Chilblains S014

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: T69.1

Brief description

Chilblains are painful, inflamed areas of skin caused by the reaction of small blood vessels in the skin to cold exposure. They are also known as pernios or perniosis.

The affected areas may appear as red, purple or swollen spots, patches or lumps. Itching, pain or a burning sensation commonly occurs. In more severe cases, blistering, ulceration or secondary infection may develop. The fingers and toes are most commonly affected, although chilblains can also occur on other areas exposed to cold, including the hands, legs, nose, face and ears.

Confirming the diagnosis

Chilblains are generally diagnosed clinically from the characteristic appearance and distribution of the skin lesions together with a history of relevant cold exposure. There is no specific investigation required to confirm uncomplicated chilblains. Further investigations may be appropriate where the presentation is unusual, persistent or recurrent, particularly if an underlying condition that may cause similar skin lesions is suspected.

The diagnosis can generally be established by a GP or general physician. A dermatologist may be appropriate where the diagnosis is uncertain or the condition is persistent, recurrent or atypical.

Additional diagnoses covered by SOP

• Erythema pernio
• Pernio
• Perniosis

Conditions not covered by SOP

• Frostnip #
• Frostbite *
• Immersion foot * - Non-freezing cold injury SOP
• Trench foot * - Non-freezing cold injury SOP
• Other non-freezing cold injuries not meeting the definition of chilblains *

* another SoP may apply

# non-SoP condition

Clinical onset

Clinical onset refers to the first development of the characteristic skin lesions and associated symptoms following cold exposure. These may include localised redness or purple discolouration, swelling, itching, pain or burning. The timing and circumstances of the cold exposure should be considered when determining whether the skin lesions represent chilblains. The lesions must represent a reaction of the small blood vessels in the skin to cold exposure rather than frostnip, frostbite or another skin condition.

Chilblains may occur as a single episode or recur following subsequent cold exposures. Where episodes are distinct and separated by complete resolution, a later episode may represent a new clinical onset rather than worsening of the original episode.

Clinical worsening

Chilblains generally improve with protection from further cold exposure and appropriate management. In some cases, lesions may persist, recur or become more severe, with complications such as blistering, ulceration or secondary infection.

When assessing clinical worsening, it is important to distinguish persistence or deterioration of an existing episode from a separate episode occurring after a new cold exposure. Assessment should also consider whether the deterioration is due to chilblains itself or another cold-related or dermatological condition.