In an earlier study on the effectiveness of vitamin D3 with 33 participants recruited in a similar way, two of the current authors observed a baseline VOC of 27.97 mm (standard deviation [SD] 18.82).Block randomisation with a block size of 10 was used to assign one of the two arms (placebo cream first or betamethasone cream first) to research medication sets with consecutive therapy numbers. Topical steroids should not be used in the treatment of chronic chilblains without new evidence.The authors thank Mrs CM (Rina) Siemons, research assistant.This work is supported by the Netherlands Organisation for Health Research and Development Programme Common Diseases (grant number 42011006).The Dutch Competent Authority (NL 3069509109) and the Medical Research Ethics Committee CMO Arnhem-Nijmegen granted permission for this study (CMO dossier number: 2009/338).Thank you for recommending British Journal of General Practice.NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. This resulted in a difference of 1.88 mm (95% CI = −2.56 to 6.31 mm) in favour of Arm 2 (The authors found no statistically significant differences between topical betamethasone cream and placebo cream for assessed redness, purpleness, oedema, and ulceration after 6 weeks of treatment (Outcomes on additional analyses (6 weeks of treatment)No adverse effects (skin irritation or signs of skin atrophy) were found during betamethasone cream application or during placebo cream use.There was no clinically or statistically significant difference between treatment with topical betamethasone valerate cream and placebo cream treatment. Owing to the recruitment method used for participants in this study, it is possible to generalise the current findings for patients with idiopathic chronic chilblains as seen in primary care.Chronic chilblains meet the criteria for the definition of a common disease.The decision to test differences on VOC and VOD one-sided is based on a power issue. Instruct patient to notify health care professional if swelling of face, Losartan potassium is a drug that effectively treats high blood pressure and diabetic neuropathy. When preparing medications from bottles or containers, compare the label of the medication container with the MAR three times: (1) before removing the container from the drawer or shelf, (2) as the amount of medication ordered is removed from the container, and (3) at the patient's bedside before administering the medication to the patient. [In Hebrew]The two-period change-over design and its use in clinical trialsUse of two-stage test statistic in the two-period crossover trialsChronic pernio. VOD was calculated using the mean value of the last 7 consecutive days of the treatment period.Additionally, the chilblain lesions were assessed during face-to-face consultations. The aim of the study allows one-sided testing. Mean duration of complaints at intake was 7 weeks (SD 4.2). The current randomised, placebo-controlled trial does not confirm the conclusions of this study. The authors also found no significant carry-over effect on either the primary or the secondary outcome. At baseline mean VAS score on complaint was 26.80 mm (95% CI = 24.04 to 29.57) and mean VAS score on disability was 17.55 mm (95% CI = 14.90 to 20.20). This resulted in a difference of 2.98 mm (95% CI = −3.78 to 9.74 mm) in favour of Arm 2 (Mean VOD at 6 weeks of treatment was 5.57 mm (95% CI = 2.63 to 8.51 mm) in Arm 1 (betamethasone cream first) and 3.69 (95% CI = 0.38 to 7.00) in Arm 2 (placebo cream first). A washout period would have caused too long a research period per participant and problems with high ambient temperatures in spring. The authors monitored for any adverse effects from the two therapies (skin irritation and signs of skin atrophy).Sample size calculation was based on the following premises. Instead this study checked for a possible carry-over effect.The study population consisted of consecutively recruited participants who suffered from chronic chilblains during the winters of 2010 to 2012. Data sources include IBM Watson Micromedex (updated 2 Sep 2020), Cerner Multum™ (updated 1 Sep 2020), … Participants suffering from Raynaud’s phenomenon were not excluded. This procedure was performed by the pharmacy that produced and issued the research medication sets blind to both research personnel and participants. VOC was assessed by a diary and defined as the 100 mm VAS score on pain or the VAS score on itch, depending on which item had the highest value at the moment of sampling. This figure may suggest some sort of relationship between chronic chilblains and Raynaud’s phenomenon. The prescription of topical steroids for patients with chilblains finds support in one study. 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