Comparative Study between The Efficacy of Diltiazem and Amlodipine in the Treatment of Chilblains.

Abstract

Background& Objective: Chilblains (pernio)  is a local inflammatory lesion that is caused by constant exposure to cold at non freezing temperatures, in the form of violet or erythemal, itchy and \ or painful lesions, and may be primary or secondary, and the distribution of the disease varies according to the prevailing climate. Up to 10% in temperate areas where winter is cold and humid. Often, the lesions develop in a single or multiple acute manner, and a difference in location between one person and another may follow the genetics factor. For lesions , which occurs in the extrimities, they are associated with a sense of burn, itching, numbness or tingling. pernio is an unpleasant disease for the patient and affects the quality of his life, and the improvement on topical treatment is usually slow and fast-reversing, so other available therapeutic alternatives with limited cost and few side effects have been sought for the treatment of pernio.

Calcium channel blockers are usually prescribed for patients with high arterial pressure. There is a need to determine the effective and safe dose of this drug group, in addition to the need to measure the differentiation between them, and to know the properties of each of its effect and effectiveness.

Materials & Methods: A randomized, prospective, open labeled, controlled comparison, clinical trial of 40 patients divided into two groups was conducted. Two patients were withdrawn. The first group consisted of 19 patients taking diltiazem 60 mg. 3 times daily, and the second group of 19 patients took 5 mg. twice a day. The patients were followed up and monitored for a period of one month at the rate of visits every two weeks and a final observation after one month of discontinuation.

The clinical events were assessed from distribution, erythema, swelling and lesions prior to ulcers, open ulcers, blisters and acrocyanosis, and evaluation of the symptoms of itching, sense of burning, numbness or tingling and follow-up of these variables during the treatment period and beyond.

Results: We observed that both the diltiazem and amlodipine alleles reduced the distribution of the lesions, especially in the ventral side, and improved swelling, lesions prior to the ulcer and acrocyanosis, since the mid-treatment period, but the results showed that amlodipine was faster than diltiazem in terms of erythema relief and pain. For open ulcer, only one month of treatment can not be cured for both.

It was also noticed that the decline of all erythema, pain, itching, numbness or tingling and their distribution on the dorsal and ventral side of fingers and toes and for the two dues despite the cessation of treatment for a month, which indicates that the benefit of Calcium channel blockers lasts even after stopping, and there is no difference between the two drugs in terms of protection from relapse and side effects.

Discussion: Calcium channel blockers play an important role in inhibiting the growth and proliferation of smooth muscle in vessel walls and in inhibiting fibroblasts. It also inhibits the formation and synthesis of extracellular protein (collagen-fibronectin-proteoglycan). It plays the role of an immune modifier that affects lymphocytes and inhibits the formation of oxygen radicals and the process of phagocytosis carried out by neutrophils, and the accumulation of platelets and degranulation of mast cells also decline, so we note the decline of symptoms and inflammatory events. Amlodipine has a more severe effect on the expansion of blood vessels, which explains its apparent effect in relieving swelling faster than its counterpart

Conclusion: Both drugs have significant and important results in the treatment of pernio, and can be relied upon as effective and safe medicine, with little side effects, within the prescribed doses and within the study period, with faster and clearer results for Amlodipine.