Chronic pernio: another cause of blue toes

It is the purpose of this report to focus attention on the clinical features, diagnosis, and management of chronic pernio. Thirty-nine patients meeting our strict criteria for a diagnosis of chronic pernio were seen at the Mayo Clinic between 1976 and 1988 and form the basis for this report. Persons with upper extremity lesions only were excluded. Twenty-eight of the patients were female, 11 were male. Age at onset of symptoms ranged from 13 to 68 years of age, with symptoms appearing from 1 to 37 years following cold injury. The lesions were bilateral in 35 (90%) of patients and symmetric in 28 (71%). Nine patients who underwent skin temperature studies following cold water immersion, showed a vasospastic response. Chronic pernio is characterized by recurring erythematous, vesicular or ulcerative lesions of the lower extremities and toes, but may present with only digital cyanosis, usually bilateral and commonly symmetrical. The diagnosis is suggested by eliciting a temporal relation between cool weather and symptom onset, particularly if there is no associated occlusive peripheral arterial disease. Treatment consists of avoidance of cold and other vasoconstrictive influences. Prazosin has been effective in the acute management and as prophylaxis against recurrences.