Erythema Pernio

Question 1

What are Chillblains/Erythema Pernio

Answer 1

So its a vasospastic condition causing cold induced lesions that affect areas of the skin vunerable to cold exposure
So there are 3 stages
* Cyanotic
* Inflammatory (Hyperaemic and Congestive)
* Ulcerative

Cyanotic = ususally asymptomatic, blueish colour to the skin due to decreased o2 from vasoconstriction

Hyperimia = reactive vasodilation red, hot swollen painfull from sudden rush of blood into cappilary, erythema due to heat from increased metabolic rate

Congestive = dark purple apperance caused by volume of deoxeygenated blood

Ulcerated = deoxeygenated blood and toxins build up causing tissue damage

Question 2

What assesments would you perform if chilblains are suspected

Answer 2

Take the patients history
* How long has it being going on for
* ascertain whether they’ve had any recent exposure to cold
* determine any risk factors from a family history, obviousley we know chilblains are often idopathic but it can be secondary to other conditions like lupus erythema so we need to try clarify that
* Previous episodes or symptoms outside the cold months

Examine the patient
* Checking for any clinical signs such as red or purple lesions on top of the skin
* Complete a Vascular assesment to asses the peripheral circulation as well as neurological assesment to asses sensation in affected area and rule out neuropathy

Question 3

How would you manage Chilblains what advice would you give

Answer 3

So if the chilblains are idopathic:
* Minimise exposure to extreme temperatures and rapid temperature change
* Avoid smoking as this can cause vasoconstriction

Hyperaemic phase
* Cooling lotions, calamine lotion
* Witch hazel

Cyanotic and congested phase
* Warming body in water at room temprature
* A rubeficient can be used during the cynaotic stage to stimulate blood flow
* Wear adequate clothing to keep warm insulating gloves insulating footwear Plastazote insoles
* wool basket

Broken Chilblain
* So i would treat as an infected lesion
* cleanse area
* So id establish drainage
* Apply dressing using aeseptic technique
* Remove pressure

Question 4

Erythema perno Aetiology 6 and 3 for exacerbating

Answer 4

Pre disposing risk factors
* bad blood supply
* Diet
* Endocrine disorders
* Anemic patients
* Diabetes
* Peripheral Aterial Disease

Contributing factors
* tight footwear or inapproiate footwear
* rapid heating
* thin socks