Chilblains — SCE Dermatology MCQ

Correct answer: C — Keep extremities warm with insulation and gradual rewarming

The correct answer is C, keep extremities warm with insulation and gradual rewarming. Idiopathic chilblains (perniosis) result from an exaggerated vasoconstrictive response to cold followed by rapid rewarming, producing localised inflammation in the digits. Since there is no underlying connective tissue disease, first-line management is conservative: protecting the feet and hands from cold with insulated footwear and gloves, avoiding abrupt temperature changes, and gradual rewarming rather than direct heat exposure, alongside smoking cessation to improve peripheral circulation. Most lesions resolve spontaneously within one to three weeks once further cold injury is prevented, so pharmacological treatment is reserved for cases that are severe, recurrent, or fail to settle with these measures. Why the other options are wrong: A. Intravenous prostacyclin: reserved for severe digital ischaemia or critical vasospasm unresponsive to oral therapy, such as in severe Raynaud phenomenon with ulceration, and is disproportionate for uncomplicated idiopathic chilblains. E. Oral Prednisolone: systemic corticosteroids are not part of standard chilblains management and are not supported by evidence for this self-limiting condition; they would only be considered if an underlying inflammatory or connective tissue process such as chilblain lupus were confirmed. B. Topical antifungal: chilblains are a vascular, not fungal, disorder, so antifungal treatment has no mechanistic rationale and does not address the cold-induced vasospasm. D. Oral Nifedipine: a recognised second-line option for frequent, severe, or persistent chilblains once cold-avoidance measures have failed, but it is not the recommended initial step. Key point: uncomplicated chilblains are managed first with cold avoidance, insulation, and gradual rewarming, reserving nifedipine for severe or refractory disease.

Reference: NHS inform (NHS Scotland), Chilblains: Treatment (reflecting NICE CKS guidance), https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/chilblains