Diseases of Skin including exanthemata by Fredrick Dearborn

71. DERMATITIS CONGELATIONIS [Dermatitis Congelationis]

Last modified on April 29th, 2015

DERMATITIS CONGELATIONIS [Dermatitis Congelationis]

 

(Frost-bite; Pernio; Chilblain)

Symptoms. Inflammation of the skin caused by cold may be of three grades similar to those forms due to heat. There is first a whitening of the skin in patches, with partial or complete loss of sensation, and a feeling of coolness to the touch. With the return of warmth, there is burning, pricking or itching of the parts. In persons whose circulation is poor, slight exposure to the cold often heads to a persistent type of inflammation, especially on the hands or feet, commonly known as chilblains. In the second degree, there are produced with reaction vesicles or blebs, the contents of which may become bloody with subsequent ulceration and scarring. The third degree commonly develops from intense or prolonged cold and causes more or less necrosis of the frozen parts with or without blisters of the second grade. Sensation is lost; the surface is whitened; forty-eight hours after the removal of the cold it appears edematous, the color changes, and a line of demarcation forms followed by the usually signs of tissue death and ulceration.

Diagnosis. It is not necessary for the average practitioners to diagnose these cases because they come already diagnosed.

Prognosis. Recovery is almost certain under proper treatment, although chilblains have a tendency to recur with cold weather until the cure is permanent. It is to be remembered that deformity from loss of tissue or by operation to remove gangrenous parts is always a possibility is severe cases, and that shock may complicate the process at any stage.

Treatment. Friction with alcohol, cologne, bay rum, menthol, peppermint or camphor solutions is all that is needed in the milder forms; care being taken to protect the parts from undue pressure or further exposure. For the more intense cases, external treatment is purely isopathic. The patient should be kept in a cool room and an effort made to restore circulation by friction with snow or ice water applied for hours to the frozen part. If blisters develop, they may be opened and some of the cooling applications mentioned above applied until further developments ensue. If gangrene develops on the extremities, early amputation is absolutely essential or, if such amputation is impracticable or delayed, antiseptic dressing is advised. When improvement ensues, the temperature of the room may be raised and hot liquids or stimulants given to the patient. The subsequent treatment is protective and exposure to severe cold should be carefully guarded against. Galvanic or high-frequency currents, mildly applied, are useful to re-establish a normal circulation. Internal remedies are of much assistance. See Agaricus, Borax, Cadmium sul., Carbo veg., Crotal., Hepar, kali mur., Lycopodium, Nat. phos., Sulphur, Sul. acid.

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Fredrick Dearborn

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