Background/Aims: Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. We sought to determine whether cold-induced vasospasm has a role in the development of pernio. Methods: We retrospectively reviewed 5 patients with pernio who were seen at our institution between January 1, 2000 and December 31, 2011, and had undergone a noninvasive arterial vascular study of the upper extremities that corresponded to a site of clinical involvement of pernio and who had also undergone vasospastic testing and ice water immersion as part of the noninvasive arterial vascular study protocol. Results: Vascular testing in all patients (mean age 37.8 years; 4 women) demonstrated vasospasm with ice water immersion. Conclusion: Our findings suggest that vasospasm likely has a role in the pathophysiology of pernio and may also provide a rationale for the pharmacological treatment of vasospasm in patients with pernio.

Keywords:
Clinical dermatology, Inflammatory diseases, Vascular diseases, Vascular disorders
1.
Cappel JA, Wetter DA: Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc 2014;89:207-215.
2.
Akkurt ZM, Ucmak D, Yildiz K, Yuruker SK, Celik HO: Chilblains in Turkey: a case-control study. An Bras Dermatol 2014;89:44-50.
3.
Boada A, Bielsa I, Fernandez-Figueras MT, Ferrandiz C: Perniosis: clinical and histopathological analysis. Am J Dermatopathol 2010;32:19-23.
4.
Prakash S, Weisman MH: Idiopathic chilblains. Am J Med 2009;122:1152-1155.
5.
Nielsen SL: Raynaud phenomena and finger systolic pressure during cooling. Scand J Clin Lab Invest 1978;38:765-770.
6.
Maricq HR, Weinrich MC, Valter I, Palesch YY, Maricq JG: Digital vascular responses to cooling in subjects with cold sensitivity, primary Raynaud's phenomenon, or scleroderma spectrum disorders. J Rheumatol 1996;23:2068-2078.
7.
Spittell JA Jr, Spittell PC: Chronic pernio: another cause of blue toes. Int Angiol 1992;11:46-50.
8.
Simon TD, Soep JB, Hollister JR: Pernio in pediatrics. Pediatrics 2005;116:e472-e475.
9.
Stanhewicz AE, Ferguson SB, Bruning RS, Alexander LM: Laser-speckle contrast imaging: a novel method for assessment of cutaneous blood flow in perniosis. JAMA Dermatol 2014;150:658-660.
10.
Chotani MA, Flavahan S, Mitra S, Daunt D, Flavahan NA: Silent alpha(2C)-adrenergic receptors enable cold-induced vasoconstriction in cutaneous arteries. Am J Physiol Heart Circ Physiol 2000;278:H1075-H1083.
11.
Herrick AL, Murray AK, Ruck A, Rouru J, Moore TL, Whiteside J, Hakulinen P, Wigley F, Snapir A: A double-blind, randomized, placebo-controlled crossover trial of the α2C-adrenoreceptor antagonist ORM-12741 for prevention of cold-induced vasospasm in patients with systemic sclerosis. Rheumatology (Oxford) 2014;53:948-952.
© 2015 S. Karger AG, Basel
2015
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