Cases reported "Chilblains"

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1/20. Erythrocyanotic discoloration of the toes.

    A 35-year-old woman from virginia presented with purplish, tender toes. She was diagnosed with pernio and successfully treated, initially with nifedipine and subsequently with management of the affected area's environment. Clinical presentations and treatment strategies are discussed below. ( info)

2/20. Idiopathic palmoplantar eccrine hidradenitis in children.

    Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments. ( info)

3/20. Verrucous form of chilblain lupus erythematosus.

    A 45-year-old woman had symmetrical livid plaques with yellowish hyperkeratoses for 5 years, which progressed on to the fingers and toes and on the soles of the feet. Two years later creamy, whitish areas and maceration appeared on the buccal mucosa and the lips. A skin biopsy revealed massive collagen hyaline degeneration in the perivascular area, hyperkeratosis and hypergranulosis, small lymphocyte infiltrates with several melanophages and extravasates of erythrocytes in the upper corium in perivascular areas and hydropic degeneration of basal keratinocytes. The findings using direct immunofluorescence were compatible with lupus erythematosus (LE). Laboratory investigation showed a slight leucopenia and thrombopenia, a slightly elevated erythrocyte sedimentation rate, hypocomplementaemia C3 and C4, a high titre of rheumatoid factor and antinuclear antibodies positivity of extractable nuclear antigen. The results reflected probably the development of a systemic form of the disease. The patient was successfully managed by methylprednisolone and hydroxychloroquine. After 1 year of therapy, a new skin biopsy revealed a substantial reduction of hyperkeratosis and hyaline degeneration of collagen tissue in the perivascular areas. The combination of the extensive hyperkeratosis and hyalinization thus seems to be features of the long-lasting, untreated lesions in chilblain LE. ( info)

4/20. Perniosis (chilblains) of the thigh: report of five cases, including four following river crossings.

    Perniosis, or chilblains, are skin lesions that occur as an abnormal reaction to cold, damp environments. We describe five cases of perniosis affecting the thighs. Four of the five cases occurred after wading across mountain rivers. Histological changes of deep perniosis and panniculitis were seen in a skin biopsy from one of the cases. In each case there was marked pain and discomfort, and lesions resolved over more than 1 week. ( info)

5/20. Chilblain lupus erythematosus lesions precipitated by the cold.

    Lupus erythematosus (LE) may exhibit a broad array of clinical presentations. Cutaneous manifestations include malar rash, discoid lesions, alopecia, and panniculitis. Cold-induced lesions are uncommon. To illustrate this unusual presentation, we describe a case of typical chilblain LE. ( info)

6/20. The chilblain-like eruption as a diagnostic clue to the blast crisis of chronic myelocytic leukemia.

    A 70-year-old Japanese man visited our clinic with the chief complaint of chilblain-like eruptions on the toes of both feet. His toes were bluish, erythematous, and swollen. Neither oral administration of vitamin e for 2 weeks nor wearing insulated socks improved the clinical manifestations. Peripheral blood examination revealed the presence of a large number of monocytic atypical cells and myeloblasts, anemia, and thrombocytopenia. In the bone marrow, monocytic cells were elevated, and myelocytic atypical cells were observed. Chromosomal analysis demonstrated philadelphia chromosome. We diagnosed him as having a blast crisis of chronic myelocytic leukemia (CML). A biopsy specimen of the skin from the chilblain-like eruption showed infiltration of large, atypical, mononuclear cells; most of them were positive for CD68, and some of them were positive for CD14. Therefore, we concluded that the chilblain-like eruptions on his toes were specific skin lesions of a blast crisis in CML. ( info)

7/20. Chronic pernio: another cause of blue toes.

    It is the purpose of this report to focus attention on the clinical features, diagnosis, and management of chronic pernio. Thirty-nine patients meeting our strict criteria for a diagnosis of chronic pernio were seen at the Mayo Clinic between 1976 and 1988 and form the basis for this report. persons with upper extremity lesions only were excluded. Twenty-eight of the patients were female, 11 were male. Age at onset of symptoms ranged from 13 to 68 years of age, with symptoms appearing from 1 to 37 years following cold injury. The lesions were bilateral in 35 (90%) of patients and symmetric in 28 (71%). Nine patients who underwent skin temperature studies following cold water immersion, showed a vasospastic response. Chronic pernio is characterized by recurring erythematous, vesicular or ulcerative lesions of the lower extremities and toes, but may present with only digital cyanosis, usually bilateral and commonly symmetrical. The diagnosis is suggested by eliciting a temporal relation between cool weather and symptom onset, particularly if there is no associated occlusive peripheral arterial disease. Treatment consists of avoidance of cold and other vasoconstrictive influences. prazosin has been effective in the acute management and as prophylaxis against recurrences. ( info)

8/20. celiac disease presenting with chilblains in an adolescent girl.

    chilblains, or pernio, are cutaneous lesions that may accompany systemic illnesses including states of malnutrition and autoimmune diseases. We report an adolescent girl in whom chilblains were the chief presenting sign of celiac disease. A gluten-free diet led to weight gain and resolution of the chilblains. We speculate that in this patient, weight loss due to celiac disease contributed to the development of chilblains. ( info)

9/20. Microgeodic disease affecting the hands and feet of children.

    Twenty cases of microgeodic disease affecting the hands or feet of children are presented, and the relevant literature is reviewed. Clinical features include chilblain-like appearance and tenderness of the involved digits. Radiographically patchy osteoporosis of the diaphysis and/or sclerosis of the diaphysis and rarefaction of the metaphysis with cortical erosion is evident, often accompanied by subperiosteal new bone formation. Characteristically, this condition occurs in winter and resolves spontaneously within 6 months clinically and radiographically. This lesion appears to result from vascular insufficiency of the hands and feet causing bone infarction secondary to intense vasospasm precipitated by cold. ( info)

10/20. Localized recurrent postoperative pernio associated with leukocytoclastic vasculitis.

    A patient with recurrent pernio of the right ankle for 21 years after surgery had a leukocytoclastic vasculitis localized in the area. We suggest that the various histologic descriptions of pernio in the literature and in this case represent different levels of severity of the disease. ( info)
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