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Pathology of Chilblains (Perniosis) and Equestrian Perniosis

Dr Sampurna Roy MD                        


Dermatopathology Quiz Case 220

Diagnosis: A) Chilblains  (perniosis) and

B) Equestrian Perniosis (Equestrian cold panniculitis)




Exposure to cold climate can produce a wide range of injuries as a result of inability to adapt to the low temperature.

Chilblains  (perniosis) is a localized disease occurring after prolonged exposure to moderate to cold temperature.

Perniosis presents as inflammatory, erythematous or purple, intensely pruritic or painful conditions on the hands and feet. 

Other locations include the ear, nose, thighs, and buttocks.

Chilblains is seen in all age.

It is more common in a younger age group, usually in the second and third decade.

These lesions appear approximately 12-24 hours after exposure to cold and spontaneous resolution is usually seen in one to three weeks.

Chilblains can present as a secondary feature of diseases such as systemic lupus erythematosus, Behçet disease, chronic myelomonocytic leukemia, metastatic breast carcinoma and cryoglobulinemia.

Histologically, there is prominent perivascular mononuclear cell infiltrate (lymphocytic vasculitis) in the upper dermis.

There is variable edema of the papillary dermis. In some cases there is intense papillary edema.

The lymphocytic vasculitis is associated with "fluffy edema" of the vessel wall.

In deep perniosis the lesion extends throughout the dermis.

Atypical lymphocytes with CD30 positive cells in classical clinical perniosis (chilblains), has been reported by Massey et al.

Equestrian perniosis is a rare condition in which the patient  develops tender, burning, nodular plaques on both thighs and buttocks after riding in the cold.

It is not associated with systemic and autoimmune connective tissue disease. 

The histology of Equestrian Perniosis is similar to perniosis.

One distinct feature is that the perivascular lymphocytic infiltrate prominently involves the fat.

Further reading:

Visit: Joy of walking in the Hills - Walking is the healthiest of all outdoor activities

CD30 positive atypical lymphocytes in perniosis: a potential histopathologic pitfall in a benign condition.

Chilblains in Turkey: a case-control study.

Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis.

Equestrian chilblain: another outdoor recreational hazard.

Equestrian perniosis: a report of 2 cases and a review of the literature.

Pattern of chilblains in a high altitude region of Ladakh, India.

Chilblains in Southern California: two case reports and a review of the literature.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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