A cluster of chilblains in Hong Kong

Y Chan, William Y M Tang, W Y Lam, Steven K F Loo, Samantha P S Li, Angelina W M Au, W Y Leung, C K Kwan, K K Lo
Hong Kong Medical Journal 2008, 14 (3): 185-91

OBJECTIVE: To report a recent clustering of chilblain cases in Hong Kong.

DESIGN: Case series.

SETTING: A regional hospital and a social hygiene clinic in the New Territories West, Hong Kong.

PATIENTS: Patients with a clinical diagnosis of chilblains in February 2008.

RESULTS: Eleven patients with chilblains were identified; seven (64%) gave an antecedent history of prolonged exposure to cold. They all presented with erythematous or dusky erythematous skin lesions affecting the distal extremities, especially fingers and toes. Laboratory tests revealed elevated antinuclear antibodies titres in two, positive rheumatoid factor in two, presence of cold agglutinins in one, and a raised anti-DNA titre (>300 IU/mL) in one. Skin biopsies were performed in six patients, four of them showed typical histopathological features of chilblains. In the patient with systemic lupus erythematosus, features of vasculitis were suspected, and in the one with pre-existing juvenile rheumatoid arthritis, there were features of livedo vasculitis. In 10 (91%) of the patients, the skin lesions had resolved when they were last assessed (at the end of March 2008), but had persisted in the patient who had pre-existing systemic lupus erythematosus.

CONCLUSION: The recent clustering of chilblains was possibly related temporally to the prolonged cold weather at the end of January to mid-February. In our series, most of the patients developed chilblains as an isolated condition and resolved spontaneously within a few weeks. Laboratory tests and skin biopsies for chilblains are not necessary, unless the condition persists, the diagnosis in doubt or an underlying systemic disease is suspected.

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