Comparative study of testing the efficacy of topical clobetasol versus clobetasol plus glyceryl trinitrate (GTN) ointment for the symptomatic relief of chilblains
DOI:
https://doi.org/10.66344/jpad.v31i4.1882Abstract
Objective To test the efficacy of topical Clobetasol versus Clobetasol plus Glyceryl trinitrate (GTN) ointment for the symptomatic relief of chilblains.
Methods This study was conducted over a period of two months starting from 1st December 2020 till 31st January 2021 at the outpatient of Dermatology department at Punjab Rangers Teaching Hospital, Lahore. A total number of sixty patients who presented to skin OPD with chilblains were enrolled in the study and were divided into two groups. One group was taken as cases (40) and the other as controls (20). Cases were labeled group A and controls were labeled group B, both were tested for five variables i.e. pain, pruritus, edema, erythema and ulcerations. Both groups were advised application of the topical preparation after washing & drying the affected area twice daily. Group A was prescribed application of topical GTN along with clobetasol ointment, while group B was advised to apply clobetasol only. Both the groups were advised follow up to the OPD after two weeks to compare the effectiveness of each & were assessed for the improvement in all the five tested variables which were pain, pruritis, erythema, edema and ulceration.
Results On the first follow-up after regular application of the prescribed preparation for two weeks, it was noted that out of 40(100%) patients in group A, significant improvement was seen in 32(80%) in all the tested variables, whereas among 20(100%) patients of group B, 9(45%) reported improvement in pruritus, pain, erythema and edema.
Conclusion Glyceryl trinitrate when added with clobetasol has a better and rapid relief of symptoms as compared to when used alone.
References
1. Danzl, Daniel F. 2021. Nonfreezing Tissue Injuries. March. https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/nonfreezing-tissue-injuries?redirectid=2106&qt=Chilblains&alt=sh#sec21-ch319-ch319b-702.
2. Mohan, Swati. 2020. From symptoms to treatment all you need to know about chilblains. January 4. https://www.business-standard.com/article/health/from-symptoms-to-treatment-all-you-need-to-know-about-chilblains-120010400969_1.html.
3. Leo Francis Tauro, corresponding author Vittal V. Shindhe, P. Sathyamoorthy Aithala, John J. S. Martis, and H. Divakar Shenoy. 2011. Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure. Indian J Surg.2011;73(4):268–77.
4. P., Verma. Topical Nitroglycerine in Perniosis/Chilblains. Skinmed.2015;13(3): 176-7.
5. M. E. Anderson, T. L. Moore, S. Hollis, M. I. V. Jayson, T. A. King, A. L. Herrick. Digital vascular response to topical glyceryl trinitrate, as measured by laser Doppler imaging, in primary Raynaud's phenomenon and systemic sclerosis. Rheumatology.2002; 41(3):324-8.
6. Okafor, Amarachi. 2020. national organization of rare disorders. Accessed 2021. https://rarediseases.org/rare-diseases/perniosis/#:~:text=Perniosis%20is%20characterized%20by%20inflammation,as%20the%20body%20becomes%20warmer.
7. Michelle Pratt, Farhan Mahmood, Kirchhof. 2021. Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review. March 2. https://journals.sagepub.com/doi/full/10.1177/1203475421995130.
8. Akkurt ZM, Ucmak D, Yildiz K, Kutlu Yürüker S, Özkaya Celik H. Chilblains in Turkey:a case-control study. An Bras Dermatol.2014;89(1):44-50.
9. Newman, Tim. 2017. What you need to know about Raynaud's disease. December 19. https://www.medicalnewstoday.com/articles/176713.
10. Brannon, Heather L. 2013. Understanding How Topical Steroids Work. July 13. https://www.verywellhealth.com/how-topical-steroids-work-1068833.
11. Stewart, Michael. 2018. Glyceryl trinitrate rectal ointment (Rectogesic). October 11. https://patient.info/medicine/glyceryl-trinitrate-rectal-ointment-rectogesic.
12. Sergio Vano-Galvan, Antonio Martorell. 2012. Chilblains. CMAJ.2012;184(1):67.
13. Michele S Maroon, William D James. 2020. Pernio. February 20. https://emedicine.medscape.com/article/1087946-overview#a2.
14. Stewart, Michael. 2018. Glyceryl trinitrate rectal ointment (Rectogesic). October 11. https://patient.info/medicine/glyceryl-trinitrate-rectal-ointment-rectogesic.
15. Souwer, Ibo H. Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care. Br J Gen Pract.2017;67(656): e187–e193.
16. Rustin MH, Newton JA, Smith NP, Dowd PM. The treatment of chilblains with nifedipine: the results of a pilot study, a double-blind placebo-controlled randomized study and a long-term open trial. Br J Dermatol.1989;120(2):267-75.
17. Leo Francis Tauro, corresponding author Vittal V. Shindhe, P. Sathyamoorthy Aithala, John J. S. Martis, and H. Divakar Shenoy. 2011. Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure Indian J Surg.2011;73(4):268–77.
18. Verma, Prashant. Topical Nitroglycerine in Perniosis/ Chilblains. Skinmed.2015;13(3): 176-7.
19. Martin S. Kleckner, Edgar C. Allen, Khalil G. Wakim. The Effect of Local Application of Glyceryl Trinitrate on Raynaud's. Circulation.1951;3:681–689. https://www.ahajournals.org/doi/10.1161/01.CIR.3.5.681.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Nadia Sultan, Fatima Tariq, Asad Ali Chaudhary, Ansa Tariq, Saad Manzoor, Ghazala Butt

This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.






