BMJ 2011: 343: 1 – 50 (2nd July)

Chronic chilblains

1. Check they actually are chilblains.  Raynaud’s syndrome is often misreported as chilblains, so take a history.  The diabetic foot, or PVD, can also be misreported/misdiagnosed as chilblains.  Check peripheral pulses.

2. This is, apparently, and with all due apologies to Dr House, a situation where it is sometimes lupus.  Chilblains persisting/commencing in the summer months can be a sign of SLE or other connective tissue diseases.  So, ask about all those other symptoms of connective tissue diseases that I can never remember – rash and arthralgia/arthritis (which I did remember), photosensitivity (which I should have but didn’t), and oral ulcers, seizures, and psychotic symptoms (which I’d never have thought to link to CT disease).  If suspicious, check ANA – other tests are not usually helpful.

3. Treatment.  There is not a huge amount of evidence available on best treatment, but, based on one extremely small RCT, 60 mg Nifedipine daily seems to be of benefit.  I’d never heard of Vitamin D as a treatment, but apparently it doesn’t work anyway so that doesn’t matter.

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About Dr Sarah

I'm a GP with a husband and two young children.
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