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Perniosis (chilblains) and Homoeopathy

Perniosis (chilblains) is an abnormal reaction to cold (Psora) that occurs most frequently in women, children, and the elderly. Chilblains may be idiopathic and self-limited, or associated with systemic diseases. It is a common ailment often familial. Exposure to cold water sometimes seems to play a role.

Definition

Chilblains are characterised by cutaneous lesions which tend to become worse in the elderly, and improve spontaneously in younger patients, often occurring after exposure to cold and high humidity during cold months due to an abnormal reaction to cold most frequently in women, children, and the elderly. (Psora)

Synonyms

Chilblain

Pernio

Frostbite is damage to the skin and other tissues caused by freezing.

Frostnip is a mild form of this cold injury.

Acrocyanosis is poor circulation, often familial, more common in females than males characterized by hands, feet, nose, ears and cheeks blue-red and cold caused due to arteriolar constriction, dilatation of the subpapillary venous plexus, and increase in blood viscosity induced by the cold temperatures.

Erythrocyanosis occurs in obese, often young, women characterized by purple-red mottled discoloration seen on the buttocks, thighs and lower legs.

Horse-riding enthusiasts who wear tight clothing in cold weather may develop similar lesions on the thighs called equestrian cold panniculitis.

Types

Idiopathic

Self-limiting

Associated with systemic diseases

Chronic myelomonocytic leukaemia, viral hepatitis, HIV infection, rheumatoid arthritis, the use of weight reduction medications, anorexia nervosa, dysproteinaemia and connective tissue disorders, especially lupus erythematosus.

Perniosis occurring in lupus erythematosus is known as chilblain lupus erythematosus or Hutchinson’s lupus.

Pathogenesis / aetiology

Cold is a prerequisite for the development of symptoms. Chilblains are caused by a combination of arteriolar and venous constrictions (Psora), the latter predominating on rewarming with exudation of fluid into the tissues (Sycosis). Perniosis can be tempted in susceptible persons by prolonged exposure to low temperatures in humid climates. Tight clothing and in some cases, particularly during childhood, dysproteinaemia may play a part (Causa occasionalis).

The four characteristic findings in chilblains are-

  1. Scattered necrosis of individual keratinocytes (Psora/ Syphilis)
  2. Marked subepidermal oedema (Psora/ Sycosis)
  3. Perivascular lymphocytes (Psora)
  4. Lymphocytic vasculitis. (Psora)

Histologic Features:

  1. Superficial and deep perivascular lymphocytic infiltrate
  2. Marked edema of the papillary dermis
  3. Edema of blood vessel with transmural lymphocytic infiltrates
  4. Occasional fibrin thrombi in the capillaries of the dermal papillae
  5. The epidermis is usually unremarkable, but epidermal necrosis or ulceration may sometimes be seen. 

Clinical features

Clinical distribution of Pernio-

Children- the hands, feet, ears and face.

Women- the legs and toes.

Men- the hands and fingers.

Appearance and course

Recurrent (Psora) painful (Psora/ Pseudopsora), tender (Psora/ Pseudopsora), erythematous-violaceous plaques (Psora/ Sycosis) on the distal extremities, especially the fingers and the toes.

Lesions are more common on the dorsal aspect of the digits but other exposed areas, such as the nose, face and ears, may also be affected.

Lesions accompany pruritus (Psora), burning (Psora)and / or blister formation (Psora/ Sycosis).

Purpuric lesions are not uncommon.

Lesions usually resolve spontaneously after cold is over within three to five weeks leaving minor residual postinflammatory hyperpigmentation (Psora/ Sycosis).

Diagnosis

Diagnosis is generally clinical.

Skin biopsy.

Differential diagnosis

  1. Discoid and systemic lupus erythematosus (Psora/ Syphilis)
  2. Sarcoidosis (Psora/ Sycosis/ Syphilis)
  3. Lupus pernio is a confusing term; it is related to neither pernio nor to lupus erythematosus, but is a particular manifestation of sarcoidosis. (Psora/ Sycosis/ Syphilis)
  4. Cryoglobulinaemia, cryofibrinogenaemia and other hypercoagulable states should be considered. (Psora/ Sycosis)

Treatment

First Steps

Avoiding chronic exposure to cold temperatures.

Ancillary Steps

Keeping both the affected extremities and the core body dry and warm are essential in foiling pernio. Patients should wear thick socks and shoes. For perniosis of the hands, gloves are recommended. Clothing should be loose fitting to avoid obstruction in capillary flow.

