3.B. Dermatoses from Physical Factors [Cold Injuries]

Question 1

Three mechanisms of cold injuries

Answer 1

1. Direct damage to tissues
2. Hypoperfusion due to vascular spasm causing vascular and tissue injury
3. Adipose tissue are predisposed to cold injury due to composition and location.

Question 2

People predisposed to cold injuries

Answer 2

Outdoor workers

Recreationalists

Military service members

Alcoholic persons

Homeless people

Question 3

A persistent blue discoloration of the entire
hand or foot worsened by cold exposure.

Answer 3

Acrocyanosis

Question 4

High-risk for Acrocyanosis

Answer 4

Young women

Question 5

.

Evolution of lesion in Acrocyanosis

Answer 5

Cyanosis increases as the temperature decreases ⇒

⇒ Erythema with elevation of the dependent part

Question 6

Cause of Acrocyanosis

Answer 6

Unknown

Question 7

Findings that differentiate

Raynaud syndrome from Acrocyanosis

Answer 7

Raynaud syndrome has

1. Episodic nature
2. Ulceration/Distal finfertip resorption

Question 8

Findings that differentiate

Acrocyanosis from Raynaud syndrome

Answer 8

Acrocyanosis has

1. Persistent nature
2. Lack of tissue damage

Question 9

Trigger of Acrocyanosis

with swelling of nose, ears and dorsal hands

Answer 9

Inhalation of Butyl nitrite.

Question 10

Puffy hand syndrome

Answer 10

Lymphedema of the dorsal hands with

Erythema or Bluish discoloration of the digits

Question 11

Cause of Puffy Hand Syndrome

Answer 11

Repeated injection of the dorsal hand
with narcotic drugs

Question 12

Other groups prone to Acrocyanosis

Answer 12

• Anorexia nervosa
• POEMS syndrome (polyneuropathy, organomegaly,
  endocrinopathy, M component, skin changes)
• Homozygous mutation in SAMDH1

Question 13

A recombinant interferon which may induce Acrocyanosis

Answer 13

Interferon alpha-2a

Question 14

Malignancy in acral vascular syndromes

Answer 14

47% of 68 of reported cases

Question 15

Localized erythema and swelling

caused by exposure to cold

Answer 15

Chilblains

Question 17

Other terms for Chilblains

Answer 17

Pernio

Perniosis

Question 18

Lesions that may be found in

severe Chilblains

Answer 18

Blisters

Ulcers

Question 19

Present in the blood in Chilblain cases

Answer 19

Cryoglobulins

Cryofibrinogens

Antiphospholipid antibodies

Cold agglutinins

Question 20

Conditions associated with Chilblains:

Answer 20

1. Discoid and Systemic lupus erythematosus (Chilblain lupus)
2. Leukemia cutis
3. Nakajo-Nishimura syndrome (infancy)
4. Aicardi-Goutières syndrome (diagnostic sign)
5. Chronic use of crack cocaine

Question 21

Sites of Chilblains

Answer 21

• Hands
• Feet
• Ears
• Face

*especially in children

Question 22

What enhances the onset of Chilblains?

Answer 22

Dampness

Question 23

Clinical picture of patient with Chilblain

Answer 23

• Unaware of cold
• Later experiences burning, itching and redness
• Extremities may be clammy due to excessive sweat

Question 24

High index of suspicion

for underlying cause of Chilblain:

Answer 24

• Recurrent
• Chronic
• Extending into warm seasons
• Poorly responsive to treatment

Question 25

Histopathology of Chilblain

Answer 25

**Lymphocytic vasculitis** * Dermal edema * Superficial and deep perivascular, tightly-cuffed, lymphocytic infiltrate. * “Fluffy” edema of the vessel walls.

Question 26

Treatment for Chilblains (Non-medical)

Answer 26

* Protection against cold and dampness * Heating pads * Cessation of smoking

Question 27

Treatment for Chilblain (Medical)

Answer 27

* Nifedipine 20 mg TID * Nicotinamide 500 mg TID * Dipyridamole 25 mg TID * Sildenafil 50 mg BID \*Pentoxifylline \*Hydroxychloroquine

Question 28

With no treatment, Chilblain will resolve in...

Answer 28

1-3 weeks

Question 29

Injury where soft tissue is frozen and locally deprived of blood supply.

Answer 29

Frostbite

Question 30

Frozen part in frostbite

Answer 30

Painlessly pale and waxy.

Question 31

Tissue destruction in Frostbite similar to Burns

Answer 31

* Erythema and edema * Vesicles and bullae * Superficial gangrene * Deep gangrene * injury to muscles, tendons, * periosteum, and nerves

Question 32

When should treatment of Frostbite be initiated?

Answer 32

Before swelling develops.

Question 33

Treatment of choice for Frostbite

Answer 33

Rapid rewarming in water bath (37-43°C or 100–110°F)

Question 34

When should rewarming be delayed?

Answer 34

When there is risk of refreezing.

Question 35

Treatment of Frostbite

Answer 35

* Covering of affected area with warm surface * Rapid thawing with warm bath * Analgesics * Tissue plasminogen activator within 24 hrs

Question 36

Adjunct therapy for Frostbite

Answer 36

* Bed rest * High-protein/high-calorie diet * Wound care and avoidance of trauma * Massage of proximal portions of the extremity that are not numb. * Anticoagulants * Pentoxifylline,ibuprofen, and aspirin * Antibiotics

Question 37

Recovery period in Frostbite

Answer 37

Months

Question 38

Assessing frosbite requiring amputation

Answer 38

* Proximal phalanx * Lack of radiotracer uptake on bone scan

Question 39

Immersion foot syndromes

Answer 39

Trench foot (cold) Warm water immersion foot

Question 40

Injury resulting from prolonged exposure to cold, wet conditions without immersion or actual freezing

Answer 40

Trench foot

Question 41

Syndrome produced when there is exposure of the feet to warm, wet conditions for 48 h or more.

Answer 41

Warm water immersion foot

Question 42

Characterize Warm Immersion Foot Syndrome

Answer 42

Maceration, blanching, and wrinkling of the soles and sides of the feet

Question 43

Symptoms associated with Warm water immersion foot that lasts for a few days

Answer 43

Itching and burning with swelling

Question 44

Prevention of Warm water immersion foot

Answer 44

1. Allow feet to dry for a few hours in every 24 2. Greasing the soles with a silicone grease OD

Question 45

Distinguish Paddy Foot Syndrome from WWIF

Answer 45

Continuous immersion of the feet in water or mud Above 22°C (71.6°F) for 2–10 days

Question 46

Paddy Foot or Tropical Immersion Syndrome is characterized by:

Answer 46

* Erythema * Edema * Pain of the dorsal feet * Fever * Adenopathy