LUPUS ERYTHEMATOSUS ( PERNIOAIS)
My dermatologist has just diagnosed me with lupus erythematosus (pernioais). She is sending me to specialst. She really did not tell me very much about this disease or how it is treated. All she said was it is because my feet are always cold and that I need to keep my feet warm all the time. Can anyone elaborate on this condition?
Skin disease is one of the most common findings in lupus erythematosus.
The three major skin diseases of lupus erythematosus are 1) acute cutaneous lupus erythematosus, 2) chronic cutaneous erythematosus (discoid LE) and 3) subacute cutaneous lupus erythematosus, including the
neonatal lupus erythematosus variant. There also are uncommon but
distinctive cutaneous lupus variants, such as lupus tumidus, lupus profundus and bullous SLE. In addition, there are many other nonspecific findings on the skin in lupus such as vasculitis, alopecia, Raynaud's and Chilblains (aka: Perniosis).
Perniosis (aka: Chilbains) are a painful, abnormal reaction of the small blood vessels in the skin when exposed to cold temperatures. Chilblains usually occurs several hours after exposure to the cold in temperate humid climates. The cold causes constriction of the small blood vessels in the skin and if rewarming of the skin happens too rapidly, there is leakage of blood into the tissues as the blood vessels do not respond quickly enough to this rewarming. Chilblains are not very common in countries where the cold is more extreme as the air is drier. People with poor peripheral circulation and sometimes with poor general health are the victims. It is more common among females than males.
Chilblains appear as small itchy, red areas on the skin. Chilblains become increasingly painful as they get congested and then they take on a dark blue appearance. They may also become swollen. As they dry out, chilblains leave cracks in the skin, so the risk of getting an infection increases. Chilblains are common on the toes, but can also affect the fingers and the face (especially the nose and ears). Chilblains are also common on areas of the feet exposed to pressure, such as the bunions or where the toes are under pressure from tight shoes or where there are corns and callus. It is distinguished from lupus erythematosus, which may even complicate chilblains. In lupus erythematosus of the hands, bluish red slightly infiltrated and scaly lesions develop on the backs of fingers, accompanied by typical lesions on the face. When one come across chronic whitlows and erosions on the fingers or toes, the possibility of chilblains must be considered.
It is distinguished from lupus erythematosus, which complicates chilblains. In lupus erythematosus of the hands, bluish red slightly infiltrated and scaly lesions develop on the backs of fingers, accompanied by typical lesions on the face. When the symptoms includes chronic whitlows and erosions on the fingers or toes, the possibility of chilblains must be considered.
Some people with cutaneous Lupus Erythematosis also have circulatory problems. They may have chilblains (chilblain lupus), especially if they live where there is a cool climate or they are smokers. They may suffer from Raynaud phenomenon: this refers to abnormal blanching of fingers and toes in response to cold weather, followed by numbness and slow rewarming by the fingers which go blue then red. Mild arthritis of finger joints may also occur. This type of lupus is a variant of discoid lupus erythematosus. Usually the chilblain lesions develop some years after the appearance of discoid lesions, but they may also occur alone or at the same time as discoid lesions.
Contributing factors for developing Chilblains include:
* A familial tendency
* Peripheral vascular disease due to diabetes, smoking, hyperlipidaemia
* Poor nutrition e.g. anorexia nervosa
* Hormonal changes: chilblains can improve during pregnancy
* Connective tissue disease, particularly lupus erythematosus or, in * association with Raynaud phenomenon, systemic sclerosis)
* Bone marrow disorders
The hands and feet must be kept warm with gloves and woollen stockings. Sudden changes of temperature like exposing parts of the body to cold and then warming them near a fire, act badly on the malady. For this reason, central heating is very useful. Unfortunately chilblains respond poorly to treatment. The following may be useful: Topical corticosteroid cream applied accurately for a few days to relieve itch and swelling and/or
Antibiotic ointment or oral antibiotics for secondary infection.
Drug therapy can include a course of thyroids, nicotinic acid and vitamin K - Pernavit, Priscol, Duvadilan and locally UVR exposures, lead lotion and galvanic baths. All these may have to be tried one by one, since in one case, one may succeed and in another, it may fail, especially in light of the fact that there is no specific drug available for chilblains.
I hope that this information has been helpful to you. Let me know if you need anything further
Peace and Blessings