What is the treatment for chilblains (pernio)?

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From the Research

Chilblains can be treated effectively with a combination of home remedies and medications, with nifedipine and pentoxifylline being supported by moderate evidence for severe or refractory cases, as shown in a systematic review 1. To treat chilblains, first warm the affected area gradually using lukewarm (not hot) water or by applying warm clothing.

  • Apply a topical corticosteroid cream like hydrocortisone 1% to reduce inflammation and itching, applying a thin layer to affected areas 1-2 times daily for up to two weeks.
  • Nifedipine, a calcium channel blocker, may be prescribed at 20-60mg daily in severe cases to improve circulation, although its effectiveness is not confirmed by all studies 2, 3.
  • Keep the affected areas clean, dry, and protected with loose, warm clothing and avoid scratching to prevent infection.
  • For pain relief, take over-the-counter medications like acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours). Prevention is crucial - keep extremities warm in cold weather, avoid tight footwear, and stop smoking as it constricts blood vessels. Chilblains occur when small blood vessels in the skin become inflamed due to abnormal response to cold, causing redness, swelling, and itching, so these treatments aim to improve circulation and reduce inflammation in the affected areas. The most recent and highest quality study, a systematic review from 2021 1, supports the use of nifedipine and pentoxifylline in severe or refractory cases, while other therapies have inadequate evidence or nonsignificant results compared to placebo. It is essential to note that the effectiveness of nifedipine is not universally confirmed, with some studies showing no significant difference compared to placebo 2. However, given the potential benefits and the lack of strong evidence for alternative treatments, nifedipine and pentoxifylline remain viable options for the treatment of chilblains, particularly in severe or refractory cases.

References

Research

Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review.

Journal of cutaneous medicine and surgery, 2021

Research

Chilblains.

VASA. Zeitschrift fur Gefasskrankheiten, 2020

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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