Chronic chilblains

Souwer, I.H.; Lagro-Janssen, A.L.M.

doi:10.1136/bmj.d2708

Cited by 14 publications

(11 citation statements)

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“…They usually resolve spontaneously in one to three weeks [8] but sometimes it can take longer [7]. Patients may develop recurrences during subsequent winters or persistent disease [9]. Chilblain could be associated with another idiopathic acrosyndrome like acrocyanosis or Raynaud's phenomenon [10].…”

Section: Definition and Epidemiologymentioning

confidence: 99%

Chilblains

Nyssen

Benhadou

Magnée

et al. 2020

Vasa

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Summary: Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. It usually resolves spontaneously. The etiology is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases. In histology, dermal edema and an inflammatory infiltrate are usually present. A distribution of the infiltrate particularly around the eccrine gland is typical. Systemic symptoms and underlying autoimmune disease should be screened. Avoiding cold and keeping extremities warm is the first recommendation for management, as well as smoking cessation. Calcium channel blockers (in particular nifedipine) seems to be the treatment that has been most evaluated in chilblains. However, their effectiveness is not confirmed by all studies. Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials. Other treatments, such as pentoxifylline, hydrochloroquine and topical nitroglycerin have shown positive effects only in a reduced number of patients. Acupuncture seems to bring a benefit.

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Section: Definition and Epidemiologymentioning

confidence: 99%

Chilblains

Nyssen

Benhadou

Magnée

et al. 2020

Vasa

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“…The diagnosis (International Classification of Primary Care [ICPC] A88.01) was confirmed by one author, based on commonly used diagnostic criteria: complaints emerging in the winter months with itching and/or painful purpleblue discoloured lesions on fingers and/ or toes and/or other localisations on the feet and/or on the lateral side of the thigh, without a history of complaints persisting in the summer months. 1,7 The validity of the confirmation of the diagnosis had previously been demonstrated. 5 The authors excluded people with a known rheumatic disorder (for example, rheumatoid arthritis or systemic lupus erythematosus), those who were using nifedipine or other calcium antagonist, those who had been using a corticosteroidcontaining cream in the previous 4 weeks, and females who were pregnant or lactating.…”

Section: Introductionmentioning

confidence: 99%

“…The ambient temperature was taken into account as a major confounder. 1,3,15,16 The calculated sample size was met. Participant compliance was good.…”

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confidence: 99%

Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care

Souwer

Bor²,

Smits³

et al. 2017

Br J Gen Pract

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BackgroundGPs prescribe topical corticosteroids to patients with chronic chilblains despite poor evidence for their effectiveness. The authors of the current study therefore decided to assess the effectiveness of topical steroids in a primary care setting.AimTo assess the effectiveness of topical application of betamethasone valerate 0.1% cream in patients with chronic chilblains.Design and settingA placebo-controlled, double-blind, crossover, randomised clinical trial in a Dutch primary care setting.MethodThe study population consisted of 34 participants suffering from chronic chilblains. Intervention was topical application of betamethasone valerate 0.1% cream twice a day for 6 weeks compared with placebo. Primary outcome was the visual analogue scale on complaints (VOC). Secondary outcome was the visual analogue scale on disability (VOD). Both were assessed with a diary of daily scores on a 100 mm visual analogue scale. The authors took ambient temperatures into account, checked for a carry-over effect, performed additional analysis, and monitored adverse effects.ResultsOn the primary outcome mean VOC, there was a difference of 0.56 mm (95% confidence interval [CI] = −2.88 to 3.99 mm) in favour of placebo (P = 0.744). On the secondary outcome mean VOD, there was a difference of 0.88 mm (95% CI = −2.22 to 3.98 mm) in favour of placebo (P = 0.567). This study found no carry-over effect and no adverse effects.ConclusionIn this study, topical betamethasone was not superior to placebo in the treatment of chronic chilblains. Topical betamethasone should not be used for chronic chilblains without new evidence.