Homoeopathy and Chilblains

Top remedies for Pernio in decreasing order-

agar. > puls. > nit-ac. > petr. > sulph. > rhus-t. > zinc. > nux-v. > phos > borx. > kali-c. > lyc. > hep. > bell. > carb-an. > ars. > colch. > merc. > sul-ac. > stann. > carb-v. > arn. > mag-c. > abrot > sep. > lach. > croc. > ph-ac. > chin. > cycl. > ter. > calc. > cortico. > cham. > staph. > bry. > op. > mur-ac. > ant-c. > aur. > thuj. > apis > hyos.    > nux-m. > tam. > berb. > ign. > m-aust. > sil. > aloe > frag. > canth. > calen. > verat-v. > alumn. > bad. > camph. > ferr-p. > kali-chl. > asar. > cadm-s. > cocc. > ham. > kali-m. > kali-p. > ran-b. > rheum > rhod. > ruta >   > syc. > arg-met. > alum. > anac.crot-h. > thyr. > acon. > am-c. > aur-ar. > Bufo > calc-s. > caust. >  crot-t. > gaert. > iod. > led. > m-arct. > morg-p. > plan. > psor. > rhus-v. > sacch-l. > sal-ac. > sec. > tub. > cit-v. > thyroiod. > cop. > abrom-a. > all-c. > alum-p. > ambr. > ambro. > aq-mar. > arist-cl. > carb-ac. > cist. > graph. > helo. > hydrog. > kali- > r. > kali-n. > kali-s. > kalm. > merc-i-r. > morg. > morph. > naja > pic-ac. > prot. > spig. > tub-m. > zinc-p. > sacch-a. > melal-alt.

Repertory of Chilblains

Chilblains abrot. Agar. alumn. ars. bad. cadm-s. calc-s. calc. Calen. carb-v. frag. ham. Hep. iod. kali-c. kali-m. kali-p. lach. mur-ac. nit-ac. nux-m. nux-v. op. Petr. ph-ac. phos. Puls.  ran-b. Rhus-t. rhus-v. sec. stann. sul-ac. Sulph. tam. Thyroiod. tub. Verat-v. zinc.

Chilblains, frostbite – unbroken ter.

EAR – CHILBLAINS agar. Apis bell. rhus-t.

EAR - DISCOLORATION - redness – chilblains AGAR.

Ears and hearing - Frostbitten and tingling, cartilage of ears were sacch-l.

Ears and hearing - Tingling - as if frostbitten, cartilage of both ears were sacch-l.

EXTREMITIES - BUNIONS - Feet - frostbite – after Calc.

EXTREMITIES - CHILBLAINS - air; in open - amel. borx.

EXTREMITIES - CHILBLAINS – blue arn. bell. kali-c. kali-s. puls.

EXTREMITIES - CHILBLAINS – burning sulph.

EXTREMITIES - CHILBLAINS - coldness agg. agar.

EXTREMITIES - CHILBLAINS – crawling arn. colch. nux-v. Rhus-t. sep.

EXTREMITIES - CHILBLAINS – cutting kali-c.

EXTREMITIES - CHILBLAINS - Feet – cracked merc. nux-v. petr.

EXTREMITIES - CHILBLAINS - Feet - Heels - swollen and red petr.

EXTREMITIES - CHILBLAINS - Feet – Heels petr.

EXTREMITIES - CHILBLAINS - Feet – inflammation Lach. merc. nit-ac. PETR.

EXTREMITIES - CHILBLAINS - Feet – purple Lach. Merc. Puls. Sulph.

EXTREMITIES - CHILBLAINS - Feet - recent, if kali-p.

EXTREMITIES - CHILBLAINS - Feet – suppurating Lach. Sil. Sulph.

EXTREMITIES - CHILBLAINS - Feet – swollen Merc.

EXTREMITIES - CHILBLAINS – Feet abrot. AGAR. Alumn. am-c. Anac. ant-c. aur-ar. aur. bad. Bell. berb. borx. bry. bufo cadm-s. Carb-an. carb-v. Cham. Chin. colch. Croc. crot-h. cycl. hep. hyos. ign. kali-chl. kali-m. kali-n. Lyc. Merc. morg-p. mur-ac. naja Nit-ac. nux-m. Nux-v. Op. PETR. ph-ac. Phos. PULS. ran-b. rhus-t. sep. stann. staph. sul-ac. Sulph. syc. tam. Thuj. zinc-p. ZINC.

EXTREMITIES - CHILBLAINS - Fingers – itching lyc. sulph.

EXTREMITIES - CHILBLAINS - Fingers – painful sul-ac.

