title: Chronic chilblains: the clinical presentation and disease course in a large paediatric series.
abstract: OBJECTIVE
  Children often present during winter with painful, red-purple swollen fingers and/or toes, usually misdiagnosed as Raynaud's phenomenon. Pernio, or chronic chilblains, is a localised inflammatory lesion of the skin resulting from an abnormal response to cold. The aim of this study was to better characterise the clinical presentation of chronic chilblains in children.
  
  
  METHODS
  This is a single-centre retrospective study of patients referred to our paediatric rheumatology clinic with cold, purple, and painful hands. Patients were identified from the paediatric rheumatology clinic database, at the Safra Children Hospital, Israel. Data of the clinical presentation, physical findings, laboratory investigations and the course of the disease were extracted from the patients' charts and analysed.
  
  
  RESULTS
  A total of 33 patients (27 females, sex ratio 4.5:1) were identified. Patients age at presentation was 13.5±2.1, and disease duration was 2.0±1.0 winters. Patients presented with prolonged capillary refill time (100%) and abnormal modified Allen test (75.6%). Fingers swelling was the most common finding (81.8%), followed by proximal interphalangeal joint (PIPs) swelling (63.6%), skin ulceration (54.5%), and dry, irritated skin (45.5%). Nailfold capillary microscopy was normal in all patients. The only abnormal laboratory test was the test for anti-nuclear factor (ANA) in 25%.
  
  
  CONCLUSIONS
  We report a large series of children with a unique symptomatology consisting in chronic chilblains.
authors: Department of Pediatrics A, Edmond & Lily Safra Children's Hospital, Tel Hashomer, Israel. shay.pade@sheba.health.gov.il
authors: Shai
authors: S
authors: Padeh
authors: Maya
authors: M
authors: Gerstein
authors: Shoshana
authors: S
authors: Greenberger
authors: Yackov
authors: Y
authors: Berkun
mesh_terms: D000293:Adolescent; D000974:Antibodies, Antinuclear / Q000276:immunology*; D001168:Arthritis / Q000175:diagnosis / Q000209:etiology; D002647:Chilblains / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003937:Diagnosis, Differential; D018450:Disease Progression; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005384:Finger Joint / Q000473:pathology; D006801:Humans; D008297:Male; D010808:Physical Examination; D011928:Raynaud Disease / Q000175:diagnosis*; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000175:diagnosis / Q000209:etiology
chemical_list: D000974:Antibodies, Antinuclear