What Is Perniosis?

  • Jennifer Grace Biomedical Sciences, The University of Manchester, UK


Perniosis, commonly known as chilblains, is a medical condition that manifests as skin discoloration, swelling, and discomfort in response to cold temperatures. Although it is not life-threatening, it causes swelling, pain, and skin discoloration that can have a serious negative influence on a person’s wellbeing. The aim of this article’s examine into perniosis includes its causes, manifestations, methods of diagnosis, possible cures, and effective prevention measures.1

Perniosis, which affects tiny blood vessels in the epidermis, can manifest even in temperatures above the freezing point. The underlying cause of it is an abnormal reaction of these blood vessels to cold that causes swelling and vasospasm. Notably, perniosis is more common in colder climates, however, it can also occur in warmer environments in damp and chilly weather.2

Causes of Perniosis

Although the specific cause of perniosis is unknown, several factors that can cause perniosis include:3

  • Cold weather: Exposure to cold, particularly non-freezing cold, is the main cause of perniosis. When cool air gets in contact with delicate skin, aberrant vascular reactions take place, small blood vessels beneath the skin may grow more quickly when cold skin is rewarmed than the nearby larger blood vessels can tolerate, causing inflammation and discomfort.
  • Underlying health condition: The risk of perniosis may be increased by specific underlying medical problems. Susceptibility may be increased by circulatory issues, autoimmune diseases, and ailments that impair blood vessel function.
  • Humidity and moisture: Cold temperatures and high humidity levels can make perniosis more difficult to develop. The effects of exposure to cold are amplified by moisture on the skin, increasing the risk of inflammation.
  • Risk factors: Perniosis affects some people more than others. Age plays a part, with younger people and older people being more susceptible. Due to the higher prevalence of perniosis in women, gender can also play a role. Family history and genetics may make the disorder more likely to occur. 

Signs and symptoms of perniosis

Signs and symptoms collectively serve to identify perniosis and act as important diagnostic key indicators. If you experience some of the following, consider consulting to a medical professional immediately1:

  • Skin discolouration: Skin patches that are reddish or purplish colour are one of the defining signs of perniosis. These spots of discolouration can vary in size and shape and frequently stand out against the surrounding skin.
  • Itching and Irritation: Intense itching brought on by perniosis frequently results in discomfort and a strong impulse to scratch the affected areas. This scratching could make the inflammation worse.
  • Burning sensation: Perniosis patients frequently describe a burning or tingling feeling in the affected areas. This sensation, which can be slight to strong, might cause discomfort.
  • Swelling: Swelling that occurs in the affected areas may give them a puffy, inflammatory appearance. Swelling often affects the fingers, toes, ears, nose, and other extremities.
  • Chronic cases: Acute cases of perniosis often go away after a few weeks if the person is no longer exposed to the cold, but chronic cases can last longer and may result in skin changes and more enduring discomfort.


A proper diagnosis is necessary for the right management and treatment. A thorough physical examination is the first step in the diagnosis of perniosis in order to find the tyoical skin edoema, discolouration, and other signs. A thorough medical history that takes into a account past occurances of perniosis, past exposure to cold temperatures, underlying medical disorders, and family history is necessary1. It is essential to distinguish perniosis from similar skin disorders like frostbite and lupus by identifying their unique signs and underlying causes. A skin biopsy may occasionally be carried out to confirm the diagnoses and rule out other possibilities4. Additionally, imaging methods like thermography can provide information on blood flow and support the diagnostic procedure5.