EXTREMITIES - CHILBLAINS – Fingers Agar. ars. berb. borx. carb-an. ign. lyc. nit-ac. Nux-v. Petr. Phos. psor. Puls. Stann. sul-ac. Sulph.

EXTREMITIES - CHILBLAINS - Hands – itching PULS. Zinc.

EXTREMITIES - CHILBLAINS - Hands – swelling Zinc.

EXTREMITIES - CHILBLAINS - Hands - weather – mild nit-ac. stann.

EXTREMITIES - CHILBLAINS - Hands - winter agg. gaert.

EXTREMITIES - CHILBLAINS – Hands abrom-a. Agar. aloe ars. borx. Bry. Carb-an. Croc. gaert. Kali-chl. lyc. Nit-ac. nux-v. op. PETR. Phos. PULS. Stann. sul-ac. Sulph. Zinc.

EXTREMITIES - CHILBLAINS – inflamed Ars. bell. Carb-an. cham. hep. kali-c. lyc. Nit-ac. Nux-v. phos. PULS. rhus-t. staph. Sulph.

EXTREMITIES - CHILBLAINS - itching - warm - bed - agg. Cortico.

EXTREMITIES - CHILBLAINS - itching - warm - room - agg. cortico.

EXTREMITIES - CHILBLAINS – itching abrot. agar. cortico. nux-v. petr. ruta

EXTREMITIES - CHILBLAINS - Lower limbs Agar. am-c. ant-c. ars. asar. aur. bry. Carb-an. Carb-v. cham. chin. cocc. Croc. cycl. hep. Hyos. ign. kali-c. m-aust. Nit-ac. nux-v. op. petr. ph-ac. Phos. Puls. rheum rhod. rhus-t. stann. staph. Sul-ac. Sulph. Thuj. Zinc.

EXTREMITIES - CHILBLAINS – moist petr.

EXTREMITIES - CHILBLAINS – painful agar. arn. Ars. aur. bell. chin. hep. kali-c. lyc. mag-c. Nit-ac. nux-v. Petr. ph-ac. phos. Puls. sep.

EXTREMITIES - CHILBLAINS – pressing kali-c.

EXTREMITIES - CHILBLAINS – pulsating Nux-v.

EXTREMITIES - CHILBLAINS – purple petr.

EXTREMITIES - CHILBLAINS – stitching kali-c.

EXTREMITIES - CHILBLAINS - Toes – bluish kali-c.

EXTREMITIES - CHILBLAINS - Toes - First Toe – cutting kali-c.

EXTREMITIES - CHILBLAINS – Toes AGAR. Alum. ambr. aur-ar. aur. borx. Carb-an. Croc. hydrog. kali-c. melal-alt. nit-ac. Nux-v. PETR. phos. psor. PULS. rhod. sacch-a. sal-ac. Thuj.

EXTREMITIES - CHILBLAINS – unbroken Ter.

EXTREMITIES - CHILBLAINS - Upper limbs Croc. cycl. Hyos. m-arct. m-aust. nux-v. op. Puls. rhus-t. staph.

EXTREMITIES - CHILBLAINS – vesicular ant-c. bell. carb-an. chin. cycl. mag-c. Nit-ac. phos. RHUS-T. sep. sulph.

EXTREMITIES - CHILBLAINS - warmth agg. - heat agg. puls. syc.

EXTREMITIES - CHILBLAINS - weather agg.; warm frag.

EXTREMITIES – CHILBLAINS abrot. acon. AGAR. all-c. aloe alum-p. Alum. Alumn. ambro. anac. ant-c. apis arist-cl. Arn. Ars. asar. aur. Bad. Bell. borx. bry. bufo cadm-s. calc-s. calc. Calen. camph. Canth. carb-ac. Carb-an. Carb-v. caust. Cham. chin. cist. cocc. Colch. Cop. cortico. Croc. Crot-h. crot-t. Cycl. ferr-p. frag. ham. Hep. hyos. ign. iod. kali-ar. kali-c. kali-chl. kali-m. kali-p. kalm. lach. led. Lyc. m-arct. m-aust. mag-c. merc-i-r. merc. morg-p. morg. Mur-ac. NIT-AC. nux-m. Nux-v. op. PETR. ph-ac. Phos. plan. prot. PULS. ran-b. rheum rhus-t. rhus-v. ruta sec. sep. sil. stann. staph. sul-ac. Sulph. syc. tam. Ter. Thuj. Thyr. tub-m. tub. Verat-v. Zinc.

EXTREMITIES - CRACKED skin - frostbite; from nit-ac.

