At a glance - Chilblains vs Gouty tophi

CHILBLAINS 

Discriminatory signs

  • Tender, itchy, red, mauve papules or nodules.
  • Appear several hours after exposure to cold.
  • May progress to blisters and open sores (ulcers).
  • Lasts up to two weeks.
  • Fingers, toes and nose can be affected.
  • Children and the elderly are often affected.

Management

  • Prevent by wearing appropriate clothing.
  • Do not warm up too quickly.
  • Ulcers should be kept clean and protected.
  • Usually clears up within seven to 14 days.
  • Nifedipine 20mg three times per day for symptomatic treatment can be used for weeks if cold weather persists.

GOUTY TOPHI

Discriminatory signs

  • Hard white cream papules or plaques.
  • Caused by deposits of urate crystals in the soft tissues.
  • The helix or antihelix and knee joints affected.
  • Likely to have gout.
  • Punched-out lesions or subcutaneous nodules.

Management

  • Allopurinol.
  • Avoid food high in uric acid such as herring, mussels, yeast, smelt, sardines, anchovies, game, salmon, turkey, haddock and scallops.
  • Avoid loop diuretics and NSAIDs.
  • Check for hyperuricemia.

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