Authors:

Aashim Singh*, Saurabh Bhatia and Somesh Gupta

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

*Corresponding Author: Aashim Singh, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Source: 

Journal of Clinical & Experimental Dermatology Research

Abstract
 

Background: 

Chilblains or perniosis is characterized by development of pruritic or painful erythematous and violaceous papules, plaques and vesicles over acral areas on exposure to cold conditions. Most of the cases resolve with rewarming and cold protection without any adverse events.

Two patients presented to us with chilblains that developed severe nail changes mimicking nail lichen planus due to this inflammatory condition.

Clinical cases:

A young adult male and a female presented with chilblains on cold exposure. Severe brittleness and thinning of nails developed with onset of chilblains in winters followed by spontaneous and painless falling off of the nails. Some regrowth of nails occurred during summers with recurrence in winters. Besides anonychia, pterygium formation and longitudinal striations were also present. There was no history of smoking, drug exposure, Raynaud's phenomenon or any other features suggestive of connective tissue disease or systemic illness. Antinuclear antibodies were negative. Nail lichen planus was considered initially as the clinical differential in both, however, the histopathology findings were not consistent and detailed history and temporal correlation indicated that these nail changes were related to severe chilblains. Both the patients were advised cold protection and oral nifedipine 10 mg twice daily which helped in improving the chilblains, however the nail condition persisted and appeared to be permanent.

Conclusions: 

The pathophysiology of chilblains is said to be an abnormal vascular response to cold temperatures. Chronic vasoconstriction leading to nail matrix ischemia can be postulated as a cause of the nail changes in our patients. Our patients developed severe cosmetically bothering nail changes mimicking lichen planus and even anonychia which have not been described previously.

Keywords: 

Nail; Lichen planus; Chilblains; Perniosis; Inflammatory disorders

Read about the two cases HERE