EXTREMITIES - DISCOLORATION - Fingers - Back - red - chilblains; after berb.

EXTREMITIES - DISCOLORATION - Fingers - redness - chilblains; like borx.

EXTREMITIES - DISCOLORATION - Fingers - redness - frostbitten, as if borx. lyc.

EXTREMITIES - DISCOLORATION - Fingers - Tips - redness - chilblains; after berb.

EXTREMITIES - ERUPTIONS - Fingers - vesicles - frostbite; after graph. Hep. Kali-c. Mag-c. Nit-ac. sil.

EXTREMITIES - ERUPTIONS - Toes - vesicles - frostbite; after mag-c. nit-ac.

EXTREMITIES - FROSTBITE - Lower limbs Agar. borx. Carb-v. Nit-ac. PHOS.

EXTREMITIES - FROSTBITE - Upper limbs borx.

EXTREMITIES - INFLAMMATION - Toes - frostbitten - as if borx.

EXTREMITIES - INFLAMMATION - Toes – frostbitten Agar.

EXTREMITIES - ITCHING - Hands - chilblains, as from AGAR. arg-met. Cit-v. Puls.

EXTREMITIES - PAIN - Feet - chilblains; as from aq-mar. berb. borx. caust. cham. nux-v.

EXTREMITIES - PAIN - Fingers - burning - frostbitten; as if agar. borx. lyc.

EXTREMITIES - PAIN - Fingers - Tips - stitching pain - frostbitten; as if spig.

EXTREMITIES - PAIN - Toes - Fifth - chilblains; as from aloe

EXTREMITIES - PAIN - Toes - Fifth - stitching pain - frostbitten; as if lyc.

EXTREMITIES - PAIN - Toes - First - burning - frostbitten; as if zinc.

EXTREMITIES - PAIN - Toes - First - frostbitten; as if bry. phos.

EXTREMITIES - PAIN - Toes - First - stitching pain - frostbitten; as if Nit-ac. zinc.

EXTREMITIES - PAIN - Toes - frostbitten, as if – burning borx.

EXTREMITIES - PAIN - Toes - frostbitten, as if borx.

FACE – CHILBLAINS agar. Colch.

FACE - Eruptions on face – Chilblains agar.

FACE - FROSTBITE; after agar.

FACE - ITCHING - frostbitten, as if Agar. Arg-met.

FACE - PAIN - burning - frostbitten; as if agar.

Face and jaw - Frostbitten, face were  agar.

GENERALS - FROSTBITE, ailments from Abrot. AGAR. Ars. bell. Borx. bry. camph. Canth. Carb-v. Colch. Ferr-p. hep. kali-c. m-aust. mur-ac. nit-ac. nux-m. nux-v. Petr. ph-ac. Phos. PULS. Rhus-t. sul-ac. sulph. zinc.

LOCOMOTOR SYSTEM - Feet – Chilblains Abrot. agar. petr. sulph. tam. zinc.

LOCOMOTOR SYSTEM - Toes – Chilblains  Nit-ac. sal-ac.

Lower extremities - Chilblains - on ball of foot rhod.

Lower extremities - Chilblains - on sole of foot morph.

Lower extremities - Frostbite, feet were burning as if recovering from helo.

Lower extremities - Frostbitten - feet were pic-ac.

Lower extremities - Frostbitten - soles were borx.

Lower extremities - Frostbitten - toes were carb-v.

NOSE - FROSTBITTEN – easily Zinc.

NOSE – FROSTBITTEN Agar. m-aust. zinc.

SKIN – Chilblains Abrot. Agar. apis ars. borx. calc. calen. Canth. carb-an. crot-t. cycl. ferr-p. frag. ham. Hep. lach. led. merc. Mur-ac. Nit-ac. Petr. plan. Puls. Rhus-t. sil. sul-ac. Sulph. Tam. Ter. thyr. verat-v. zinc.

SKIN - ERUPTIONS - vesicular - frostbite; after mag-c. nit-ac. rhus-t.

SKIN - FORMICATION - frostbite; after colch.

Skin - Frostbitten in many parts colch.

SKIN AND EXTERIOR BODY - Chilblains – blue Arn. bell. kali-c. PULS.

SKIN AND EXTERIOR BODY - Chilblains - crawling in Arn. colch. nux-v. RHUS-T. sep.

SKIN AND EXTERIOR BODY - Chilblains – inflamed ARS. bell. Cham. hep. Lyc. Nit-ac. phos. PULS. rhus-t. Staph. SULPH.