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“…based on commonly used diagnostic criteria: symptoms emerging in the winter months with itching and/or painful purpleblue discolored lesions in any of several locations (fingers, toes, feet, or lateral thigh) without a history of persistence into the summer months. 1,9 Swelling and ulceration, and reporting of earlier episodes in previous winters could also be present but were not mandatory for diagnosis. The validity of diagnosis by this author has previously been demonstrated.…”

Section: Participantsmentioning

confidence: 99%

“…The condition occurs throughout the world during the winter months when daily mean temperatures drop below the range of 12 o C to 15 o C. 1 The prevalence in the Netherlands as reported by the Netherlands Institute for Health Services Research (NIVEL) varies between 0.9 per 1,000 and 1.7 per 1,000 depending on year-to-year variation and coding issues. The condition is more common among women than men, with respective prevalences of 0.9 to 2.1 per 1,000 vs 0.6 to 1.2 per 1,000 (written information provided by NIVEL).…”

Section: Introductionmentioning

confidence: 99%

Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial

Souwer

Bor

Smits

et al. 2016

The Annals of Family Medicine

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PURPOSE Nifedipine is commonly prescribed for the treatment of chilblains (pernio, perniosis) on the basis of observational studies and a single small, older clinical trial. We aimed to confirm the proposed superiority of oral nifedipine 60 mg per day over placebo for treatment of chronic chilblains in primary care. METHODSWe performed a randomized, placebo-controlled, double-blind, crossover trial, closely following the design of the older trial. A total of 32 patients with chronic chilblains were randomly assigned to nifedipine (30 mg controlled release twice a day) or placebo. The primary outcome was patient-reported complaints; the secondary outcome was patient-reported disability. Both were assessed from daily ratings on 100-mm visual analogue scales recorded in a diary. We took ambient temperatures into account and checked for a carry-over effect, and monitored for adverse effects.RESULTS After 6 weeks of treatment, mean scores on the visual analogue scale on complaints showed a nonsignificant difference of 1.84 mm (95% CI, -6.67 to 2.99 mm) in favor of nifedipine (P = .44). Mean scores on the visual analogue scale on disability showed a nonsignificant difference of 0.56 mm (95% CI, -2.97 to 4.09 mm) in favor of placebo (P = .75). There was no carry-over effect of prior study treatment. Nifedipine was associated with significantly lower systolic blood pressure and a significantly higher incidence of edema.CONCLUSIONS In our study, nifedipine was not superior to placebo for treating chronic chilblains. These findings contrast with those of the older study and do not support routine use of nifedipine for this condition. 2016;14:453-459. doi: 10.1370/afm.1966. Ann Fam Med INTRODUCTIONC hilblains (pernio, perniosis) are cold-induced, painful or itching lesions on the fingers, feet, ears, or thighs. The condition occurs throughout the world during the winter months when daily mean temperatures drop below the range of 12 o C to 15 o C. 1 The prevalence in the Netherlands as reported by the Netherlands Institute for Health Services Research (NIVEL) varies between 0.9 per 1,000 and 1.7 per 1,000 depending on year-to-year variation and coding issues. The condition is more common among women than men, with respective prevalences of 0.9 to 2.1 per 1,000 vs 0.6 to 1.2 per 1,000 (written information provided by NIVEL).Patients with chilblains report serious restrictions in daily life and feel an urgent need for effective treatment.2 A review of the literature through March 15, 2016 revealed evidence that vitamin D 3 , corticosteroidcontaining cream, nifedipine, and pentoxyfylline, among a wide range of other therapies, are used to treat symptoms of chronic chilblains. 3,4 In an earlier study, we found that vitamin D 3 was not superior to placebo, however.5 Five studies evaluating the effectiveness of nifedipine in patients with chilblains have been published and have concluded that the drug is an effective treatment. These studies included only 1 randomized controlled trial, having 10 patients and conducted in ...

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Chronic chilblains

Cited by 14 publications

References 2 publications

Chilblains

Chilblains

Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care

Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial

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