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Review
. 2022 Nov 28;61(12):4631-4642.
doi: 10.1093/rheumatology/keac231.

Chilblains in immune-mediated inflammatory diseases: a review

Shirish Dubey  1   2 , Nilay Joshi  3 , Olivia Stevenson  3 , Caroline Gordon  4 , John A Reynolds  5   6
Affiliations
Review

Chilblains in immune-mediated inflammatory diseases: a review

Shirish Dubey et al. Rheumatology (Oxford). .

Abstract

Chilblains were first described over a hundred years ago as cutaneous inflammatory lesions, typically on the digits, occurring on cold exposure. Chilblains can be primary, or secondary to a number of conditions such as infections, including COVID-19, and immune-mediated inflammatory disorders (IMIDs) with SLE being the commonest. Chilblain lupus erythematosus (CHLE) was first described in 1888 as cold-induced erythematous lesions before the terms 'chilblains' or 'perniosis' were coined. Diagnostic criteria exist for both chilblains and CHLE. Histopathologically, CHLE lesions show interface dermatitis with perivascular lymphocytic infiltrate. Immunofluorescence demonstrates linear deposits of immunoglobulins and complement in the dermo-epidermal junction. This narrative review focuses on chilblains secondary to immune-mediated inflammatory disorders, primarily the epidemiology, pathogenesis and treatment of CHLE.

Keywords: CHLE; Chilblains; IMID; chilblain lupus erythematosus; immune-mediated inflammatory diseases.

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Figures

<sc>Fig.</sc> 1
Fig. 1
Patient photo of CHLE lesions on the foot and also demonstrating splinter haemorrhage
<sc>Fig.</sc> 2
Fig. 2
Skin biopsy appearances under low magnification Histopathological features of CHLE on skin biopsy (×100 magnification, haemotoxylin and eosin staining) demonstrating RBC extravasation, fibrin in vessel and perivascular lymphocytic infiltrate.
<sc>Fig.</sc> 3
Fig. 3
Skin biopsy appearances under higher magnification Histopathological features of CHLE on skin biopsy (×400 magnification, haemotoxylin and eosin staining) demonstrating perivascular mid-dermal lymphocytic infiltrates.
See this image and copyright information in PMC

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