SKIN AND EXTERIOR BODY - Chilblains – painful Arn. Bell. chin. Hep. lyc. mag-c. NIT-AC. nux-v. PETR. Ph-ac. phos. PULS. sep.

SKIN AND EXTERIOR BODY - Chilblains - vesicles or bullae, with ant-c. bell. Carb-an. chin. cycl. Mag-c. NIT-AC. Phos. RHUS-T. sep. sulph.

SKIN AND EXTERIOR BODY – Chilblains acon. AGAR. aloe Ant-c. ARN. ARS. asar. Aur. Bell. BORX. bry. Camph. CARB-AN. CARB-V. CHAM. CHIN. cocc. COLCH. Croc. CYCL. Hep. HYOS. ign. Kali-c. Lach. LYC. mag-c. mur-ac. NIT-AC. Nux-m. Nux-v. op. PETR. PH-AC. PHOS. PULS. rheum RHUS-T. ruta Sep. Stann. Staph. SUL-AC. SULPH. THUJ. Zinc.

UPPER EXTREMITIES - Frost bite; chilblains – fingers carb-an. Lyc. PETR. PULS. Sul-ac. SULPH.

UPPER EXTREMITIES - Frost bite; chilblains – hands nit-ac. Stann. Zinc.

Upper extremities - Frostbitten, fingers were borx.

Bibliography

  • Encyclopedia Homoeopathica
  • Chilblains (Pernio) CURRENT Diagnosis & Treatment Emergency Medicine, 7e > Chapter 46. Disorders Due to Physical & Environmental Agents > Emergency Treatment of Disorders Due to Cold
  • Chilblains Fitzpatrick's Dermatology in General Medicine, 8e > Chapter 94. Cold Injuries
  • Chilblains or Pernio Tintinalli's Emergency Medicine > Chapter 202. Frostbite and Other Localized Cold Injuries > Nonfreezing Cold Injuries
  • Frostnip & Chilblain (Erythema Pernio) CURRENT Medical Dx & Tx > Chapter 37. Disorders Related to Environmental Factors > Cold & Heat
  • Pernio (Chilblains) Harrison's Online > Chapter 249. Vascular Diseases of the Extremities > Arterial Disorders
  • Pernio The Atlas of Emergency Medicine > Chapter 16. Environmental Conditions
  • Radar 10
  • The two most common nonfreezing peripheral cold injuries are chilblain (pernio) and ...
  • Harrison's Online > Chapter 19. Hypothermia and Frostbite > Frostbite > Clinical Presentation

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Comment by Dr Rajneesh Kumar Sharma MD(Hom) on January 16, 2013 at 11:32pm

Thanks Sir. Salutes...

Comment by Dr Ravindra Saraswat on January 16, 2013 at 11:20pm
Comment by Dr Rajneesh Kumar Sharma MD(Hom) on January 16, 2013 at 10:45pm

Thanks Jana. Why not Rhus tox for its affinity for cuticles, suppurations and inflammations of dermal layers?

Comment by Jana Shiloh on January 16, 2013 at 8:27pm

Thank you for the rubrics! I have a patient with this condition who also has inflammation and infection around the cuticles. I have tried many remedies without success so far. You have given me some new ones to try. Any suggestions are welcome. My next option is Nux vomica. Sulphur, Silica, Nat mur, Nitric acid have failed. Maybe Psorinum if Nux doesn't work. The infections are bad and the medical profession  has given her creams. Also recommended antibiotics which she has refused.

Comment by Dr Rajneesh Kumar Sharma MD(Hom) on January 16, 2013 at 6:33am

Thanks Dr. Amir, regards.

Comment by Dr. Aamir Mustafa on January 16, 2013 at 6:27am

Thanks to you Dr. Rajneesh, it is very helpful knowledge for those practitioners, who want to cure their patients from chilblains now in these cold days .

Dr. Aamir Mustafa

www.draamir.com

Comment by Dr Rajneesh Kumar Sharma MD(Hom) on January 15, 2013 at 6:20am

Thanks with regards.

Comment by Debby Bruck on January 15, 2013 at 1:52am

I think the first remedy that pops into the mind of a homeopath is agaricus. Having this resource will widen our scope. Thank you Dr Rajneesh. 

Comment by Dr Rajneesh Kumar Sharma MD(Hom) on January 14, 2013 at 10:57pm

Thanks Kavitha for your precious comments and additions. Regards.

Comment by Kavitha Kukunoor on January 14, 2013 at 10:05pm

Thanks Dr Rajneesh for providing insights/homeopathic remedies on Perniosis. The given info is very detailed and helpful. I have seen Ars alb and Rhus tox helpful in addressing chilblains.

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