Management and treatment options for perniosis

The following are several remedies for managing perniosis1:

  • Conservative measures: The first measure involve gently rewarming the damaged areas, preventing abrupt temperature fluctuations, and shielding the skin from additional exposure to the cold. It is crucial to dress appropriately and keep your extremities warm and dry.
  • Topical medications: To help lessen inflammation and irritation, doctors may prescribe topical creams with corticosteroids or other anti-inflammatory medications.
  • Anti-itch medications and pain relief: Antihistamines and painkillers sold over the pharmacies can help control itching and discomfort.
  • Vasodilators: Vasodilators can widen blood arteries, and in some situations may be advised to enhance blood flow and lessen vasospasm.
  • Changes in lifestyle: Quit smoking, maintaining a warm environment, and taking care of underlying medical conditions are a few examples of lifestyle changes that can help with long-term management and recurrence prevention of perniosis.
  • Medical supervisions: To avoid consequences like developing skin ulcers or secondary infections, severe or chronic cases may need continuing medical attention.

Complications of perniosis

Despite the fact that perniosis is typically thought of as a benign condition, it can have problems, particularly in situations of chronic or severe perniosis. Skin ulcers may develop as a result of persistent inflammation and become more prone to infection. Perniosis complications are identical to the other vasospastic conditions, and if it is persistent, it can lead to tissue necrosis. To avoid issues of this nature, proper medical attention and care are required.6

In addition, secondary bacterial or fungal infections may develop as a result of the da,aged skin barrier in affected areas. These infections have the potential to exacerbate pain and delay the healing process.7

Once exposure to the cold is stopped, acute perniosis frequently goes away on its own, with symptoms disappearing within a few weeks. Chronic conditions might need more thorough management and supervision. The prognosis for most individuals with perniosis is positive with appropriate care and preventive measures, and the condition is unlikely to have long-term negative effects.6


How common is perniosis?

Perniosis is a relatively common condition, especially in colder climates and during the wintertime. Based on variables such as geographic location, climatic conditions, and individual susceptibility, its prevalence varies.1

Who is most at risk of perniosis?

Perniosis can affect people of all ages. However, certain groups such as kinds, teenagers, older adults, and those with particular underlying medical conditions, may be more vulnerable. Due to environmental factors, perniosis can develop occasionally and present as infrequent episodes or more frequent occurences.6 If you suffer symptoms of perniosis, it is crucial to see a doctor for a proper diagnosis and treatment.

How to prevent perniosis?

Perniosis can be avoided by altering one’s lifestyle and taking precautions, especially in the winter or while exposed to cold and damp circumstances. Here are several practical methods to reduce the chance of developing perniosis:1

  • Layer clothing: Wearing layers improves insulation against the cold and helps keep heat near to the body. For the innermost layer, pick textiles that drain moisture away from the skin.
  • Avoiding tight clothing: Wearing restrictive clothing increases the risk of perniosis by limiting blood flow. Choose loose clothing that allows for optimum circulation.
  • Limit cold exposure: Reduce your exposure to damp and chilly conditions as much as you can. If you must spend time outside, try to keep your exposure brief and take breaks to warm up inside.
  • Quit smoking: Blood flow to the extremities is decreased as a result of smoking’s constriction of blood vessels. The risk of perniosis can be decreased and circulation can be improved by quitting smoking.
  • Moisturize: Apply moisturizers to avoid dry skin because perniosis can spread more easily on dry skin. Maintain adequate skin hydration, especially during cold temperatures.
  • Wearing hand and foot warmers: When exposed to extreme cold weather for an extended period of time, consider using disposable hand and foot warmers to keep your extremities warm.

Is perniosis related to COVID-19?

Yes, there have been some studies suggesting a potential association between COVID-19 and perniosis. In some people who have COVID-19, perniosis-like skin lesions, also known as “COVID toes”, have been seen. These signs of inflammation are characterized by swelling, itching, and red or purple staining on the fingers, toes, or other body parts.8

it is crucial to note that studies on the exact connection between COVID-19 and skin symptoms resembling perniosis is ongoing, and the prevalence of this occurrence varies. These skin signs have appeared in some COVID-19 patients while not in all. Although the fundamental causes of COVID-19 and perniosis are not fully known, it is thought that inflammation and the immune system are involved.9

If you experience strange skin symptoms, such as lesions that resemble perniosis, and think you may have COVID-19 or have been exposed to the virus, seek medical assistance immediately to receive proper assessment. It is also critical to keep up with the most recent findings in research and medical advice regarding COVID-19’s probable dermatological symptoms.


