PERNIO (PERNIOSIS OR CHILBLAIN)
Exposure to cold, particularly cold associated with
damp conditions, is the precipitating event leading to pain and,
usually, swelling of the affected body part. Most cases involve fingers
or toes, but other locations, such as thighs, may affect equestrians or
snowmobile riders. Most patients do not have overt evidence of an
underlying condition but lupus erythematosus or cryoglobulinemia have
been present in some cases.
The most characteristic pathologic finding is the presence of lymphocytic infiltration of the walls of small blood vessels that have muscular walls. Deeper vessel involvement is seen in most cases though superficial vessel preponderance has been reported. Subepidermal edema, the presence of PMN's or other inflammatory cells, and fibrin deposition vary from case to case and often are absent.
The most characteristic pathologic finding is the presence of lymphocytic infiltration of the walls of small blood vessels that have muscular walls. Deeper vessel involvement is seen in most cases though superficial vessel preponderance has been reported. Subepidermal edema, the presence of PMN's or other inflammatory cells, and fibrin deposition vary from case to case and often are absent.
This 26 year old female developed painful and tender macules and papules of her fingers during January.
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Scanning power view showing
superficial and deep perivascular lymphocytic infiltrates. The
infiltrates in the deep reticular dermis and around sweat glands are
larger than those in the superficial dermis. |
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Medium power view of the
superficial part of the specimen. There is no edema of the papillary
dermis. The perivascular cells are lymphocytes. |
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A
high power view of one of the blood vessels in the deep reticular
dermis. The muscular wall is infiltrated by lymphocytes, and some of
the lymphocytes have localized beneath the endothelial cells. |
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