Perniosis idiopática: reporte de un caso y revisión de la literatura / Chilblains: report of a case and literature review

Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. It is reported a case of a 59-year-old otherwise healthy woman with acute primary perniosis. She had a 3-day history of lesions on the toes brought on by cold, damp weather. On initial presentation, a biopsy sample was taken of a hallux lesion, and the patient was given a trial course of oral pentoxifylline, topical corticoid and nifedipine therapy. Follow-up at 2 weeks showed complete relief of symptoms and the biopsy results confirmed the diagnosis. Pentoxifylline therapy has been shown to be effective and should be considered the standard of care in the treatment of perniosis along with conservative environmental measures.The etiology and pathogenesis of perniosis are reviewed and discussed, as well as differential diagnoses and treatment options. (AU)

[Influence of manufacturing procedure on stability of Unguentum contra perniones preparations].

BACKGROUND: Application of various technological procedures for the manufacture of officinal preparation ointment against chilblains (Unguentum contra perniones) produce essential variations in the quality and stability of the final product. Changing the sequence of admixing active substances into the ointment base indicated the presence of incompatibility between the active substances, as well as between the active substances and the ointment base components. The aim was to examine the influence of various technological manufacturing procedures on quality and stability of the preparation. METHODS: Changes in the samples of ointments and aqueous solutions of active substances were analysed microscopically. RESULTS: Microscopic analysis of hydrosoluble active substance solutions demonstrated destruction of ichthammol, induced by an acidic medium due to the dissolution of tannin and resorcinol, which is well known from the literature. It also demonstrated the destruction of tannin and resorcinol in aqueous solution, which had not been described in the literature. Application of the prescribed procedure for the manufacturing of ointment against chilblains, conceals the incompatibility reactions due to a slow dissolution of the tannin suspended in the officinal ointment base Unguentum cera lanae. Admixture of an ready-made aqueous solution of tannin caused an instant contact between ichthammol and the acidic medium, which caused the destruction or the complete absence of the formation of emulsion droplets. The problem of incompatibility reactions between lanolin alcohols in the ointment base and ichthammol and resorcinol, as well as the reaction between Peruvian balsam and sulfur from the ichthammol sulfate ion was observed. Numerous incompatibility reactions of ointment against chilblains, components indicated that it was necessary to introduce alterations in both the qualitative and quantitative composition of the preparation. CONCLUSION: Excipient preparation procedure, as well as the technological procedure for incorporation of active ingredients can cause the incompatibilities and therefore the formulation stability problems.

A double-blind study of ultraviolet phototherapy in the prophylaxis of chilblains.

A randomized, double-blind study was carried out to assess the prophylactic value of ultraviolet irradiation in the autumn as a means of preventing the development of chilblains on the toes and fingers during the course of the winter. Placebo irradiation was achieved by means of an optical filter which absorbed all ultraviolet radiation from the lamps but allowed the visible light component to be transmitted, thus giving patients the impression that both limbs were being treated. Patients were reviewed at monthly intervals during the winter. The response between patients was variable; some patients developed chilblains whilst others remained symptom free. However, in no patient did the ultraviolet treated limb differ from the untreated limb. We conclude that the ultraviolet phototherapy is of no value in the prophylaxis of chilblains.

[Chilblains]. / Les engelures.

Chilblain is a frostbite, it belongs to the vascular acrosyndromes by the mere fact of symmetrical lesions and to the dystrophic group by its organic obstructive and thrombotic microangiopathy, especially of venules. Chilblain is conditional on a dysesthesia for cold, diagnosis is easy if in the know, prognosis as usual good and treatment must be more preventive than curative.