Perniosis, commonly known as chilblains, is a medical condition marked by discomfort, swelling, and discoloration of the skin brought on by exposure to cold temperatures. Even though it is not life-threatening, it can cause severe pain, and discomfort that can affect a person’s wellbeing. Small blood vessels in the skin are predominantly affected by perniosis, which is brought on by exposure to cold even in above-freezign temperature. This odd response of blood vessels to cold results in inflammation and vasospasm. Although more common in colder regions, it can also appear in warmer areas, specifically, in damp and chilly weather. Age, gender, genetics, and underlying medical disorders are the risk factors of this condition. Recognizable symptoms of this condition include skin discolouration, itching, burning, and swelling. Physical examination, medical history, and differentiation from related illness are all part of the diagnosis procedure. Vasodilators, topical medicines, conservative measures, and lifestyle changes are all possible forms of treatment. Skin ulcers and secondary infections are some of the complications, but severe cases frequently go away when exposure to the cold is stopped. Chronic conditions could need continual care. In relation to COVID-19, some infected people have had skin lesions that resembled perniosis. Seeking medical attention immediately when experiencing symptoms and signs of perniosis is critical for early diagnosis and treatment.


  1. Chilblains - Symptoms and causes [Internet]. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097
  2. Perniosis [Internet]. NORD (National Organization for Rare Disorders). Available from: https://rarediseases.org/rare-diseases/perniosis/
  3. Chilblains [Internet]. www.nhsinform.scot. Available from: https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/chilblains
  4. Frostbite: Signs & Symptoms, Stages, Treatment & Prevention [Internet]. Cleveland Clinic. [cited 2023 Aug 25]. Available from: https://my.clevelandclinic.org/health/diseases/15439-frostbite#:~:text=Chilblains%20(pernio)%20are%20patches%20of
  5. McDougall, A. C., & Salter, D. C. (1977). Thermography of the nose and ear in relation to the skin lesions of lepromatous leprosy, tuberculosis, leishmaniasis, and lupus pernio. The Journal of investigative dermatology, 68(1), 16–22. Available from: https://doi.org/10.1111/1523-1747.ep12485135
  6. Whitman, P. A., & Crane, J. S. (2023). Pernio. StatPearls [Internet]. Available from: https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK549842/
  7. UpToDate [Internet]. www.uptodate.com. [cited 2023 Aug 25]. Available from: https://www.uptodate.com/contents/pernio-chilblains/print
  8. Starkman E. COVID Toes: What You Should Know [Internet]. WebMD. Available from: https://www.webmd.com/covid/what-are-covid-toes
  9. Cappel, M. A., Cappel, J. A., & Wetter, D. A. (2021). Pernio (Chilblains), SARS-CoV-2, and COVID Toes Unified Through Cutaneous and Systemic Mechanisms. Mayo Clinic proceedings, 96(4), 989–1005. Available from: https://doi.org/10.1016/j.mayocp.2021.01.009
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Jennifer Grace

Biomedical Sciences, The University of Manchester

My name is Jennifer Grace, and this September marks the beginning of my final year pursuing BSc. (Hons) Biomedical Science studies at the University of Manchester. Born in Indonesia, I embarked on a journey fueled by curiosity. From a young age, my passion for Biology and healthcare framework emerged, propelling my achievements of biological science. Driven by my ardour for scientific exploration, I have actively engaged with various organizations dedicated to environmental and healthcare frameworks. My commitment to advancing science found expression through my participation in the Klarity internship program as an article writer to improve my writing skills, especially scientific writing skills. With each step, I'm unflinchingly dedicated to blending my affection for science with a significant feeling of direction for my career.

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