Antichilblain Components in Eggplant Based on Network Pharmacology and Biological Evaluation.

Eggplant, the fruit of Solanum melongena L. (Solanaceae), is applied externally to relieve the symptoms of chilblains in the folk in East Asia. However, the mechanisms and biological ingredients are not clear. A network pharmacology approach was used to shed light on the mechanisms of eggplant against chilblains, which illustrated that anti-inflammation and antioxidation are mainly involved in the curative effects. Bioassay-guided assays led to the isolation of 44 ingredients (1-44), including two new natural compounds (1-2) and 42 known compounds. Thirteen compounds (3-15) were first reported from the Solanum genus. The anti-inflammatory and antioxidative effects of all isolates were evaluated, and the results showed that 11 compounds have anti-inflammatory activity and 27 have antioxidant activity. Fatty acids, flavonoids, alkaloids, phenolic acids, saponins, and lignans from eggplant have certain anti-inflammatory and antioxidant effects. These results provide a scientific basis for eggplant to treat chilblains.

New use of old medicine: Nifedipine acts on the TRP family and inflammatory proteins in the treatment of chilblain.

As a calcium antagonist, the mechanism of nifedipine for treating chilblain has not been reported. In the present study, we established the chilblain model by using -20 ℃ 95% ethanol to freeze the right back foot of SD rats, and investigated the effects of this drug. Hematoxylin-eosin (HE) examination indicated most of pannus in the skin tissue of chilblain rats had disappeared, and the local inflammatory cells were also greatly reduced when given nifedipine at 15.0 mg/kg/d. The enzyme-linked immunosorbent assay (ELISA) revealed that nifedipine inhibited release of inflammatory factors TNF-α, IL-6, IL-1ß and VEGF in serum. The RT-PCR analysis showed that nifedipine down regulated mRNA levels of TRPC-6 and VEGF in skin tissue. Furthermore, immunohistochemical examination showed nifedipine inhibited expression of IL-1ß, IL-6, and TNF-α inflammatory protein and further inhibited expression of TRP (transient receptor potential) family proteins TRPM-7, TRPC-1, TRPC-3 and TRPC-6 and reduced expression of VEGF in skin and relieved erythema and oedema. This study demonstrated that nifedipine as an old medicine can be new use for the treatment of chilblain by acting on TRPs family and inflammatory proteins.

Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review.

Idiopathic chilblains is a cold-induced inflammatory condition that causes significant morbidity. When preventative measures alone are inadequate, oral nifedipine is generally recommended as first-line pharmacologic therapy. Given the natural course of this spontaneously remitting/relapsing condition, controls are needed to critically appraise studies and determine the value of treatments. We report a systematic review of placebo-controlled or comparative therapeutic trials for the treatment of idiopathic chilblains. Our search of PubMed, Embase, and Cochrane databases, identified 11 studies that met our inclusion criteria for a combined study population n = 576. Therapies included nifedipine, pentoxifylline, tadalafil, topical glyceryl trinitrate (GTN), topical minoxidil, diltiazem, corticosteroids, and vitamin D. There was moderate evidence to support the use of nifedipine and pentoxifylline in the treatment of severe or refractory cases of idiopathic chilblains, while other therapies had inadequate evidence or nonsignificant results compared to placebo.

Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial.

PURPOSE: Nifedipine is commonly prescribed for the treatment of chilblains (pernio, perniosis) on the basis of observational studies and a single small, older clinical trial. We aimed to confirm the proposed superiority of oral nifedipine 60 mg per day over placebo for treatment of chronic chilblains in primary care. METHODS: We performed a randomized, placebo-controlled, double-blind, crossover trial, closely following the design of the older trial. A total of 32 patients with chronic chilblains were randomly assigned to nifedipine (30 mg controlled release twice a day) or placebo. The primary outcome was patient-reported complaints; the secondary outcome was patient-reported disability. Both were assessed from daily ratings on 100-mm visual analogue scales recorded in a diary. We took ambient temperatures into account and checked for a carry-over effect, and monitored for adverse effects. RESULTS: After 6 weeks of treatment, mean scores on the visual analogue scale on complaints showed a nonsignificant difference of 1.84 mm (95% CI, -6.67 to 2.99 mm) in favor of nifedipine (P = .44). Mean scores on the visual analogue scale on disability showed a nonsignificant difference of 0.56 mm (95% CI, -2.97 to 4.09 mm) in favor of placebo (P = .75). There was no carry-over effect of prior study treatment. Nifedipine was associated with significantly lower systolic blood pressure and a significantly higher incidence of edema. CONCLUSIONS: In our study, nifedipine was not superior to placebo for treating chronic chilblains. These findings contrast with those of the older study and do not support routine use of nifedipine for this condition.

