| Also known as pernio or perniosis, a chilblain
is an abnormal skin reaction to cold or damp weather in humid climates.
It is painful swelling that also has red, burning and itching feelings
that are intensified when coming in from the cold. Chilblains is
a medical condition that is often confused with frostbite and trench
foot. Chilblains are acral ulcers (that is, ulcers affecting the
extremities) that occur when a predisposed individual is exposed
to cold and humidity. The cold exposure damages capillary beds in
the skin, which in turn can cause redness, itching, blisters, and
inflammation. The skin may also break down over the swelling which
may become infected. The toes, fingers, nose and ears are most common
areas for appearance. Chilblains are often idiopathic in origin
but can be manifestations of serious medical conditions that need
to be investigated.
ETIOLOGY
EXTERNAL CAUSE
• Cold.
PREDISPOSING CAUSES
• Poor peripheral circulation.
• Poor general health.
• Vasomotor irritability.
• Constitution:
o Fat, phlegmatic subject.
o Thin, highly strung, nervous subjects.
WEATHER
• Common in winters.
SEX
• Common in females.
CLINICAL FEATURES of Chilblains
ONSET
• Acute.
LOCATION
• Toes, fingures, ears, tip of nose.
Symptoms
• Ulceration of the digits and toes.
• Red nose.
• Skin redness.
• Toe skin inflammation.
• Finger skin inflammation.
• Earlobe inflammation.
• Intense, distressing itching and burning pain.
• Worse from sudden change from cold to hot atmosphere.
LESION
• Parts become dusky red, cold.
• Bilaterally symmetrical.
• Oedema of affected parts.
• Heals with change of weather.
• Mild desquamation occurs at site of lesion.
• Brownish mark left on resolution.
COMPLICATIONS
• Ulceration.
General management
• Avoid exposure to cold.
• Keep feet, hands warm by wearing warm shoes & gloves.
• Improve general health.
• Wash hands with warm water.
• Thorough drying after washing.
Prevention of Chilblains
Exposure
• Avoid rapid changes in temperature.
• Wear gloves or socks.
• Use warm footwear.
• Keep area warm.
• Avoid scratching.
• Keep hands and feet warm.
Dietary
• Healthy diet.
• Exercise.
• High doses of vitamin K.
• Avoid alcohol before going out in snow.
HOMOEOPATHIC TREATMENT
• Abrotanum.
• Agaricus.
• Borax.
• Calendula.
• Heper sulph.
• Lachesis.
• Petroleum.
• Rhus-ven.
• Sulphur.
ABROTANUM
The characteristic is sensation of itching in the lesion. Loose
& flabby skin. Skin becomes purplish after suppression of eruptions.
This is especially indicated in persons with tendency towards marasmus.
In general worse by cold air, wet weather.
Alternate constipation and diarrhoea: lienteria. Marasmus of children
with marked emaciation, especially of legs; the skin is flabby and
hangs loose in folds.
AGARICUS
Burning, itching, redness & swelling as if frozen. Itching
change place on scratching. Pricking as from needles. Chilblains
more painful during cold weather, freezing air. Worse after alcohol.
Persons with light hair; skin and muscles lax. Old people, with
weak, indolent circulation. Drunkards, especially for their headaches;
bad effects after a debauch. Delirium: with constant raving; tries
to get out of bed; in typhoid or typhus. Headache: of those who
readily become delirious in fever or with pain; of persons subject
to chorea, twitchings or grimaces; from spinal affections. Chilblains,
that itch and burn intolerably; frostbite and all consequences of
exposure to cold, especially in face.
BORAX
Extreme dryness of the skin. Withered, witted, wrinkled skin. Tendency
to develop whitish pimples with red areola. Slightest injury suppurates.
Dread of downward motion in nearly all complaints.
CALENDULA
Tendency to develop chilblains after an injury with formation of
ulcers with excessive secretion of pus. The surrounding part is
red. The pain in the chilblains tend to become worse at night.
