Dr Puneet Kumar Misra<\/strong><\/p>\n
Abstract
\n<\/strong>During the cold weather when the person come with the main complaint as the swollen finger of lower extremities or both extremities with or without ulcer, the new as well as experience clinicians first choice of the\u00a0\u00a0 drug are the dynamic \u00a0\u00a0petroleum i.e. the petroleum in the potency and this prescription never dispirited the prescriber. But most of the physicians are unawares about the\u00a0\u00a0\u00a0 major quality of this medicine which is highly\u00a0 \u00a0proved effective in the winter dryness of skin and other associated disorder of dry skin due to cold wind exposed specially kids and old age group.<\/p>\n
Key words<\/strong> \u2013 Petroleum, skin, Chilblain, winter, dryness, eczema<\/p>\n
Introduction <\/strong><\/p>\n
The skin is the largest organ in the human body. Forming a major interface between man and his environment, it covers an area of approximately 2 m and weighs about 4 kg. The structure of human skin is complex, consisting of four distinct layers and tissue components with many important functions. Reactions may occur in any of the components of human skin and their clinical manifestations reflect, among other factors, the skin level in which they occur, and sometimes they act as a \u2018window\u2019 of systemic changes elsewhere in the body, e.g. medical conditions , such as those associated with pruritus , systemic causes of erythema nodosum \u00a0or paraneoplastic skin conditions . The accurate diagnosis of most skin lesions requires an adequate history, careful examination of the patient and, occasionally, laboratory investigation, but dermatology is predominantly a visual specialty.1<\/p>\n
Non-freezing cold injury (trench or immersion foot) – <\/em><\/strong>This results from prolonged exposure to cold, damp conditions. The limb (usually the foot) appears cold, ischaemic and numb, but there is no freezing of the tissue. On rewarming, the limb appears mottled and thereafter becomes hyperaemic, swollen and painful. Recovery may take many months, during which period there may be chronic pain and sensitivity to cold. The pathology remains uncertain but probably involves endothelial injury. Gradual rewarming is associated with less pain than rapid rewarming. The pain and associated paraesthesia are difficult to control with conventional analgesia . The patient is at risk of further damage on subsequent exposure to the cold.2<\/p>\n
Chilblains –<\/em><\/strong>Chilblains are tender, red or purplish skin lesions that occur in the cold and wet. They are often seen in horse riders, cyclists and swimmers, and are more common in women than men. They are short-lived and, although painful, not usually serious.2<\/p>\n
\u00a0<\/strong>\u00a0PERNIO (CHILBLAINS) is a vasculitic disorder associated with exposure to cold; acute forms have been described. Raised erythematous lesions develop on the lower part of the legs and feet in cold weather . They are associated with pruritus and a burning sensation, and they may blister and ulcerate. Pathologic examination demonstrates angiitis characterized by intimal proliferation and perivascular infiltration of mononuclear and polymorphonuclear leukocytes. Giant cells may be present in the subcutaneous tissue. Patients should avoid exposure to cold, and ulcers should be kept clean and protected with sterile dressings.3<\/p>\n
Chilblains, is a cold-induced vasospastic inflammatory process that affects the skin after exposure to nonfreezing temperatures or damp climates. Pernio is seen more commonly in the northern United States and northwestern Europe. It is most common in individuals with a low body mass and in young women between the ages of 15 to 30 years, although it also can occur in children and in the elderly. The cause is unknown but is likely a result of cold-induced vasoconstriction that induces inflammation and ischemia of vessels and surrounding tissue. The histopathologic findings include dermal edema, keratinocyte necrosis, and a deep dermal lymphocytic infiltrate. Pernio can be classified as acute or chronic. Acute pernio develops a few hours after exposure, whereas chronic pernio develops after repeated exposures to nonfreezing cold or damp conditions.4<\/p>\n