A case of perniosis.

Perniosis is a localized, inflammatory reaction that ischaracterized by erythematous papules and nodulesthat often are located on the acral surfaces in youngwomen. The lesions of perniosis are thought to bedue to cold-induced vasoconstriction that leadsto hypoxemia and inflammation of the vessel wall.Histopathologic and laboratory studies are indicatedfor patients with suspected perniosis to distinguishbetween idiopathic perniosis and secondaryperniosis. Treatment includes adequate heating andclothing, proper food intake, nifedipine, ultravioletA1 phototherapy, topical glucocorticoids, andvasodilators.

Thermotherapy: a novel possible treatment strategy of chronic rhinosinusitis based on the chilblain-like alteration in the early pathophysiology.

Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases affecting large number of patients globally. The pathogenesis of CRS is still unclear and the treatment is unsatisfied. Clinical data provide the evidence that the chilblain-like alteration occurs in the early pathophysiology of CRS. We hypothesize that thermotherapy may offer a novel possible treatment strategy of chronic rhinosinusitis. In this article, we discuss the possibility of the chilblain-like alteration in the early pathophysiology and a therapeutic role of thermotherapy.

Constitutional and behavioral risk factors for chilblains: a case-control study from Pakistan.

OBJECTIVES: To study constitutional and behavioral risk factors for chilblains in patients at Abbottabad and Sialkot, Pakistan. METHODS: One hundred patients and matched controls completed a single-page, close-ended questionnaire which included demographic data and questions related to possible constitutional and behavioral risk factors for chilblains. Computer program SPSS-10 was used to manage and analyze the data. Risk factors were identified statistically by determining odds ratios and 95% confidence intervals using multivariate analysis. RESULTS: There were an equal number of male and female respondents in each group. Age of the patients and controls ranged from 2 to 80 years with a mean of 24.51 +/- 16.02. Twenty-six patients and 3 controls had a positive family history for chilblains (odds ratio = 9.33); 42 patients and 14 controls reported a history of constipation (odds ratio = 2.69); 32 patients and 8 controls had a history of either numbness or tingling of fingers or toes (odds ratio = 2.93); 55 patients and 45 controls led sedentary lifestyles (odds ratio = 1.27); 85 patients and 58 controls consumed a low number of cups of tea daily (odds ratio = 3.20); 65 patients and 29 controls frequently washed their hands and/or feet (odds ratio = 4.93); and 56 patients and 33 controls had occasional sun exposure during winter months (odds ratio = 2.08). CONCLUSION: Significant risk factors for the development of chilblains for people at Abbottabad and Sialkot included a history of chilblains in first-degree relatives, numbness and tingling sensations of fingers or toes, frequent hand or feet washing, and lower tea consumption during winter months.

Application of Bukuryoingohangekobokuto and Hangekobokuto for Perniosis with Ki Obstruction / 日本東洋医学雑誌

We experienced four cases of perniosis successfully treated with bukuryoingohangekobokuto, or hangekobokuto. Swollen tongue, pulsation at the pit of the navel, and tympanitic abdominal sounds were taken as common objective findings in all four cases. In addition, decreased surface body temperature was diagnosed at the bilateral hands and feet, so as to be distal from the trunk in palpation. These four cases had both symptoms of an eminent Ki obstruction, and a disorder of body fluid metabolism. For the two cases administered bukuryoingohangekobokuto especially, a state of strong Ki deficiency was diagnosed. Efficacy in each case was prompt. Thus, we consider bukuryoingohangekobokuto and hangekobokuto to be prescriptions worth trying for perniosis that does not responding to the usual Western medicines, or Kampo treatment.

Perniosis en pacientes pediátricos / Perniosis(chilblains) in pediatric patients

La perniosis es una respuesta anormal al frío, que se manifiesta como lesiones violáceas, edematosas y dolorosas que generalmente afectan a zonas acrales del cuerpo. Es más frecuente en otoño e invierno, y en regiones con clima frío y húmedo. Con frecuencia. los pacientes son mujeres jóvenes, aunque este cuadro también se ha descrito en niños. El curso generalmente es autolimitado, y es suficiente empezar un tratamiento sintomático

Chilblains is an abnormal response to cold, that manifests as painful, purplish, edematous lesions, usually affecting acral sites of the body. It is more frequent in fall and winter, and in regions with cold and damp weather. The patients are usually young women, but this condition has algo been described in children. The course is nearly always self-limited, and only symptomatic treatment is necessary

[Clinical observation on 136 cases of chilblains treated by acupuncture combined with massage].

