06/02/2020    Ellen M Anderson, DPM

Chilblains Protocol

If you are considering chilblains (pernio) in
your differential diagnosis of COVID toe, I have
a protocol that I use with success. It was
presented at a seminar in Maine a number of years
ago, lecturer unknown. I see several new cases a
year, primarily in November and March, as well as
patients that are maintained with a prevention
protocol.

The protocol depends on how involved the reaction
is. It is self-limiting. For simple red blotches,
wash affected areas of feet twice daily with
benzoyl peroxide wash. Dry toes gently. Apply
“kitchen powder” (1/2 corn starch to ½ baking
soda.) If the reaction has advanced to crust like
lesions, wash the area as before, gently dry,
apply topical benzoyl peroxide/erythromycin gel
or solution, allow to dry before applying the
“kitchen” powder. If the skin has started to
break down, a course of oral erythromycin is
added to the regime.

For some patients who have a severe reaction or a
recurrent problem, oral pentoxifylline (Trental)
can be added. I had one patient for whom I
prescribed it from November to March
prophylactically. Nefedipine (Procardia) has been
suggested in some cases. However, I personally
leave that one up to the patient’s primary care
provider.

A big part of the protocol involves prevention.
It focuses on keeping the patient’s feet dry and
warm. A two layer sock system is recommended,
preferably natural fibers. One lightweight liner
sock, one heavier outer sock. Change them
several times a day if the feet get damp. Wear
warm boots outside ALL winter regardless of snow
cover. Wear warm shoes or slippers at ALL times
in the house. (This is important if the
patient’s house is on a cement slab, is a mobile
home or doesn’t have a cellar) DO NOT go
barefoot. DO NOT smoke. The issue of increased
perspiration also needs to be address whether it
is directly due to choice of shoe gear or
symptomatic hyperhidrosis.

It will be interesting to see if the number of
cases go down now the weather is warmer. COVID-
19 is certainly wreaking havoc on people’s immune
systems. It will be interesting to see what is
learned as more data is collected. Are people who
test positive for COVID-19 more susceptible?
However, on a final note, I must add (warn?) that
getting some of my patients to wear warm
practical boots during the winter might rate
right up there with trying to get some of them to
wear a mask!

Ellen M Anderson, DPM, Dover-Foxcroft, ME

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