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Chilblain lupus

Has it ever happened to you that winters and cold get your fingers and toes swelled more than called to be okay? Or have you ever got your fingers reddish blue, itchy, and irritatingly painful because of a cold? This condition is termed as “chilblain lupus” in the medicinal dictionary.

The term ‘chilblain’ is basically derived from ‘chill’ meaning ‘cold’ and ‘blegen’ meaning ‘sore’. It is an abnormal reaction to the severe cold. In this condition, the skin becomes irritating and itchy. Moreover, it can lead to some severe consequences if one suddenly goes to a warm area. The reason behind it is that the exposure to cold tightens the skin and rewarming causes the small blood vessels in the skin to expand quickly. This quick expansion increases blood flow suddenly, which cannot be handled by nearby tissues sometimes. So, it leads to the leakage of blood to the neighboring tissues and causes swelling. Not only this, but the irritation of nerves in the affected area can also cause pain.

Chilblain lupus

Chilblains usually end up within a few weeks and do not cause any serious and fatal injury. But it can definitely lead to infection, which can be problematic if left untreated. Patches usually develop on the toes, fingers, knee, and hands while they are usually rare on the nose. Chilblain lupus fingers are one of the most evident symptoms of this medical situation. Most of the time, the symptoms disappear on their own within a few weeks but if these symptoms persist for a longer time and continue to prolong even during the summer season, then it must need to be diagnosed and treated properly. If you face a situation this severe then we recommend you go to the physician.

While lupus is an autoimmune disorder in which the immune system of the body starts killing its own healthy cells. Primarily, lupus causes inflammation in a specific part of the body, and then it goes to be systemic where inflammation occurs throughout the body. Till now, there is no proper cure for lupus. So, the treatment basically depends on reducing the inflammation and hindering the end-stage consequences before it’s too late.

You should also read: Blepharitis and stress

Chilblain lupus erythematosus:

Chilblain lupus erythematosus is a type of chilblain and subtype of chronic cutaneous lupus erythematosus. It is a rare chronic disease mostly affecting middle-aged women. It was reported for the first time in 1888 by Hutchinson. It is triggered by cold temperature leading to the red and blue plaques on the fingers, nose, feet, and most prominently on the dorsal joints of the hands. It can be quite painful, itchy, and also leads to swelling of hands and feet. It is basically caused by a cold stimulus which leads to the constriction of blood vessels due to which the viscosity of the blood increases and decreases the flow of blood. One can get this medical condition either way: it can occur randomly or can also be inherited.

Types of chilblain lupus erythematosus

There are two types of chilblain lupus erythematosus including sporadic or familial.

Sporadic chilblain lupus erythematosus:

Sporadic chilblain lupus erythematosus is a rare disorder that usually occurs in the middle ages. There are no mutations involved in this and develop randomly. Moreover, an interesting observation is that it does not affect the children and teenage people. 20% of the sporadic patients might develop systemic lupus erythematosus.

Familial chilblain lupus erythematosus:

Familial chilblain lupus erythematosus is the inherited type of chilblain lupus erythematosus (autosomal dominant) that occurs from a mutation in a gene (TREX1) and passes from one generation to the next. It manifests itself usually at an early age. Unlike sporadic, there is no evidence of the progression of familial chilblain lupus erythematosus to systemic lupus erythematosus.

Autosomal dominant:

In these type of conditions, the mutant gene is present on the autosomal chromosome, that doesn’t take part in the sexual properties of an organism. ‘Dominant’ refers to the fact that even a single allele of this gene can cause the disease single-handedly since it’s dominant in character.

Chilblain lupus erythematosus symptoms OR Chilblain lupus symptoms:

There are some symptoms to diagnose this situation which are as following:

  • Small patches on the body parts like feet, hands, ears, fingertips.
  • Swelling of the skin
  • Changing of the skin color to reddish blue
  • Pain and itching on the affected area

Immunologic abnormalities like polyclonal hypergammaglobulinemia elevated rheumatoid factor, and antinuclear antibodies, especially anti-Ro/SSA are observed in patients with chilblain lupus erythematosus.

Risk factors:

There are various factors that can play role in the onset of chilblain lupus erythematosus, some are discussed below:

  • Damp weather and the skin exposed to cold can lead to this disease.
  • People living in humid areas are more likely to be affected by chilblains lupus erythematosus.
  • People having poor circulation can be easily affected by chilblains.
  • People who are underweight can also develop the disease.
  • People having autoimmune disorders can easily become victims of this disease. In this disease mostly the immune system is concerned since it starts killing the body’s own cells against the harsh environment.
  • Family history is also considered while taking observation notes. If the disease exists in your family then you are more likely to be affected as it has a fair chance to be inherited.
  • People having diseases related to the vascular tissues are also vulnerable to this situation in winters.

chilblain lupus on toesComplications in chilblain lupus erythematosus

Chilblain lupus erythematosus can lead to many complications including koebnerization, which is basically the appearance of new skin lesions on healthy skin. You might develop bacterial infections in these lesions. Some of the signs that can give you a signal about the infection are feeling unwell, pus coming from the infected area, running through a high fever (38°C), and swollen glands. It can also lead to systemic lupus erythematosus, ulcer formation, and permanent change in skin color.

