Discolored, Painful Toes in a 43-Year-Old Woman

Colin C. Edgerton, MD

Disclosures

September 03, 2015

The treatment of primary chilblains includes both conservative and pharmacologic measures. Conservative measures include avoidance of cold temperatures; use of warm clothing; and avoidance of vasoconstrictive agents, including nicotine, caffeine, and ephedra-containing substances (such as decongestants and diet aids).

Maintenance of core body temperature should be emphasized, along with protection of the extremities, because a threat to core body temperature will induce peripheral vasoconstriction despite adequate peripheral insulation. The use of layered clothing on the trunk and moisture-wicking socks and gloves can be helpful.

Nifedipine (Procardia®) has demonstrated efficacy in the treatment of chilblains, a benefit thought related to its vasodilatory properties.[8] At dosages of 20-60 mg daily, nifedipine reduced existing lesions and prevented new lesions from developing. Clinical improvement with nifedipine was accompanied by reduced dermal edema and perivascular infiltrates on follow-up skin biopsy, as well as increased blood flow to the affected area. Few data support the use of other vasodilators for the treatment of chilblains.

One study comparing diltiazem (Cardizem®) with nifedipine for the treatment of chilblains concluded that diltiazem had poor efficacy at standard doses.[9]

Treatment of secondary chilblains includes these measures, in addition to specific treatment of the associated condition (ie, appropriate pharmacologic therapy for systemic lupus erythematosus, discontinuation of a suspected offending pharmaceutical agent, or initiation of chemotherapy for leukemia).

The patient in this case was counseled regarding conservative treatment measures, such as avoiding cold and wearing warm clothing. Treatment with low-dose, extended-release nifedipine (30 mg once daily) was initiated. The lesions resolved completely within 1 month of therapy, and nifedipine was discontinued after 3 months of disease-free therapy. The lesions did not recur, which was in keeping with the generally excellent prognosis for properly treated primary chilblains.

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