Chilblains

Chilblains (also known as pernio or perniosis) are itchy, sore, red or purple bumps that occur on the skin as a reaction to cold. Painful inflammation of the small blood vessels occurs with repeated exposure to cold air, usually several hours after the exposure. Cold temperatures make the small arteries and blood vessels in the skin constrict. When the skin is warmed again, these small blood vessels can sometimes expand more quickly than the nearby blood vessels can handle. A bottleneck effect can happen with blood leaking into the tissues and causing swelling. The swelling irritates nerves in the affected area, causing pain.

Chilblains can look swollen, shiny and change colour from red to dark blue. They cause pain and burning sensations. If severe, blisters, pustules, scabs and ulcers can form. The area can be dry and prone to cracks. They occur commonly on the backs and sides of the fingers and toes, the heels, lower legs, thighs, nose and ears. Babies will commonly get chilblains on their wrists. Chilblains last for 7 to 14 days and clear up when the weather warms, but often recur seasonally. The symptoms are made worse by sudden temperature changes such as going back into a warm house after being outside in the cold, or heating your hands and feet too quickly e.g putting your feet next to a heater or on a hottie (rather than slowly warming your whole body).

Chilblains most commonly affect children, elderly and sedentary people and in places with damp, temperate climates. They are less likely to occur in colder and drier areas as living conditions and clothing in these places are more protective against the cold. In children, chilblains can occur each winter for a few years, then clear up. In the elderly chilblains tend to worsen every year unless steps for prevention are taken.

Factors that seem to contribute to development of chilblains are wearing tight fitting shoes or clothes, having poor peripheral circulation, a family history of chilblains, low body weight, and peripheral vascular disease due to diabetes, smoking or high cholesterol.

Treatment for chilblains usually involves a topical steroid cream applied for a few days to decrease the itch and swelling. Calamine or witch hazel can also soothe the itching. A mucopolysaccharide cream applied once or twice a day can decrease swelling and inflammation. Try not to scratch the itch as this can damage the skin more and increase the risk of infection. Any infection can be treated with oral antibiotics. If you have diabetes or poor circulation your healing may be impaired and any infection can be life-threatening if left untreated – be cautious if you have these conditions and seek treatment. Gentle exercise will improve the circulation to the feet and increase the peripheral circulation in general.

The best approach for prevention is to limit the chance of developing chilblains by dressing warmly in cold conditions, and covering exposed skin. Keeping the whole body warm at all times is the key to prevention. Wear gloves, thick socks and protective footwear. Make sure footwear is not tight as this can decrease the circulation to the toes. Wear several layers of clothing as this will trap body heat more effectively than one bulky layer. Insulate your home and workplace, minimise caffeine intake and limit decongestants as both can constrict blood vessels. Don’t smoke.

If your skin is exposed to the cold, rewarm gradually as sudden rewarming can worsen chilblains. Soak hands in warm water or put feet under a blanket, and don’t apply direct heat. