Intended for healthcare professionals



BMJ 2011; 342 doi: (Published 25 May 2011) Cite this as: BMJ 2011;342:d3170
  1. Manju Paul, teaching fellow1,
  2. Maulina Sharma, specialist registrar1,
  3. Sheelagh Littlewood, consultant 1,
  4. Iain Leach, consultant2
  1. 1Department of Dermatology, Queen’s Medical Centre, Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, UK
  2. 2Department of Histopathology, Queen’s Medical Centre, Nottingham University Hospital NHS Trust
  1. manjupaul{at}

A 20 year old woman horse rider presented with painful lesions on her outer thighs in the winter months for five years. Examination showed bilateral symmetrical erythematous indurated tender plaques on the lateral aspects of her thighs. Blood investigations, including a vasculitis screen, serum cryoglobulins, and cold agglutinins, were normal. Skin biopsy from the affected area showed features of perniosis with lymphocytic vasculitis. Equestrian perniosis occurs in female horse riders, affecting their buttocks or lateral thighs, with worsening symptoms in cold weather. Wearing warm loose clothes, avoidance of cold, and use of oral nifedipine or pentoxyfylline may be helpful.


Cite this as: BMJ 2011;342:d3170


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