ARTICLE CHILBLAIN ASSOCIATION WITH ANEMIA.

Dhari Kettan Aouda Aladwan and Saja Mohammed Abbas. 1. MBChB, DVD (dermatology) Head of department of dermatology, Al-Yarmouk Teaching Hospital. 2. MBChB, DVD (dermatology), Dermatologist, Al-Yarmouk Teaching Hospital. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 6(4), 324-328 325 Introduction:-Chilblain also known as pernio, chill burns and perniosis (1) other synonyms are cold induced vascular disease and erythema pernio. (2) It is a medical situation that happens when a liable persons are exposed to cold and humidity, causing tissue injury. It is frequently confused with frostbite and trench foot and usually misdiagnosed as Raynaud's (3) . Symptoms and signs are caused by insult to capillaries below the skin. (4) Tend to develop during the winter months of the year. Appearance of the lesions is approximately 12-24 hours after exposure to cold. (5,6) . It is a form of inflammation of small blood vessels (vasculitis) seen when the skin is exposed to non-freezing temperatures for long time. (7) Usually targets the legs, hands, toes, feet, ears and face. It is manifested as bluish red discoloration of the skin and presented with pain, itching, burning sensation and swelling especially as the body becomes warmer. Blisters may formed in severe cases and even ulcerate and secondarily infected. These lesions are usually last for 2 to 3 weeks. (2,5,6) Although the cause is not determined, however, there are factors recognized to contribute to the development of chilblain such as poor circulation, poor nutrition, anemia, a familial tendency, hormonal changes, connective tissue disorders, and bone marrow disorders. Certain drugs, such as beta-blockers, may causes vasoconstriction and results in chilblains. (8) it can be related to serious medical condition that must be investigated as lupus. Low body mass index and genetic predisposition are more likely to predispose for development of chilblains. (7,9) Preventive measures should be followed by those persons living in such conditions or who are predisposed for chilblains. Precautionary measures may include regular care of feet as soaking in warm water and drying them, the use of emollients, wearing nylon socks in layers and avoiding tight or loose shoes. (10) "The practice of adding tea leaves and beet to warm water for soaking of the feet in these areas requires scientific analysis. Though the Defence Research and Development Organization (DRDO) of India has introduced nitroglycerine and salbutamol sulfate creams for the prevention of cold injuries after pilot studies on soldiers and workers residing in high altitudes, (11) larger clinical trials are needed to establish their efficacy. "Cutfar, an Ayurvedic cream is effective in treating chilblains; however, this needs validation by a clinical trial"(envi derma). Oral nifedipine has been found to be effective but should be prescribed under supervision. (12) The aim:-To discover the relation of anemia, age and gender to chilblain To discover the commonest feature and site of involvement in chilblain

Patients and method:-
The current study was cross sectional study conducted at dermatology consultation unit in Al-Yarmouk Teaching hospital during the period from the 1 st of December 2016 to the first of March 2017. It included 40 patients. Patient selection was sequential according to their presentation to the clinic during the study period. Patient eligibility for the study was according to pre-accustomed inclusion criteria. Preformed questionnaire formula was prepared and included the details of the patient full history and physical examination. All patients referred to perform complete blood picture. The ethical issue is satisfied.
Table no. 1 showed that the commonest age group affected was 11 -20 years (17 patients 42.5%) and this may be due to hormonal changes. Half of the patients were in the age group 21 -30 years (12 patients, 30%) and the age group 31 -40 years (8 patients, 20%), these 2 groups constituted the main working groups and this is may explain the higher percentage of exposure to weather and the development of perniosis.
Pramanik T et al in their study discussed the frequency of perniosis in 49 patients in relation to age and gender and they documented that 25 patients (10 males, 15 females) were in the age group of 7-20 years a result nearly similar to the results of the current study. Also they revealed that eighteen patients (7 males, 11 females) were in the age group of 21-40 years and only 6 (2 males, 4 females) were in the age group of 41-65 years. (13) Z Meltem Akkurt et al (14) discovered the following results in their study of 69 patients with chilblains, 45 (65.2%) were females and 24 (34.8%) were males. These results run parallel to the gender distribution in the current study. From the forty patients involved in the current study 17 patients were anemic (42.5%) and 23 patients were not (57.5%) as shown in 327 Adolescent females (age group 11 -20 years) are more prone to perniosis than males especially when they are anemic; however, males when they are non-anemic are more prone to perniosis than females in all other age groups. It seems that anemia has uneven influence on the frequency of chilblain and this influence is modulated by the age and gender of the patients were the main impact on 11 -20 age group especially in female patients. Table no.3 revealed the frequency of the clinical features among the studied patients, the commonest clinical feature noticed among the patients was erythema, and it was seen in 77.5% of the patients, followed by swelling 23%. The least common feature seen was tenderness; it was seen in 2 patients 5%.
The main features in female and male patients was erythema, 47.5% and 30% respectively, however, the 2 nd commonest feature in females was itching 37.5% and in males was swelling of the affected part 22.5%. The least common feature was tenderness with equal gender distribution. Z Meltem Akkurt et al (14) in their study documented different result regarding the main features seen in the affected patients, they revealed that 71.2% of the patients complained of itching, 51.6% of pain, 31.3% of burning in the lesions.
Table no. 4 revealed the sites of involvement; nearly 2 thirds of the patients (70%) presented with involvement of the toes, nearly half of the patients (52%) suffered from finger lesions and the least common area involved was the legs, it was affected in one patient (2.5%).
The commonest site of involvement in female and male patients was the toes, 50% and 20% respectively; however, males show equal frequency of involvement of both the toes and fingers 20%, the 2 nd commonest site of involvement in females was the fingers 32.5%. The lowest site of involvement was the lower legs in females and males, 2.5% and 0% respectively.
Z Meltem Akkurt et al (14) revealed that only the feet were involved in 50.7% and only the hands were involved in 26.1%. Both the hands and feet were involved in 23.2%. Acral cyanosis was observed in 23.2%. The mean number of fingers with lesions of chilblains was seven. The mean number of toes with lesions was five.