{ "schema_version": 1, "kind": "condition", "id": "chilblains", "name": "Chilblains (Perniosis)", "category": "chronic", "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", "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)", "verified_date": "2026-08", "treatments": [ { "id": 396, "generic": "Nifedipine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg twice daily of a modified-release (retard/SR) preparation, titrating up to 60 mg daily in divided doses if needed", "adult_duration": "Through the cold season for recurrent or severe chilblains; reassess need the following winter", "dose_source": "DermNet NZ: Chilblains", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Chilblains in children are usually managed conservatively; seek specialist advice before starting nifedipine in a child", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "EPILAT RETARD 20MG SR. 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "chilblains" }, { "id": 398, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Pernio - disease-level clinical article (chilblains-clinical.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "chilblains" }, { "id": 397, "generic": "Betamethasone", "line": 1, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "Apply 0.1% cream/ointment thinly twice daily to affected areas for itch and inflammation", "adult_duration": "Short courses during active flares; stop once itch and inflammation settle", "dose_source": "Betamethasone Valerate 0.1%w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 102491)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Short, thin-layer courses only if used in a child; this is a potent topical steroid", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CRONOMESONE 0.1% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CRONOMESONE 0.1% OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETNOVATE 0.1% TOP. OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SMITHKLINE BEECHAM > GLAXO SMITHKLINE", "price_egp": 6.9, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETADERM 0.1% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETAVAL 0.1% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETADERM 0.1% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETAMETHASONE DIPROPIONATE 0.05% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 11.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETAMETHASONE DIPROPIONATE 0.05% OINT. 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 11.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "chilblains" } ] }