Ahmet Bilal DOSTBİL, İlknur BALTA, Pınar ÖZUĞUZ, Özlem EKİZ

Pernio: Tanı ve tedavi seçenekleri

Pernio (chilblains), ilk olarak 1881 yılında Henry Piffard tarafından tanımlanan, nem ve soğuğa karşı anormal bir inflamatuvar cevaptır. Pernio dondurucu olmayan soğuğa maruz kalan duyarlı kişilerde gelişir. Genç kadınlarda oldukça yaygın görülmekle birlikte, çocuk ve yaşlılarda da görülebilir. Özellikle el ve ayak parmakları olmak üzere, distal ekstremiteleri etkileyen, inflamatuvar, eritemli veya menekşe rengi, ağrılı veya kaşıntılı kutanöz lezyonlarla karakterizedir. Şiddetli olgularda bül ve ülserayon görülebilir. Tanı genellikle klinik bulgulara dayalı olarak konur. Deri biyopsisi perniyoyu taklitçilerinden ayırmada yardımcı olabilir. Histopatolojide genellikle yoğun papiller dermal ödem, süperfisyal ve derin perivasküler lenfositik infiltrat izlenir. Pernio idiyopatik olabileceği gibi, sistemik lupus eritematozus gibi sistemik hastalıklarla da ilişkili olabilir. İdiyopatik pernio kendi kendini sınırlayıcıdır ve günler içerisinde rezolüsyona uğrayabilir. Perniyonun anahtar tedavisi soğuk maruziyetinden kaçınılmasıdır. Nifedipin, tedavide ve relapsların önlenmesinde etkili bulunmuştur. Diğer tedaviler topikal florlu kortikosteroidler, nikotinamid, sempatektomi ve ultraviyole B tedavisini içerir. Bu derleme, perniyonun klinik özellikleri, ayırıcı tanısı ve tedavisi ile ilgili genel bir bakış sağlamaktadır.

Perniosis: Diagnosıs and treatment alternatives

Perniosis (chilblains) is an abnormal inflammatory response to cold and damp that was first described by Henry Piffard in 1881. Perniosis develops among susceptible individuals who are exposed to nonfreezing cold. Perniosis most commonly occurs among young women but may occur among older individuals or among children. It is characterized by inflammatory, erythematous or violaceous, pruritic or painful cutaneous lesions involving distal extremities, espe¬cially the fingers and the toes. In severe cases, blistering and ulceration may occur. The diagnosis of perniosis is usually based on clinical grounds. A skin biopsy may assist differentiation from mimicks. Histology usually shows intense papillary dermal edema, superficial and deep perivascular lymphocytic infiltrates. Perniosis can be idiopathic or associated with a systemic disease such as systemic lupus erythematosus. Idiopathic perniosis is self-limited and can resolve within days. The key therapy for perniosis is avoiding further cold exposure. Nifedipine was found to be effective and to prevent relapse. Other therapies include topical fluorinated corticosteroids, nicotinamide, sympathectomy, and ultraviolet B phototherapy. This review provides an overview of the clinical features, differential diagnosis ve treatment of perniosis.

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