# Chilblains (Perniosis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Nifedipine — 20 mg — oral.solid - Referral & safety-netting (no drug therapy) - Betamethasone — topical ## Complete treatment card ```text CHILBLAINS (PERNIOSIS) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Pernio" - disease-level clinical article Status traced to the source above 1. NIFEDIPINE [1st line] Adult 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 Peds Chilblains in children are usually managed conservatively; seek specialist advice before starting nifedipine in a child 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. Caution 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. Egypt EPILAT RETARD 20MG SR. 20 F.C.TAB. EIPICO 22.00 EGP (1.10/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult 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 Peds Short, thin-layer courses only if used in a child; this is a potent topical steroid 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 Caution Potent topical steroid - short courses only; avoid prolonged continuous use because of skin atrophy risk. Do not apply to broken or ulcerated skin. Egypt CRONOMESONE 0.1% CREAM 15 GM PHAROPHARMA 4.00 EGP CRONOMESONE 0.1% OINT. 15 GM PHAROPHARMA 4.00 EGP BETNOVATE 0.1% TOP. OINT. 15 GM SMITHKLINE BE... 6.90 EGP BETADERM 0.1% CREAM 15 GM EIPICO 18.00 EGP BETAVAL 0.1% CREAM 20 GM ARAB DRUG COM... 20.00 EGP BETADERM 0.1% CREAM 30 GM EIPICO 23.00 EGP BETAMETHASONE DIPROPIONATE 0.05% CREAM 20 GM AMRIYA 11.50 EGP BETAMETHASONE DIPROPIONATE 0.05% OINT. 20 GM AMRIYA 11.50 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)