Chilblains in Iraqi patients in Hilla City (Clinical study)
Kerbala Journal of Medicine,
Volume 2, Issue 3, Pages 336-344
Abstractchilblain is a major medical problem in Iraqi population in winter time and the purpose of
this study was to determine the clinical patterns of involvement in patients at Hilla city.
A total of 60 patients with chilblains were assessed in the department of dermatology in
Merjan teaching hospital during the cold months between January 2007 to February 2008. Their
ages ranged from 1.5-70 years (mean ± SD, 22.6±13.6 years).The duration of the disease ranged
from 2-90 days (mean ±SD, 24.5±20.7 days). There were 40 females (66.6%) and 20 males
(33.4٪) with a sex ratio of 2:1. The majority of patients were between 11-30 years of age (71.6%)
and females forming about 79.5%, female: male ratio was about 3.8:1.
All patients were presented in January and February and the attacks in majority of patients
started in December (20 patients) and January (30 patients) forming about 83.3%. Family history
in close relatives were positive in 14 patients (23.3 %).Thirty one patients developed similar
attacks at previous winters (51.6%). Numbers of previous attack of perniosis / winter were from 1-
Associated systemic and dermatological diseases were: hypertension (3.3%), diabetes
mellitus (3.3%), systemic lupus erythematosus (3.3%), pregnancy (3.3%), atopic dermatitis
(3.3%), allergic rhinitis (3.3%), anemia (1.6%) and hand eczema (1.6%).
Regarding the sites of the lesions, chilblains commonly affected either hands alone (48.3%),
feet alone (33.3%) and to a lesser extent both hands and feet (18.3 % ). The feet alone were
commonly affected in females (88.2%) while the hands alone in males (60 %). Hands and feet
were affected together most commonly in females (91%).Ears, nose and buttock were also affected
(1.6%) for each.
Clinically, the types of lesions in patients with chilblains were: erythematous cyanotic
swelling (81.6%), some with diffuse welling sausage - like (13.3%),erythema multiforme –like
picture with target lesions (20 %), purpuric rash (15 %),ulcerated lesions (11.6%), eczematization
with fissuring (11.6%),blisters or vesicles (6.6%),dusky red papules (6.6%), lupus erythematosus –
like rash on dorsum of the hands (5%) and nodules (3.3%).
In Iraq, chilblains clinically could be presented in a form of erythema multiforme-like,
erythema nodosum –like, lupus erythematosus-like or sausage-like swelling with cold fingers and
toes, pain, tenderness and itching.
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