What is Pernio?

Pernio (aka chillblains) is a condition that typically occurs in colder climates during the winter months.  It results in painful or itchy, discolored (reddish or purple), circular areas of skin irritation usually found on the tips of toes or fingers.  Swelling may be seen too.  It can also occur on the ears, nose, and elsewhere.  Occasionally it can progress to blisters and sores that can lead to infection.  It is more common in women.  Most of the time it occurs as an isolated problem, but can rarely be associated with other disorders such as lupus.

Anyone who spends time outside in frigid temperatures can be susceptible to it.  We generally see several cases of this each winter, often from our patients that live at higher elevation such as Woodland Park and Teller county.  If you are a smoker, have a thin build, or have a history of Raynaud’s phenomenon you are at increased risk of pernio.  Surprisingly, it sometimes occurs in those people that haven’t been outside in cold temperatures for what they think are extended periods of time.  Rapid rewarming of your toes next to a space heater or other heat source after coming in from freezing temperatures may contribute pernio.

What causes pernio?

The theory is that exposure to the cold causes temporary constriction of the blood vessels in the toes, called vasoconstriction.  After the toes warm up the opposite occurs, as the blood vessels open up (vasodilation), a rush of blood flows into the digits which leads to inflammation/pain.

The good news is that pernio is usually self-limited and resolves in a few weeks on its own.  Sometimes it may persist until warmer weather arrives in spring.

How to prevent and treat pernio:

• Avoid prolonged cold exposure and/or rapid rewarming of the toes
• Wear insulated boots and warmer socks such as wool socks when going outside in cold weather
• Chemical toe warmer packs may be helpful
• Stop smoking
• Topical steroids, nifedipine, or other oral medicines are sometimes needed
• Bloodwork to check for other secondary causes of the condition may be ordered by your podiatrist or family doctor

Unfortunately, a new condition which mimics pernio called “Covid toes” has been observed during the current Covid pandemic as one of the many symptoms of Covid-19 infection.  If you have recently been exposed to Covid or have other symptoms such as fever, cough, etc…. then getting tested for Covid may be recommended.