Diagnosis chilblain lupus erythematosus Or chilblains lupus diagnosis:

There are two major and four minor criteria for the diagnosis of chilblain lupus erythematosus.

Major criteria include the patches on the distal parts of the body due to lower temperature, deposition of fibrin in the skin blood vessels, the reaction of white blood cells to the vascular tissues, and also the deposition of immunoglobulins IgA, IgM, and complement C3 along with inflammation of the skin.

Minor criteria involve the negative results of cold agglutinin and cryoglobulin, response to anti lupus erythematosus therapy, and the existence of systemic lupus erythematosus.

There are several other conditions having similar symptoms and need to be considered during diagnosis. These include,

  • Perniosis (ordinary chilblains)
  • Lupus pernio
  • Raynaud phenomenon
  • Cold panniculitis
  • Livedo reticularis
  • Dermatomyositis
  • Cold urticarial
  • Acrocyanosis

Thus care should be taken while diagnosing the disease efficiently.

Precautionary measures:

Since winters exploit this situation, thus care must be taken to avoid exposure to cold and moist environments. Heaters should be used to keep the room temperature a bit comfortably warm. In addition to that, the person must wear warm clothes, gloves, socks, and other winter accessories to keep the body as warm and cozy as possible. One can warm up the shoes by putting those near heaters before wearing them. Make sure not to put your cold feet in hot shoes in order to avoid triggering chilblain. Tight shoes should be avoided as they can reduce circulation towards the feet. Hands can be dipped in warm water before going out in order to avoid the sudden change in external temperature.

The person must have physical activities so that the temperature of the body remains high. One must eat at least one hot meal during the day as it can also help in warming up your body.  If the person is addicted to smoking, he must quit it because the nicotine present in it causes the narrowing of vascular tissues, which slows down the blood supply and so can trigger chilblain lupus erythematosus.

Moreover, when you observe the symptoms, try to slowly warm your body and avoid direct and spontaneous heating such as quick warming, which can make your symptoms get worse. Rubbing and massage of the affected area might seem like a great way to warm that area but it should be avoided as it can increase the irritation and inflammation in that area. In order to avoid infection, the body must be kept clean and moisturized.

Moreover, some people with diabetes cannot feel their feet, so they must regularly check on their feet as they might have infected chilblain without knowing.

Chilblain lupus erythematosus treatment and Patient management:

The diagnosis of chilblain lupus erythematosus is difficult and must be diagnosed carefully to avoid confusion with other cold-related diseases. The symptoms must be carefully observed to determine the stabilization of the disease. If the symptoms do not recover in a few weeks and lead to the infection, then there is a need to take prescribed medicines for the treatment of the problem.

The basic purpose of the treatment is to heal the existing lesions and to avoid the development of new ones. Mostly, anti-malarial agents, antibiotics, topical and systemic steroids, and calcium channel blockers are used for the treatment. Anti-malarial and topical treatment have less severe side effects as compare to other variety of pharmaceutical chemicals used for the same purpose.

For the patients having a disease that is not responding to the treatment, therapies are needed which can have more side effects. The side effects must be discussed with the patient before starting the therapies.

One thing to be noted is that smokers can develop many diseases easily and can lead to the severity of the disease sooner than non-smokers. Most of the time, the drugs do not work effectively in the body of smokers making the treatment very strenuous. So, it must be ensured that the patient is avoiding the usage of any kind of smoking material, especially during the treatment.

The surgical option for severe chilblain lupus:

If the medicines do not work, then chilblains lupus can be treated through surgery. Basically, the infected skin portion is removed and the little piece of skin having less thickness, taken from some other part of the body is placed on the wounded area. The wounded area will heal within a few weeks. Patients have been successfully treated through this method.

chilblains on toesWhat do chilblains on toes look like?

Chilblains lupus toes usually affect the toe fingers, particularly the fingertips. The affected area gets reddish with an early desire to itch that leads to pain and lesions afterward. Those lesions get scaly and are vulnerable to most infections. Swelled up toe fingers sometimes prove to be a hindrance for the person to walk comfortably. An inflicted person is advised not to use tight shoes to avoid the severity of pain during the feet movement. Keeping feet warmed up with regular dipping in warm water helps to keep the extreme consequences at bay.

 

Are chilblains serious?

Although this condition can be quite painful while walking and doing regular stuff but no permanent change is evitable. Furthermore, it does not reach any kind of fatal stage and at the most, it can result in ulcers. Moreover, it doesn’t affect everybody. Those who are more sensitive to environmental conditions or acquire a compromised immune system with time usually get chilblains easily. Some people also have this disease in genetic inheritance. Thus it’s quite possible for a person to suffer from it when some other family members are also already victims of this medicinal situation.

Are chilblains a sign of diabetes?

Smoking different health-compromising products, diabetes, high cholesterol, and underweight persons suffer from poor blood circulation. This situation increases the chances of developing chilblains. Moreover, having diabetes slows down the natural healing process greatly. So diabetes can increase the chances of having chilblains but later one is not characterized as a sign of diabetes.

Can chilblains last for months?

Although chilblains usually get better in no time i.e in a few weeks. But sometimes it may take months to be fully recovered from chilblains. Moreover, it can get to peak again whenever the weather gets cold again. But some patients get wounds by itching or simply the severity of the condition. Those wounds may take longer to heal properly, especially when are not treated properly.

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