Clinical Case

Case 1

  • 30-year-old healthy woman
  • No significant past medical history
  • Review of systems is noncontributory, notably negative for fever, joint pains, bleeding gums, or easy bruising
  • Social history is unremarkable, except for a recent trip to England to visit relatives, went horse-back riding in the damp countryside
  • Presents in December for management of red-purple tender papules on the dorsal toes, which occurred in a similar distribution almost exactly a year ago after another trip to England

Initial evaluation

  • Healthy appearing woman
  • Scattered varying sized red-to-purple papules and plaques, partially blanching, on the dorsal toes arrayed roughly symmetrically
  • No other skin lesions
  • Normal joint exam
  • Diagnosis: pernio
  • Recommend warm, layered clothing, extra socks, and careful monitoring of temperature and clothing, including avoiding any damp clothes, both now and on future trips to England
  • Follow-up if fails to respond

Follow-up evaluation

  • Patient notes symptomatic relief and feels the papules resolved after about 2-3 weeks
  • Maintain warm attire and avoid cool, damp environments
  • Follow-up as needed; report any systemic symptoms such as joint pain