1.3.2 Pernio

Grading & Level of Importance: A




Dermatitis congelatio escharotica; Chilblains; perniosis


Congelatio quite frequent in winter sport activities, mountain tracking; perniones mostly appear in spring and autumn around 0ºC degree. Often in adolescents with acrocyanosis (horse riding, long time cycling, inappropriate shoes, wet socks). 


Congelatio: 1st to 3rd degree with maximum of irreversible necrosis or death. Perniones: Cold-induced blue-red indurated papules or nodules, usually on legs or feet. F > M.

Aetiology & Pathogenesis

Congelatio dependent on temperature grade and exposure time. Persistent exposure to cold, damp conditions predisposes to development of pernio over days to weeks.

Signs & Symptoms

In congelatio in grade 1 erythematous lesions, in grade 2 bullous lesions and grade 3 necrosis with irreversible sequelae. In perniones blue-red oedematous papules or nodules, sometimes quite tender or painful.


Typically occur at acral sites and in areas which are easily cooled (especially the shins, fingers, toes and other thighs in equestrians). Dampness is also important and some professions are at increased risk, such as butchers and farmers. In congelatio depending if local or full body cold exposure.


Congelatio: Grade 1 – 3. 

Laboratory & other workups



Congelatio: depending of degree vessel narrowing, blistering, apoptosis and necrosis.


Perniones: severe courses show blistering, edema, hyperemic vessels and lymphocytic vasculitis. 


Congelatio: depending on length of injury in part reversible or irreversible.


Perniones: Recurrent, more common in spring and autumn (cool, moist climatic conditions).


Congelatio: longterm downcooling death.

Perniones: Rarely ulceration.


History, localization, clinical features.

Differential diagnosis

Lupus pernio (sarcoidosis), chilblain lupus (lupus erythematosus).

Prevention & Therapy

Congelatio: slow warming up of central temperature, no direct warming of involved lesions. Hyperbaric oxygenation to avoid amputation, prostaglandin infusions.
Perniones: warm, water-resistant protective clothing, topical or oral vasodilators (e.g. calcium channel blockers).


Severe congelatio to special centers and intensive care. 

Mark article as unread
Article has been read
Mark article as read


Be the first one to leave a comment!