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Chronic chilblains are cold induced, painful or itching, red-blue lesions on the fingers, feet, ears, or thighs (fig⇓).1 The condition occurs throughout the world, more commonly in women than men. The average Dutch general practitioner reports four new cases a year (Continuous Morbidity Registration Nijmegen, The Netherlands; unpublished data). If patients consult a doctor at all, it will be their general practitioner.2

Symptoms usually start in early winter and vanish in spring, but often recur the next winter. Sometimes symptoms persist owing to continued exposure to cold, which is commonly associated with work conditions (cold storage work, for instance). Ulceration may also be …