OBJECTIVE: To compare therapeutic effects of acupuncture plus massage and medicine on chilblains. METHODS: Two hundred and sixty-four cases of chilblains were randomly divided into an acupuncture group of 136 cases and a medicine group of 128 cases. The acupuncture group were treated by acupuncture at 9 acupoints such as Yamen (GV 15), Laogong (PC 8), Sanyinjiao (SP 6), etc. plus massage, and the medicine group by dong chuang Plaster. RESULTS: In the acupuncture group, 111 cases were cured and 136 cases were effective, the effective rate being 100.0%; and in the medicine group, 55 cases were cured and 98 cases were effective, the effective rate being 76.6%, with a very significant difference between the two groups in the therapeutic effect (P < 0.01). CONCLUSION: Acupuncture plus massage is superior to dong chuang plaster in therapeutic effect on chilblains.

Clinical observation on 136 cases of chilblains treated by acupuncture combined with massage / 中国针灸

<p><b>OBJECTIVE</b>To compare therapeutic effects of acupuncture plus massage and medicine on chilblains.</p><p><b>METHODS</b>Two hundred and sixty-four cases of chilblains were randomly divided into an acupuncture group of 136 cases and a medicine group of 128 cases. The acupuncture group were treated by acupuncture at 9 acupoints such as Yamen (GV 15), Laogong (PC 8), Sanyinjiao (SP 6), etc. plus massage, and the medicine group by dong chuang Plaster.</p><p><b>RESULTS</b>In the acupuncture group, 111 cases were cured and 136 cases were effective, the effective rate being 100.0%; and in the medicine group, 55 cases were cured and 98 cases were effective, the effective rate being 76.6%, with a very significant difference between the two groups in the therapeutic effect (P < 0.01).</p><p><b>CONCLUSION</b>Acupuncture plus massage is superior to dong chuang plaster in therapeutic effect on chilblains.</p>

Perniosis: Estudio clinico e histologico de 5 casos / Perniosis: Histological and Clinical study of 5 cases

Incluimos en este trabajo 5 casos de perniosis(2 superficiales,2 profundas,1 mixta)observados durante el invierno de 1990 en nuestro servicio. Clinicamente se presentaron como maculas o pequenias placas dolorosas de coloracion rojo-violacea localizada en miembros inferiores(4 casos) y cara (1 caso). La histologia revelo la tipica angeitis linfocitaria con edema de la pared vascular. Referimos otras variantes histologicas y consideramos sus principales diagnosticos diferenciales

Perniosis: Estudio clinico e histologico de 5 casos / Perniosis: Histological and Clinical study of 5 cases

Incluimos en este trabajo 5 casos de perniosis(2 superficiales,2 profundas,1 mixta)observados durante el invierno de 1990 en nuestro servicio. Clinicamente se presentaron como maculas o pequenias placas dolorosas de coloracion rojo-violacea localizada en miembros inferiores(4 casos) y cara (1 caso). La histologia revelo la tipica angeitis linfocitaria con edema de la pared vascular. Referimos otras variantes histologicas y consideramos sus principales diagnosticos diferenciales

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.

A pilot study, a double-blind placebo-controlled randomised study and a long term open trial have indicated that nifedipine is effective in the treatment of perniosis. At a dose of 20 mg to 60 mg daily, nifedipine significantly reduced the time to clearance of existing lesions and prevented the development of new chilblains. Nifedipine also reduced the pain, soreness and irritation of the lesions. A comparison of the pre- and post-treatment skin biopsies showed resolution of the dermal oedema and diminution of the perivascular infiltrate. An increase in cutaneous blood flow following administration of nifedipine suggests that the vasodilator action of this drug may be important in its action.

A double-blind study of ultraviolet phototherapy in the prophylaxis of chilblains.

A randomized, double-blind study was carried out to assess the prophylactic value of ultraviolet irradiation in the autumn as a means of preventing the development of chilblains on the toes and fingers during the course of the winter. Placebo irradiation was achieved by means of an optical filter which absorbed all ultraviolet radiation from the lamps but allowed the visible light component to be transmitted, thus giving patients the impression that both limbs were being treated. Patients were reviewed at monthly intervals during the winter. The response between patients was variable; some patients developed chilblains whilst others remained symptom free. However, in no patient did the ultraviolet treated limb differ from the untreated limb. We conclude that the ultraviolet phototherapy is of no value in the prophylaxis of chilblains.