Pernio occurs most frequently in late fall to early spring in wet or non-freezing cold environments. Acute pernio is characterized by intense itching, numbness, or a burning sensation that develops shortly after exposure to cold or damp conditions and disappears within a few weeks. Pernio is generally symmetrical. It usually involves the toes and fingers and less commonly the nose, ears, or cheeks. Pernio may also affect the thighs of horse riders, young women wearing tight slacks, motorcycle riders, or people who frequently apply ice packs. Pernio is associated with single or multiple erythematous, brownish or purple-blue skin lesions (macules, papules, or plaques) that may progress to blisters or ulcers. Chronic pernio develops after repeated cold exposure and results in cyanotic papules, macules, or nodules. Patients often report a history of similar episodes that develop each year during the cold months and typically resolve with warmer temperatures. The diagnosis is based on the history and physical examination. Patients generally have a normal arterial examination. Pulse volume recordings may reveal vasoconstriction, but capillaroscopy is usually normal. A skin biopsy may be necessary to differentiate pernio from other disorders, such as Raynaud phenomenon, frostbite, acrocyanosis, atheromatous embolization, erythema nodosum , erythema induratum , lupus erythematosus , sarcoidosis , or atherosclerosis . Laboratory testing is important to exclude an underlying collagen vascular disease. Up to 35 to 40% of patients may have cold agglutinins as a precipitating cause . Prevention Patients susceptible to pernio should be advised to avoid cold exposure. If they must go outside in cold or damp weather, they should dress appropriately with layered outdoor clothing, insulated footgear, gloves, scarf, and hat. Pernio is usually self-limiting in the acute state. Chronic pernio can lead to scarring, atrophy, and chronic occlusive vascular disease.4<\/p>\n
PROPOSED DIAGNOSTIC CRITERIA OF PERNIO<\/p>\n
MAJOR CRITERIA –<\/strong>Localized erythema and swelling involving acral sites and persisting for >24 hours 4<\/p>\n
MINOR CRITERIA – <\/strong>Onset and\/or worsening in cooler months (between November and March) Skin biopsy consistent with pernio (dermal edema with superficial and deep perivascular lymphocytic infiltrate) without findings of lupus erythematosus. Response to conservative treatments (warming and drying of affected areas). 4<\/strong><\/p>\n
FROSTBITE – <\/strong>Peripheral cold injuries include both freezing and nonfreezing injuries to tissue. Tissue freezes quickly when in contact with thermal conductors such as metal and volatile solutions. Other predisposing factors include constrictive clothing or boots, immobility, and vasoconstrictive medications. Frostbite occurs when the tissue temperature drops below 0\u00b0C (32\u00b0F). Ice-crystal formation subsequently distorts and destroys the cellular architecture. Once the vascular endothelium is damaged, stasis progresses rapidly to microvascular thrombosis. After the tissue thaws, there is progressive dermal ischemia. The microvasculature begins to collapse, arteriovenous shunting increases tissue pressures, and edema forms. Finally, thrombosis, ischemia, and superficial necrosis appear. The development of mummification and demarcation may take weeks to months. 3<\/p>\n
CLINICAL PRESENTATION The initial presentation of frostbite can be deceptively benign. The symptoms always include a sensory deficiency affecting light touch, pain, or temperature perception. The acral areas and distal extremities are the most common insensate areas. Some patients describe a clumsy or \u201cchunk of wood\u201d sensation in the extremity. Deep frostbitten tissue can appear waxy, mottled, yellow, or violaceous-white. Favorable presenting signs include some warmth or sensation with normal color. The injury is often superficial if the subcutaneous tissue is pliable or if the dermis can be rolled over bony prominences. Frostnip may precede frostbite. Frostnip is a nonfreezing cold injury resulting from intense vasoconstriction of exposed acral skin. Clinically, frostbite is superficial or deep. Superficial frostbite does not entail tissue loss but rather causes only anesthesia and erythema. The appearance of vesiculation surrounded by edema and erythema implies deeper involvement . Hemorrhagic vesicles reflect a serious injury to the microvasculature and indicate severe frostbite. Damages in subcuticular, muscular, or osseous tissues may result in amputation. An alternative classification establishes grades based on the location of presenting cyanosis; that is<\/p>\n
Grade 1, absence of cyanosis;<\/p>\n
+Grade 2, cyanosis on the distal phalanx;<\/p>\n
Grade 3, cyanosis up to the MP joint; and<\/p>\n
Grade 4 cyanosis proximal to the MP joint.<\/p>\n
