skin conditions and disorders

PERNIOSIS SKIN DISEASES

Diagnosis

Lesions which may be mistaken for chilblains are papulo-necrotic tuberculides , lupus erythematosus and nodular vasculitis . The former are smaller and more regular in size than chilblains, they occur also on the elbows, shoulders, and legs, and leave small white depressed scars. Ordinarily chilblains leave no scars, but it they become ulcerated they leave irregular scars. Papulo-necrotic tuberculides are apt to occur in people who have acrocyanosis and possibly actual chilblains as well. Lupus erythematosus when it occurs on the hands forms oval plaques or rings on the backs of the fingers; these are bluish-red and may be scaly, or may show the characteristic stippling. other lesions of lupus erythematosus will most likely be present also on the face. Nodular vasculitis causes more inflammatory lesions, does not ulcerate, lacks the background of cold, blue calves and occurs in older women.

Treatment

Warm clothing is essential, and this applies as much to the trunk as to the extremities. on the whole, vasodilator drugs have proved disappointing, but some improvement may be obtained from tolazoline hydrochloride 25-50 mg. thrice daily, dibenylene 10-20 mg. thrice daily or bamethan sulphate (Vasculit) 12.5 mg. four times a day. The latter is probably the most effective, but the side-effects may be troublesome. Severe chilblains can be incapacitating and then sympathectomy may be indicated.