Dawaa Reference

Clinical reference

Chilblains (Perniosis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

DermNet NZ: Chilblains · Valni 20 Retard (nifedipine) SmPC sections 4.1, 4.2, 4.3 (eMC product 11473) · Betnovate Cream SmPC section 4.2 (eMC product 929) · Betamethasone Valerate 0.1%w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 102491)

Verified against5 documents
  • DermNet NZ: Chilblains
  • Valni 20 Retard (nifedipine) SmPC sections 4.1, 4.2, 4.3 (eMC product 11473)
  • Betnovate Cream SmPC section 4.2 (eMC product 929)
  • Betamethasone Valerate 0.1%w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 102491)
  • Pernio - disease-level clinical article (chilblains-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

  • Burning, tenderness or itching are commonly reported, and lesions can blister or ulcerate [blisters · itching]
  • Nail changes have been reported after prolonged exposure to cold, damp conditions [nail changes]

Signs — what you find (3)

  • Multiple symmetric red-blue macules, papules or nodules appear on the toes or fingers of both hands or feet after cold, damp exposure [papules]
  • Lesions typically show up within 24 hours of cold exposure and clear within a few weeks
  • Blistered or ulcerated lesions carry a risk of secondary bacterial infection through the broken skin

Tests (3)

  • Skin biopsy is often unhelpful and nonspecific overall, but seeing a lymphocytic infiltrate together with dermal edema and dying keratinocytes can back up the diagnosis
  • Initial workup can include a complete blood count, ANA and serum protein electrophoresis
  • Serum cryoglobulin testing is only rarely relevant and is usually added after the initial workup rather than upfront

If not this — what else fits (5)

  • Chilblain lupus erythematosus, a key mimic, has familial forms linked to TREX1, SAMHD1 or STING mutations
  • Raynaud phenomenon is a vasospastic mimic to consider
  • Acrocyanosis is a vasospastic mimic to consider
  • Cryoglobulinemia is a mimic to consider
  • Cold panniculitis is a mimic to consider

SourceStatPearls "Pernio" - disease-level clinical article

Presentation findings are traced to the source above.

1

NIFEDIPINE

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg twice daily of a modified-release (retard/SR) preparation, titrating up to 60 mg daily in divided doses if needed - Through the cold season for recurrent or severe chilblains; reassess need the following winter

Paediatric dose

Chilblains in children are usually managed conservatively; seek specialist advice before starting nifedipine in a child

Dose source

DermNet NZ: Chilblains

Why

Reserved for recurrent, persistent, or severe chilblains not settling with rewarming and protective measures alone; evidence is mixed (see caution) so this is a discussion with the patient, not an automatic step.

Cautions
  • Evidence for benefit is mixed - an earlier placebo-controlled and open trial supported faster healing and fewer new lesions, but a 2016 randomized controlled trial did not confirm benefit.
  • Emphasize conservative measures alongside or before drug therapy: keep extremities warm and dry, avoid abrupt cold exposure, protective clothing, smoking cessation.
  • Contraindicated in significant hypotension, cardiogenic shock, and severe aortic stenosis; common side effects include flushing, headache, and ankle oedema.
  • Exclude an underlying cause (chilblain lupus erythematosus, other connective tissue disease) if lesions are atypical, persist into summer, or occur with systemic symptoms - refer to rheumatology if suspected.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPILAT RETARD 20MG SR. 20 F.C.TAB.EIPICO22.00 EGP (1.10/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Pernio - disease-level clinical article (chilblains-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Workup or referral is needed to evaluate for chilblain lupus erythematosus (CHLE) and systemic lupus erythematosus (SLE) in pernio presentation.
3

BETAMETHASONE

add-on - not a substitute

Formtopical

Adult dose and duration

Apply 0.1% cream/ointment thinly twice daily to affected areas for itch and inflammation - Short courses during active flares; stop once itch and inflammation settle

Paediatric dose

Short, thin-layer courses only if used in a child; this is a potent topical steroid

Dose source

Betamethasone Valerate 0.1%w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 102491)

Why

Adjunct for itch and inflammation of active lesions; does not replace rewarming, protective measures, or nifedipine for recurrent disease

Cautions
  • Potent topical steroid - short courses only; avoid prolonged continuous use because of skin atrophy risk.
  • Do not apply to broken or ulcerated skin.
Egyptian brands
Egyptian brandManufacturerIndicative price
CRONOMESONE 0.1% CREAM 15 GMPHAROPHARMA4.00 EGP
CRONOMESONE 0.1% OINT. 15 GMPHAROPHARMA4.00 EGP
BETNOVATE 0.1% TOP. OINT. 15 GMSMITHKLINE BEECHAM > GLAXO SMITHKLINE6.90 EGP
BETADERM 0.1% CREAM 15 GMEIPICO18.00 EGP
BETAVAL 0.1% CREAM 20 GMARAB DRUG COMPANY (ADCO)20.00 EGP
BETADERM 0.1% CREAM 30 GMEIPICO23.00 EGP
BETAMETHASONE DIPROPIONATE 0.05% CREAM 20 GMAMRIYA11.50 EGP
BETAMETHASONE DIPROPIONATE 0.05% OINT. 20 GMAMRIYA11.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.