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Chilblains/Pernio
Published in Charles Theisler, Adjuvant Medical Care, 2023
Small painful or itchy red or purple bumps that form on the fingers or toes as a reaction to cold temperatures are known as chilblains. Swelling and/or blisters are often present. It is a form of localized vasculitis frequently associated with Raynaud’s disease. The disorder affects primarily women, but also children or the elderly, in damp temperate climates.1 As a rule, chilblains tends to respond poorly to treatment. Existing lesions often clear up in a few weeks with or without active treatment.
General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Chilblain, also known as pernio, is a superficial injury typically occurring after one to 5 hours in cold, wet conditions at temperatures below 16°C (50°F). Small erythematous papules appear on the skin, most often on the dorsal surface of the fingers, though the ears, face, shins, and feet may also be affected. The lesions are swollen, tender, itchy, and painful. Upon rewarming, the skin becomes inflamed, red, and hot to the touch, with an itching or burning sensation that may continue for several hours.18 It is during this rewarming phase that chilblain becomes thermographically visible. Recovery from chilblain is usually complete without lasting effects.
Decontextualised Chinese medicines
Published in Vivienne Lo, Michael Stanley-Baker, Dolly Yang, Routledge Handbook of Chinese Medicine, 2022
Michael Heinrich, Ka Yui Kum, Ruyu Yao
The successful transmission of Ginkgo seems to be wrapped up with these religious and poetical connotations. Yet, this did not mean that the medicine was processed or used in the original way. In 1691 the German naturalist Engelbert Kaempfer, ‘discovered’ G. biloba trees in Japan. Forty years later (1730) it arrived in Utrecht and thus Europe (Heinrich 2013). East Asian records of medical functions generally relate to the seeds (pseudofruits). Importantly, the leaves are much less frequently used. There are topical preparations including for treating chilblains (frostbites, resulting in swelling, reddening and itching of the skin) and for asthma (as a throat spray). European fascination is linked to its symbolic importance in the context of longevity. Since its European ‘discovery’, the unusual shape of the leaves has fascinated scientists and poets, including J. W. von Goethe 1749–1832), the famous Romantic poet, statesman, solicitor and natural historian from Frankfurt, who from 1775 onwards worked in Weimar. His poem on ginkgo both crystallises European fascination with the tree and stimulated its spreading fame:
Use of calcium channel blockers in dermatology: a narrative review
Published in Expert Review of Clinical Pharmacology, 2021
Yang Lo, Lian-Yu Lin, Tsen-Fang Tsai
The etiology of chilblain LE is still unclear, but vasospasm may play a role in the reaction to coldness [19]; furthermore, many cases of chilblain LE are associated with Raynaud’s phenomenon (RP) [20]. Regarding RP, CCB is one of the treatment option for chilblain LE because of its association with vasodilation [20]. One double-blind crossover study showed that retreatment with oral nifedipine does not affect the cold-induced vasodilation response in healthy individuals [21]. According to a recent study [22], topical 10% nifedipine application improved the cold response in healthy fingers as assessed by thermography, but possibly caused harmful effects over previously frostbitten tissue and amputated digits. Another disease with similarities to chilblain LE is chilblains (pernio), for which CCB is also reportedly effective due to its efficacy for peripheral vasodilation, and nifedipine 20–60 mg given three times daily is the most frequently used [23]. It can also be administered topically [24]. But the efficacy of nifedipine has not been confirmed by all studies [25]. Nifedipine is considered an effective treatment for both chilblain LE and chilblains.
Human and novel coronavirus infections in children: a review
Published in Paediatrics and International Child Health, 2021
Nipunie Rajapakse, Devika Dixit
Many cutaneous findings in COVID-19 patients have been described in the literature, although additional studies will be required to confirm a causal link as well as the underlying pathophysiological mechanism(s). An apparent increase in the incidence of chilblain-like lesions on the feet (colloquially referred to as ‘COVID toes’) and/or hands have been described in children and adults. However, only a minority of these patients have demonstrated evidence of SARS-CoV-2 infection by either PCR or serology [164–173]. Other rash morphologies including vesicular eruptions, urticarial lesions, maculopapular eruptions and livedo or necrosis have also been described [165]. In some cases, vesicular eruption preceded the onset of other COVID-19 symptoms [165].
Cutaneous manifestations in a series of 417 patients with SARS-CoV-2 infection: epidemiological and clinical correlates of chilblain like lesions
Published in Pathogens and Global Health, 2021
G Brancaccio, N Gussetti, L Sasset, M Alaibac, M Tarantello, R Salmaso, M Trevenzoli, AM Cattelan
Skin lesions were detected in 1.7% out of 417 patients with confirmed SARS-CoV-2 infection. In particular, the chilblain-like lesions in our as in other cases were present in young subjects and were characterized by microthrombotic pathological findings associated with an inflammatory vasculitis [9–11]. The association of chilblain-like lesions with SARS-CoV-2 infection remains uncertain; some studies attributed the lesions to the lifestyle changes during the lockdown measures since the SARS-CoV-2 RNA remained undetected on nasopharyngeal swabs and in biopsy samples and serological tests were negative in most cases [12–14]. Interestingly, chilblain-like lesions have been described in genetically induced overproduction of type I interferons, thus indirectly suggesting that a robust cellular mediated immunological reaction to SARS-CoV-2 might be the trigger for the lesion [15] while at the same time achieving a rapid control of the infection. Accordingly, in our four cases (Cases 1–4) the chilblain-like lesions were associated to an asymptomatic or mild disease, with negative nasopharyngeal swab in all and a positive serology for SARS-CoV-2 in three cases. In the fourth case (Case 3), which was not included in the prevalence calculation, specific antibodies were not demonstrated on repeated testing; however, the documented family SARS-CoV-2 spread strongly suggested a pathogenic relation with the virus as causative agent of the chilblain-like lesions observed in this patient. The age of the patients with chilblain-like lesions ranged from 15 to 29; Case 3 highlights that chilblain lesions may be the sole manifestation of SARS-CoV-2 infection and should be considered as a potential signal of familial or community spread of the virus.