PHOTO CLINIC

Brief Photo-Based Cases

Violaceous, Sore, Cold Toes

Benjamin Barankin, MD, FRCPC

A 44-year-old female presents with violaceous, sore and cold toes. These symptoms began in early November.

What is your diagnosis?

a. b. c. d. e. Pernio Raynauds phenomenon Polycythemia vera Antiphospholipid syndrome Erythromelalgia

This condition can occur repeatedly with falling temperatures, and disappears in the summer.

t o changes occur. Toes are often cold to palpation. N

l n ca ona s Answer er ers s u rp d e y fo Pernio (answer a) or chilblains is a recurrent, is p r Figure 1: Violaceous, Sore, Cold Toes localized, violaceous-to-erythematous soreness ho co t caused by exposure to cold. There is often some Au ngle . si areas should be kept warm (e.g., wool swelling, and erosions and ulcerations can some- ted Affected i a b t socks at night, no bare-foot walking at home) and times occur. Those with an impaired peripheral hi in roarepr smoking should be discouraged. Various oral circulation are more commonly affected p as e nd those living in damp climates. This condition us w a is medications have been tried with some benefit, also associated with cryoglobulinemia ie lupus including: nifedipine, pentoxyfylline and nicotied and is y, v r namide. erythematosus. o th pla u s Patients are often unaware of this mild cold a di Un itching and colour Dr. Barankin is a Dermatologist practicing in injury until later when burning,

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Toronto, Ontario

The Canadian Journal of CME / March 2011 9