Milkers' chilblains

To report on the clinical features, causative factors, management and preventive measures for chilblains of the hands occurring in milkers in the Waikato area of New Zealand.

A review was made of the case notes of all patients with milkers' chilblains seen in dermatological practice in Hamilton over a ten year period ending in 1991 and follow up interviews were made.

Eleven milkers were seen with distinctive, at times disabling, seasonally-recurring chilblains of the hands. In most patients the chilblains had developed early in their milking careers. Difficulty was experienced by both the patients and their doctors in recognising the nature of their skin condition. Sunlight aggravation of the lesions was a feature. In most patients treatment of the presenting episode required time off work and in several patients significant scarring resulted. Three patients left dairying because of the chilblains. Those who continued received preventive advice but four patients had further lesions in subsequent years although these were mild.

Milkers' chilblains are uncommon but some cases are misdiagnosed and milder cases may not present for medical attention. Morbidity can be significant. Preventive measures are helpful but their effect may be limited by the difficulty of wearing gloves for milking. The vasodilator nifedipine is suggested as a prophylactic therapy for these patients.