Clinical Findings and Diagnosis

On closer inspection of the toe lesions, it became apparent that the condition could fall into one of three broad categories:

• Inflammatory,

• Infective, or

• Vascular conditions,

all of which can present with similar features.

Diagnosis: Chilblains or Pernios.

Chilblains are a common non-freezing cold injury, typically affecting the fingers and toes, but they can also involve the ears, nose, and even the buttocks.

Clinical Features of Chilblains

Chilblains usually present with:

• Swelling

• Redness

• Burning sensation

• Itching

• Sometimes pain

Importantly, chilblains have been reported as early or presenting features of conditions such as anorexia nervosa and other autoimmune disorders.

Pathophysiology and Risk Factors

Pathologically, chilblains are described as a form of vasculitis, where blood vessels are surrounded by perivascular inflammatory cell infiltrates.

Certain groups are at higher risk, including:

• Girls, particularly those with a history of Raynaud’s phenomenon

• Individuals at the extremes of age (older adults and during puberty)

• Patients with anorexia nervosa

• Those with underlying inflammatory or autoimmune conditions

Management of Chilblains

The cornerstone of management for chilblains is prevention. Key preventive measures include:

• Avoiding direct heat exposure

• Never going barefoot

Protecting the body from cold exposure.