By Gary M. White, MD
Perniosis is an inflammatory condition of the acral areas chronically exposed to the cold.
Pruritic, often painful areas are seen on the fingers and toes. The condition is more common in women and those who are thin. It most commonly occurs in and may recur every winter.
Chilblain lupus and familial chilblain lupus can present in an identical manner.
- One should inquire about a history of Raynaud's phenomenon and lupus erythematosus.
- ANA, SS-A and SS-B, anticardiolipin, antiphospholipid antibody and cryoglobulins.
- Make sure patient is not on a stimulant, e.g., Adderall [J Am Acad Dermatol. 2011 Jun;64(6):1218-9].
If the patient is able to avoid all cold, damp environments, the condition will resolve without any other treatment. A topical steroid may be given acutely. Nifedipine has been used in severe cases.
In speaking with one patient with toe perniosis on followup, she said "Doing great on thick socks. Got the electric ones and worked but are not as comfortable. The steroid cream (fluocinonide) helped."
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