Traumatic affections: to secure union by first intention and prevent
suppuration. In all cases of loss of soft parts when union cannot
be effected by means of adhesive plaster. External wounds with or
without loss of substance; torn and jagged looking wounds; post-surgical
operations; to promote healthy granulation and prevent excessive
suppuration and disfiguring scars. Traumatic and idiopathic neuroma;
neuritis from lacerated wounds; exhausted from loss of blood and
excessive pain. Rupture of muscles or tendons; lacerations during
labor; wounds penetrating articulations with loss of synovial fluids.
Wounds: with sudden pain during febrile heat; constitutional tendency
to erysipelas; old, neglected, offensive, threatening gangrene.
HEPER SULPH.
The skin is extremely sensitive tocold air. Tendency to develop
deep cracks with chilblains. Better by warm application, warm wraps
& heat. Worse in cold air, winter & cold application. Easy
suppuration developing in chilblains.
For torpid lymphatic constitutions; persons with light hair and
complexion, slow to act, muscles soft and flabby. The slightest
injury causes suppuration. Diseases where the system has been injured
by the abuse of Mercury. In diseases where suppuration seems inevitable,
Hepar may open the abscess and hasten the cure. Oversensitive, physically
and mentally; the slightest cause irritates him; quick, hasty speech
and hasty drinking. Patient is peevish, angry at the least trifle;
hypochondriacal; unreasonably anxious. Extremely sensitive to cold
air, imagines he can feel the air if a door is opened in the next
room; must be wrapped up to the face even in hot weather; cannot
bear to be uncovered; takes cold from slightest exposure to fresh
air.
LACHESIS
Chilblain with bluish-red or bluish-black discoloration round it.
Chilblains tends to develop ulceration leading to gangrene. Severe
burning sensation worse at night & during sleep. Chilblains
are very sensitive to touch. Chilblains bleed easily & copiously.
Severe excoriation of the affected part.
Persons of a less melancholy temperament, dark eyes, and a disposition
to low spirits and indolence. Women of choleric temperament, with
freckles and red hair. Better adapted to thin and emaciated than
to fleshy persons; to those who have been changed, both mentally
and physically, by their illness.
PETROLEUM
Itching chilblains with chapped hands & feet. Slightest injury
on the chilblains tends to suppurate. Severe excoriation of the
affected part. Itching sensation & from it moist discharge comes
out which is very acrid. In general there is aggravation of symptoms
from warmth of bed.
Adapted to persons with light hair and skin; irritable, quarrelsome
disposition; easily offended at trifles; vexed at everything. Ailments:
from riding in a carriage, railroad car, or in a ship. Ailments
which are worse before and during a thunderstorm. Symptoms appear
and disappear rapidly. During sleep or delirium: imagines that one
leg is double; that another person lies along side of him in same
bed; that there are two babies in the bed. Vertigo on rising; in
occiput as if intoxicated; like seasickness.
RHUS-VEN.
Chilblains with severe burning sensation. The affected parts looks
red, indurated & swollen. Formation of deep corroding, phagadenic
ulcers with offensive discharge. Itching is worse by warmth &
better by cold.
SULPHUR
Voluptuous itching sensation. Burning sensation sensitive to air
& wind & washing. Chilblains alternate with various other
bodily complaints. Skin is dry rough chapped. Offensive odour of
skin, worse at night in bed, scratching & washing.
Adapted to persons of a scrofulous diathesis, subject to venous
congestion; especially of portal system. Persons of nervous temperament,
quick motioned, quick tempered, plethoric, skin excessively sensitive
to atmospheric changes. For lean, stoop-shouldered persons who walk
and sit stooping like old men. Standing is the worst position for
sulphur patients; they cannot stand; every standing position is
uncomfortable. Dirty, filthy people, prone to skin affections. Aversion
to being washed; always <. after a bath.
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