Dawaa Reference

chronic

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.