Perniosis(Chilblains)

Perniosis is a common conditions and is an abnormal reaction to cold and high humidity during winters. It occurs frequently in women, children and elderly patients present with recurrent painful, tender, erythematous violaceous plaques on the distal extremities, especially the finger and toes.  The disease seems to be more common in environments where heating is inadequate for a few months of the year and is less common in localities characterised by harsh frigid winters where adequate home heating is the norm. Exposure to cold water some­times seems to play a role.

How does Chilblains feel like :

Chilblains appear as small itchy, red areas on the skin. Chilblains become increasingly painful as they get congested and take on a dark blue appearance. They may also become swollen. As they dry out, chilblains leave cracks in the skin  so the risk of getting an infection increases. Chilblains are common on the toes, but can also affect the fingers and the face (especially the nose and ears). Chilblains are also common on areas of the feet exposed to pressure, such as bunions or where the toes are under pressure from tight shoes or where there are corns and callus.

Chilblains start during the winter (when the weather gets colder) - the initial symptoms include burning and itching in the area of the developing chilblain. These symptoms are often intensified when going into a warm room. There is often some swelling and redness. In many cases, the skin over the chilblain can break down and becomes a sore (ulcer). An infection may develop in the chilblain.

Prevention
Keeping your feet warm is an important way to prevent chilblains - use trousers, high top boots, tights, leg warmers and long, thick woolen socks. If your feet do get cold, allow them to warm up slowly - do not put them straight in front of a source of heat (this gives a chance for the circulation to respond to the warming skin). Do not let the feet become exposed to any source of direct heat (e.g. heater), especially if the foot is very cold - this is a common factor causing chilblains. Smoking also interferes with the circulation in the small blood vessels and increases the risk of getting chilblains.

Treatment

• Do not rub or scratch chilblains
• Avoid direct heat, but keep the feet warm by the use of woolen socks and footwear
• Use soothing lotions (e.g. calamine lotion)
• Those with diabetes or poor circulation should see a Podiatrist. The risk of further complications from the chilblains in those with a foot that is 'at risk' is too high to delay seeking professional help
• Thermal or insulating insoles can help keep the foot warm to prevent chilblains.
• Padding and pressure relief may give some relief for the chilblain symptoms.
• Topical steroids may need to be used in case of very swollen severe chilblains.