Today I saw a woman with a painful toe. She said another doctor used to give her mupirocin, an antibiotic cream, for this recurring painful redness and swelling in one toe she believe suffered a frostbite years ago.
I looked at the toe. The skin was intact, but there was redness, tenderness and a little swelling. I didn’t think topical antibiotics would help that.
“Did the cream work?“ I asked.
“I don’t know, it went away in about a week most of the time but sometimes the toes next to it started to bother also“, she said.
I was sure her flareups resolved on their own and not because of the antibiotic cream she used. It just kept her busy while she waited them out.
Frostbite, recurring pain, inflammation. I have never been shown or diagnosed a case of chilblains before, but the word and the basic concept was in the back of my mind. I remember British people speaking about them. Lately, I have also read that Covid-19 can trigger chilblains.
As I often do, I minimized the EMR on my screen and did a search, this time on up-to-date. I showed her the pictures of toes with chilblains and she agreed with me that they looked like hers and the description of all the symptoms rang a bell with her, too.
The choice seems to be between powerful topical steroids for inflammation or systemic medications including nifedipine, which increases blood flow to cold fingers and toes but could also lower blood pressure. That side effect would be something she could ill afford.
We agreed on a strong topical steroid in ointment form for better penetration and she will let me know how it works for her.
One of the sources I looked up claims that 10% of Brits will experience chilblains in their lifetime. Sweden is colder than Great Britain but perhaps not as damp. I wonder why nobody bothered to tell me about this condition.
A Country Doctor Writes: 
My mother grew up in Northern Ireland and she talked about having chilblains as a child. I never saw them, but knew they were triggered in the cold. Of course, they had no central heating.