Hypothalamus and Pituitary Gland
Authors: G. W. Harris
Journal: BMJ (1948)

Total 12 3 8 3 1abolished, but they were not counted as cures unless there was no evidence of chilblains on examination.Observations were made on results only during the severe weather.Every patient was asked if this was the best treatment so far tried, and 26 responded in the affirmative; this gives a failure rate of only 3.7%.The one failure was a female telephonist aged 30, who suffered from very severe chilblains of the hands and feet.Her work may have militated against a cure.She was given only 150 mg. of nicotinic acid daily, and in the light of further experience it was felt that the dose should have been increased.Four patients blamed a change in the weather, such as a thaw, for the onset of their chilblains; one blamed sitting still for a long time; two blamed sitting in front of a fire; sixteen blamed cold weather and frost; four blamed cold weather and damp.All but two said sitting in front of a fire made the chilblains worse.Fifteen were chronic sufferers and got chilblains practically every year; of these eight were cured and seven improxed.Nine were sufferers for the first time: of these six were cured and three improved.The others were only occasional sufferers.Two patients complained of occasional cracks at the corners of the mouth and one of a sore tongue, but it was difficult to relate these symptoms to a systemic deficiency of the vitamin B complex.Two patients noticed improve- ment after taking only 50 mg. of nicotinic acid; five noticed improvement after treatment for three days, ten after four days, six after seven days, and three were indefinite.It is interesting to record that two patients found that they could tolerate the cold with much greater comfort during treatment; this may have been due to a " stoking up " of skin-cell metabolism resulting from the vasodilata- tion of the subcutaneous arteries.Untoward effects noticed during treatment were of little significance and were only transitory: constipation was recorded in three cases, sleepiness in two, slight headache in two, and transient flushing and mild irritation of the skin in twelve.Conclusions Regarding Treatment On the basis of the action of nicotinic acid-namely, vasodilatation-it stands to reason that this treatment can- not be expected to benefit to any great extent chilblain sufferers who have pronounced arteriosclerosis or other condition of the peripheral circulation which interferes with the vasodilatation of the skin vessels.Nevertheless it is felt that nicotinic acid has a specific action on chilblains, and that the very vast majority of chilblain sufferers will benefit from this treatment.Treatment should start as soon as the first sign of a chilblain makes its appearance and should be continued, possibly in reduced dosage, until the chilblain season has passed.Summary The problem of chilblains is discussed as regards their aetiology and pathogenesis.It is claimed that nicotinic acid, given orally, has a specific effect on chilblains.Twenty-seven cases are quoted to prove this, and it is suggested as the treat- -ment of choice in genera-l practice owing to its ease of administration and its freedom from serious untoward effects.