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

Souwer, I.H.; Bor, Jacobus H J; Smits, Paul; Lagro-Janssen, Antoine L. M.

doi:10.1370/afm.1966

Cited by 28 publications

(25 citation statements)

References 25 publications

(42 reference statements)

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“…The prevalence of chilblain is difficult to estimate due in particular to the diagnostic difficulties. In the Netherlands, the prevalence varies between 0.9 per 1,000 and 1.7 per 1,000 as reported by the Netherlands Institute for Health Services Research (NIVEL) [24]. The condition is more common among women than men, with respective prevalences of 0.9 to 2.1 per 1,000 vs 0.6 per 1,000.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

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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%

“…This drug reduces relapses and is usually well tolerated. However, the efficacy of nifedipine is not confirmed by all studies and remains controversial [24]. Indeed, Souwer et al have recently performed a randomized controlled trial in 32 patients with chilblains.…”

Section: Managementmentioning

confidence: 99%

Chilblains

Nyssen

Benhadou

Magnée

et al. 2020

Vasa

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“…Pharmacological agents such as pethidine (Meperidine) [ 23 ] and other analgesics are used to effectively control labour pain [ 24 ]. In addition, the use of herbal medicine has been reported to relieve labour pain [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana

Aziato

Acheampong

Umoar

2017

BMC Pregnancy Childbirth

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BackgroundWomen have experienced severe labour pain over the years and various attempts have been made to effectively manage labour pain. However, there is paucity of literature on the labour pain experience and perceptions about labour pain with the contemporary Ghanaian health system. Therefore this study sought to gain an in-depth understanding on labour pain experiences and perceptions of post-partum women.MethodsThe study adopted an exploratory descriptive qualitative approach and collected data through individual interviews. Informed consent was obtained from all the participants who were purposively sampled. After transcription of interviews, the data were analyzed inductively using content analysis techniques.ResultsWomen in this study experienced pain during labour rated as mild, moderate and severe and the pain was felt at the waist area, vagina, lower abdomen and the general body. The women expressed labour pain through crying, screaming and shouting. They prayed to God to help reduce the severe pain. Some women endured the pain, cried inwardly and others showed no sign of pain. Some women believed that crying during labour is a sign of weakness. Pain reliefs such as pethidine (Meperidine) was occasionally given. Non-pharmacologic measures employed included walking around, deep breathing, side-lying, waist holding, squatting, taking a shower and chewing gum. The individuality of pain experience and expression was emphasized and the socio-cultural orientation of women made some of them stoic.ConclusionWe concluded that it is necessary for all health professionals to manage labour pain effectively taking the socio-cultural context into consideration.

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“…Oral nifedipine formulations have been investigated as a treatment for diabetic ulcers, peripheral vascular diseases (Rirash et al, 2017), wound healing and hypertrophic scars (Yamamoto et al, 2010;Santis et al, 2013), with moderate evidence of effectiveness. Such oral preparations are associated with secondary systemic effects such as low systemic blood pressure and edema, and have not shown better results than placebos when treating peripheral cold-related injuries such as chilblains (Souwer et al, 2016). Therefore, we decided to use a topical Vaseline R -based preparation of nifedipine at 10% concentration, which we considered a sufficient dosage to induce local vascular action while avoiding clinical systemic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Topical Nifedipine Administration for Secondary Prevention in Frostbitten Patients

2020

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Frostbite is a cold-related injury with a growing incidence among healthy subjects. Sequelae after frostbite are frequent and vary among individuals. Here, we studied the thermal response in the digits of hands and feet of five subjects who had recovered from previous frostbite, except for their lasting sequelae. We considered three different conditions: digits unaffected by frostbite nor sequelae (healthy), those affected but which did not suffer amputation (frostbitten without amputation), and the remainder/stumps of digits that underwent partial amputation (frostbitten with amputation). Three consecutive immersions in cold water (8 • C; 3 min) interspersed by 1 minute of thermal recovery were performed. After 30 min, a topical 10% nifedipine preparation was applied to hands and feet, and the same cold exposure protocol to evaluate its effect was followed. In basal condition and immediately after each immersion, the temperature of individual digits was assessed using thermography. We observed different thermal responses among the different digits of hands and feet, even without the nifedipine treatment. Nifedipine had a cooling effect on healthy and post-amputated tissue without thermal stress. In cold conditions, topic nifedipine application improved the cold response in healthy fingers but had a negative effect on those from which parts had been amputated. The topical nifedipine had detrimental effects on toes in all conditions. Topical nifedipine can help to the preservation of healthy fingers exposed to cold, with adequate thermal insulation; but it is necessary to remark its potentially harmful effects on previously frostbitten tissue. Because of the differences observed on individual regional response to cold, thermography can be a useful tool in the frostbite prevention for subjects habitually exposed to cold environment.

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

Cited by 28 publications

References 25 publications

Chilblains

Chilblains

Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana

Topical Nifedipine Administration for Secondary Prevention in Frostbitten Patients

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