The two most common nonfreezing peripheral cold injuries are chilblain (pernio) and immersion (trench) foot. Chilblain results from neuronal and endothelial damage induced by repetitive exposure to damp cold above the freezing point. Young females, particularly those with a history of Raynaud\u2019s phenomenon, are at greatest risk. Persistent vasospasticity and vasculitis can cause erythema, mild edema, and pruritus. Eventually plaques, blue nodules, and ulcerations develop. These lesions typically involve the dorsa of the hands and feet. In contrast, immersion foot results from repetitive exposure to wet cold above the freezing point. The feet initially appear cyanotic, cold, and edematous. \u00a0Frostbite with vesiculation, surrounded by edema and erythema. The subsequent development of bullae is often indistinguishable from frostbite. This vesiculation rapidly progresses to ulceration and liquefaction gangrene. Patients with milder cases report hyperhidrosis, cold sensitivity, and painful ambulation for many years. Treatment of peripheral cold injury – Management of the chilblain syndrome is usually supportive.<\/p>\n
\u00a0Asteatotic eczema<\/strong> This occurs in dry skin and is common in older adults. Low humidity caused by central heating, over-washing, diuretics and cholesterol lowering drugs predispose. The most common site is the lower legs, and a \u2018crazy paving\u2019 pattern of fine fissuring on an erythematous background is seen. Emollients are a mainstay, in combination with topical glucocorticoids. Patients must be advised to use caution with flammable emollients and to avoid bathroom slippages related to emollients on floor and feet, and this is particularly relevant for older individuals.2<\/p>\n
Asteatotic eczema, also known as xerotic eczema or \u201cwinter itch,\u201d is a mildly inflammatory dermatitis that develops in areas of extremely dry skin, especially during the dry winter months. Clinically, there may be considerable overlap with nummular eczema. This form of eczema accounts for many physician visits because of the associated pruritus. Fine cracks and scale, with or without erythema, characteristically develop in areas of dry skin, especially on the anterior surfaces of the lower extremities in elderly patients. Asteatotic eczema responds well to topical moisturizers and the avoidance of cutaneous irritants. Overbathing and the use of harsh soaps exacerbate asteatotic eczema.3<\/p>\n
Materia\u00a0 Medica Chronicle<\/u><\/strong><\/p>\n
The study are focused on \u00a0mentioned disorder in the table 01\u00a0 \u00a0and\u00a0 Continues observation of drug action on more than four years\u00a0 on the\u00a0 265 case\u00a0 details are given in table 02 \u00a0.<\/p>\n
Table 01<\/u><\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n Table 02<\/strong><\/p>\n\n\n\n Table 03<\/strong><\/p>\n\n\n\n\n\n Discussion<\/strong><\/p>\n Conclusion \u00a0<\/strong>– the potentized petroleum are having excellent\u00a0 effect on the skin disorder specially winter when intake of fluids is inadequate and exposure of cold environments are marked, with\u00a0\u00a0\u00a0 \u00a0whole body skin dry( Asteatotic eczema) and <\/strong>finger are swollen(peripheral cold injuries are chilblain (pernio) and immersion (trench) foot.) \u00a0. skin dryness with or without \u00a0itching\u00a0 during summer season under continua use of cooling appliances\u00a0 also controls by this remedy . for better results of this medicine is essential need of good hydration .<\/p>\n Reference<\/strong><\/p>\n Dr Puneet Kumar Misra<\/strong>S.No<\/td>\n Disorder<\/strong><\/td>\n Observation <\/strong><\/td>\n<\/tr>\n 01<\/td>\n Whole body itch with dryness in winter<\/td>\n Good response<\/td>\n<\/tr>\n 02<\/td>\n Itching & Burning \u00a0of lower extremities finger\u00a0 in winter<\/td>\n Marked response<\/td>\n<\/tr>\n 03<\/td>\n Swelling of lower extremities finger<\/td>\n Moderate effect<\/td>\n<\/tr>\n 04<\/td>\n Itching & Burning\u00a0 Both extremities finger are effected<\/td>\n Marked effect<\/td>\n<\/tr>\n 05<\/td>\n Crack in the finger hand or heel or both<\/td>\n Mild to moderate<\/td>\n<\/tr>\n 06<\/td>\n Vertigo with\u00a0\u00a0 finger Swelling in winter<\/td>\n Moderate<\/td>\n<\/tr>\n 07<\/td>\n Vertigo without\u00a0\u00a0 finger Swelling \u00a0and\u00a0 dry skin<\/td>\n No effect<\/td>\n<\/tr>\n 08<\/td>\n Gastric disorder with\u00a0\u00a0 finger and skin are effected<\/td>\n Mild to moderate<\/td>\n<\/tr>\n 09<\/td>\n Gastric disorder without dry skin and finger are effected<\/td>\n No effect<\/td>\n<\/tr>\n 10<\/td>\n Facial eruption with dryness in winter<\/td>\n Moderate effect<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \u00a0TOTEL CASE<\/td>\n 263<\/td>\n MALE<\/td>\n 189<\/td>\n FEMALE<\/td>\n 74<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Age group distribution in Years<\/td>\n<\/tr>\n Up to 10<\/td>\n 11-20<\/td>\n 21-30<\/td>\n 31-40<\/td>\n 41-50<\/td>\n 51-60<\/td>\n 61-70<\/td>\n 71 Above<\/td>\n<\/tr>\n 20<\/td>\n 67<\/td>\n 45<\/td>\n 38<\/td>\n 36<\/td>\n 22<\/td>\n 23<\/td>\n 13<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
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\nLecturer(Practice of Medicine)
\nGovt L B S H M C\u00a0 Prayagraj<\/p>\n","protected":false},"excerpt":{"rendered":"