Anatomic Pathology: Skin Pathology

721) A 20-year-old woman has a history of developing pruritic violaceous papules and macules on the dorsum of multiple fingers and toes around the same time each year. The biopsy specimen shown identifies the process as:

• Pernio, also known as chilblains, is an inflammatory skin condition characterized by the presence of pruritic, painful, or pruritic and painful violaceous papules and nodules that occur on acral surfaces, most commonly the dorsum of the fingers and toes, but the nose, ears, and thighs also can be affected.

• Pernio is characterized histologically by superficial and deep perivascular lymphocytic dermal inflammatory infiltrates that are periadnexal in distribution. Perieccrine accentuation of the infiltrate is characteristic. A varying amount of interface change can be seen affecting the epidermis.

• Pernio and chilblains lupus erythematosus have overlapping clinical and histologic features, and routine evaluation of patients for lupus erythematosus is prudent.

• A clue to the diagnosis is the anatomic distribution and cyclic nature of the lesions. Pernio develops in patients exposed to nonfreezing cold in damp conditions. Classically, the lesions develop with a change of weather going into winter and resolve during spring and summer.

• Most commonly, pernio occurs in young women but can also occur in children and older adults.

• Pernio should not be confused with lupus pernio, which refers to a form of cutaneous sarcoidosis.

Almahameed A, Pinto DS: Pernio (chilblains). Curr Treat Options Cardiovasc Med 2008;10(2):128-135.

Boada A, Bielsa I, Fernández-Figueras MT, et al: Perniosis: clinical and histopathological analysis. Am J Dermatopathol 2010;32(1):19-23.

Simon TD, Soep JB, Hollister JR: Pernio in pediatrics. Pediatrics 2005;116(3):e472-e475.

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