A 30-year-old woman from Himachal Pradesh develops painful, dusky violaceous papules and plaques on her toes and ear helices each winter. Lesions ulcerate superficially and heal with scarring. Antinuclear antibody is positive at low titre and cryoglobulins are negative. The lesions persist into spring. The most likely diagnosis is:

• A Idiopathic chilblains (perniosis)
• B Chilblain lupus erythematosus ✓
• C Raynaud disease with digital ischaemia
• D Erythema induratum of Bazin

Explanation

Chilblain lupus erythematosus presents as cold-induced acral violaceous papules and plaques that, unlike idiopathic perniosis, tend to be persistent, recur beyond the cold season, heal with scarring, and are associated with positive antinuclear antibodies. A significant proportion progress to meet criteria for systemic lupus erythematosus. Erythema induratum occurs on the calves, is associated with tuberculosis, and shows lobular vasculitic panniculitis on biopsy.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.