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Pernio (chilblains)

Daniela Kroshinsky, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


Pernio (also known as chilblains or perniosis) is a condition characterized by the development of cold-induced erythrocyanotic skin lesions. The word "chilblains" may be derived from the Old English words "chill" and "blegen" (sore) [1].

Pernio manifests as erythematous to violaceous macules, papules, plaques, or nodules in sites of cold exposure. The most common sites for involvement are the fingers and toes (picture 1A-E). Symptoms of pruritus, pain, or burning often accompany the skin lesions, and complications of blistering, ulceration, or secondary infection can occur.

In many patients, pernio presents as an acute eruption that begins 12 to 24 hours after cold exposure and resolves within a few weeks. However, pernio may also follow a chronic or recurrent course. Treatment primarily involves protection of affected areas from cold environments.

The clinical features, diagnosis, and management of pernio will be reviewed here. Pernio is distinct from lupus pernio, a form of cutaneous sarcoidosis. Lupus pernio is discussed separately. (See "Cutaneous manifestations of sarcoidosis", section on 'Lupus pernio'.)


Data on the epidemiology of pernio are limited. Pernio usually occurs following exposure to cold, damp environments, and thus is most common among individuals who live in cold climates. Symptoms commonly begin in early winter and resolve by spring as cold exposure decreases. However, patients may develop recurrences during subsequent winters or persistent disease [2-4].  

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Literature review current through: Oct 2017. | This topic last updated: Aug 16, 2016.
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