Pernio is an uncommon condition, also known as chilblains.
Pernio is a localized inflammatory condition that causes erythematous purple or red macules and papules on the toes or fingers. It can cause intense pain, itching, or burning. Pernio occurs most often in young women between the ages of 15 and 30 years but can also occur in older adults and younger children following exposure to nonfreezing cold.
The etiology of pernio is unclear although the presence of cryoproteins in some patients may amplify a cold injury, as this case illustrates. The cause of cryoproteinemia also is uncertain but might be the result of a recent viral and Mycoplasma infection, though no such history was present in this case. Factors that may predispose to pernio include anorexia nervosa, thin body habitus, systemic lupus erythematosus, and rheumatoid arthritis.
The most effective treatment is to keep the affected areas warm and dry. Topical corticosteroids are not effective. Oral therapy with the vasodilator nifedepine can help reduce pain and facilitate healing in some patients.
The patient in this case began taking meticulous care to keep her feet warm and dry. The lesions improved significantly.
Weston W, Morelli, J. Childhood pernio and cryoproteins. Pediatr Dermatol. 2000;17:97-99.
Simon T, Soep J, Hollister R. Pernio in pediatrics. Pediatrics. 2005;116:472-475.