Erythema Pernio

Question 1

What is Erythema Pernio also known as?

Answer 1

Chillblain, Pernio, Perniosis

Question 2

What is Erythema Pernio?

Answer 2

A vasospastic disorder resulting in ishcaemia due to an abnormal response of the blood vessels to cold environments

Question 3

What is a vasospastic disorder?

Answer 3

A disorder which causes spasms in arteries and vessels causing them to constrict and narrow, reducing blood flow to peripheral limbs

Question 4

What is ischaemia?

Answer 4

A shortage of blood supply to tissues, reducing supply of oxygen to tissue cells

Question 5

What are signs and symptoms of Erythema Pernio?

Answer 5

• Lesions appearing 12-24 hours after exposure to cold environment
• burning / itching sensation
• erythematous, swollen lesions - bullae and ulceration in severe cases
• Located in the extremities
• Acute - manifests for 1-3 weeks
• Chronic - persists after cold seasons have ended

Question 6

What are three differential diagnosis for Erythema Pernio?

Answer 6

• Trenchfoot
• Raynauds Phenomenon
• Acrocyanosis
• COVID Toes?

Question 7

What are primary aetiologies of Erythema Pernio?

Answer 7

• Cold / Damp conditions
• Rapid change in temperatures
• Poor insulation (thin footwear etc.)

Question 8

What are secondary (host) aetiologies for Erythema Pernio?

Answer 8

• Defective Thermoregulation
  
  • Autoimmune disease
  • Hypothyroidism
  • Peripheral Arterial Disease

Question 9

What is an Auto-immune disease?

Answer 9

• Where your immune system attacks healthy cells and tissue in the body, resulting in inflammation and damaged tissue

Question 10

What is this?

Answer 10

• Chillblain Lupus Erythematosus
• Persistent plaques visible on dorsal IPJ’s of digits
• Associated with Systemic Chillblain Erythematosus

Question 11

What is Hypothyroidism?

Answer 11

• Underactive Thyroid
• Endocrine Disorder
• Thyroid gland does not produce enough Thyroid hormone
• Leads to inability to tolerate cold conditions

Question 12

What is Peripheral Vascular Disease?

Answer 12

• Inadequate blood supply to the extremities
• Anaemia - reduced oxygen supply reaching tissues
• Atheriosclerosis - plaque/fat build up in arteries
• Arteriosclerosis - stiffening of arteries restricting blood flow

Question 13

What is the pathology of Erythema Pernio?

Answer 13

• Exposure to damp/cold condition
• Vasoconstriction occurs naturally due to thermoregulation, however vasospasm also accurs as the vessles are constricted for too long.
• This leads to an abnormal circulatory response from cold conditions to warm conditions
• Impaired and delayed vasodilation and an inability to remove toxins and metabolites
• Blood supply becomes deoxygenated due to absence of normal vasodilation
• Chillblain formation