From the Guidelines
For chilblains pain management, a multidisciplinary approach is recommended, starting with gentle warming and moisturizing of the affected area, and using over-the-counter pain relievers like acetaminophen or ibuprofen to reduce pain and inflammation. The goal of treatment is to improve circulation and reduce the inflammatory response, which is crucial in managing chilblains [ 1 ].
When managing pain, it is essential to consider the type of pain, whether it is nociceptive, stimulant-dependent, or neuropathic, and to take into account any psychologic comorbidities [ 1 ]. For acute pain, topical analgesics such as lidocaine, oral acetaminophen, and oral nonsteroidal anti-inflammatory drugs are preferred [ 1 ].
Some key points to consider in chilblains pain management include:
- Gentle warming of the affected area by soaking in lukewarm water for 15-20 minutes
- Applying moisturizing lotions containing lanolin or petroleum jelly to prevent skin dryness
- Using over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to reduce pain and inflammation
- Avoiding scratching, direct heat sources, and tight footwear
- Elevating affected extremities when possible
- Keeping extremities warm with proper insulation in cold weather, avoiding rapid temperature changes, and quitting smoking to improve circulation [ 1 ].
It is also important to note that if symptoms persist beyond 2-3 weeks, worsen, or if open sores or signs of infection develop, medical attention should be sought, as prescription medications like nifedipine or stronger topical steroids might be needed [ 1 ].
From the Research
Pain Management for Chilblains
- Chilblains, also known as pernio, is a localized inflammatory lesion of the skin resulting from an abnormal response to cold 2.
- The condition is characterized by intense pain, itching, or burning, and can be acute or chronic 2.
Treatment Options
- Nifedipine, a calcium channel blocker, is commonly prescribed for the treatment of chilblains, but its effectiveness is not confirmed by all studies 3, 4, 5.
- A randomized controlled trial found that nifedipine was not superior to placebo for treating chronic chilblains 3.
- However, other studies suggest that nifedipine can be effective in reducing pain and facilitating healing, especially in severe or refractory cases 2, 6, 4.
- Other treatment options, such as pentoxifylline, tadalafil, topical glyceryl trinitrate, and vitamin D, have shown promise, but more research is needed to confirm their effectiveness 4, 5.
- Topical betamethasone is often used, but its effect has not been confirmed by randomized clinical trials 5.
- Acupuncture may also bring benefits, but more research is needed to confirm its effectiveness 5.
Management Strategies
- Avoiding cold and keeping extremities warm is the first recommendation for management 5.
- Smoking cessation is also recommended, as smoking can exacerbate the condition 5.
- Symptomatic treatment, with or without medication, can help alleviate symptoms 2.
- Prevention is the best form of therapy, and cold exposure should be minimized after an initial insult 2.