
Discrasias sanguineas, que cursan con criodisproteinemia, crioglobulinas o aglutininas frias, pueden presentar lesiones cutaneas similares a las de la perniosis, pero en estos casos una evaluacion hematologica completa permite establecer la causa de las lesiones cutaneas.
La perniosis aguda es inusual en personas mayores; por esto, la aparicion subita de eritema pernio en un individuo mayor, sobretodo en hombres, sin evidencia de trastornos vasculares, autoinmunes, o relacion con medicamentos, puede ser un signo de una enfermedad sistemica asociada (29).
Se desconoce la naturaleza de su asociacion con la perniosis; sin embargo, se ha sugerido buscar signos de leucemia mielomonocitica cronica en personas mayores que desarrollen eritema pernio, ya que esta no es la edad mas frecuente de presentacion de la perniosis (30).
La relacion patogenica entre la perniosis y la enfermedad celiaca se desconoce.
En la anorexia nerviosa se ha propuesto vasoreactividad cutanea elevada y termorregulacion alterada con una respuesta vascular periferica al frio hiperreactiva que produce lesiones de perniosis (32).
Por este motivo no se recomiendan los niveles de crioglobulinas como prueba de laboratorio inicial para los pacientes con perniosis clasica.
Hasta el momento la mejor terapia para la profilaxis y tratamiento de la perniosis es con nifedipino, un bloqueador de los canales de calcio, que produce vasodilatacion (8,28,34,35).
Otros tratamientos que se han usado en la perniosis como vasodilatadores topicos (cremas de nitroglicerina), unguento de heparina, preparaciones con calcio, vitaminas intramusculares y simpatectomia (4), luz ultravioleta, nicotinamida, pentoxifilina, fenoxibenzamida (10), corticoides topicos y sistemicos, antibioticos topicos, calcio intravenoso y antihistaminicos no han demostrado ser utiles.
Se ha sugerido que la lesion ocasionada por la fototerapia con luz ultravioleta intensa era seguida por disminucion de la capacidad de las arteriolas para contraerse, y que este efecto persistiria por meses; lo cual aliviaria el vasoespasmo cronico en la perniosis (15).
Finalmente, es importante tratar la enfermedad subyacente en individuos con una perniosis secundaria (4).