Management

Reassurance is important. The patient should be informed that acute episodes are usually self limiting and fundamental factor in this disease is its association with cold and damp conditions. Prevention of exposure to cold is important (1,2).

Offer self-care advice to keep warm and minimize exposure to cold:

• should wear thick socks and shoes to protect feet and gloves to protect fingers (1)
• wear a hat to reduce heat loss from head
• wear several layers of loose clothes to avoid heat loss (3)
• feet should be kept dry to reduce heat loss (4).

Other measures include use of calcium antagonists (nifedipine) and ultraviolet light:

• there is evidence that the use of nifedipine improved clearance of chilblains and prevented the development of new lesions – mainstay therapy (1)
• other pharmacologic therapies with low-level evidence include corticosteroids, topical minoxidil, topical nitroglycerin, nicotinamide, and pentoxyifylline (5).

Reference:

• (1) Simon TD, Soep JB, Hollister JR. Pernio in pediatrics. Pediatrics. 2005 Sep;116(3):e472-5. doi: 10.1542/peds.2004-2681. PMID: 16140694.
• (2) AlMahameed, A., Pinto, D.S. Pernio (Chilblains). Curr Treat Options Cardio Med 10, 128–135 (2008). https://doi.org/10.1007/s11936-008-0014-0.
• (3) Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH) Safety and Health Topic: Cold Stress.
• (4) Jordaan H.F. The diagnosis and management of perniosis (chilblains). SA Fam Pract 2007;49(6): 28-29.
• (5) Pratt M, Mahmood F, Kirchhof MG. Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review. J Cutan Med Surg. 2021 Sep;25(5):530-542. doi: 10.1177/1203475421995130. Epub 2021 Mar 2. PMID: 33653127; PMCID: PMC8474327.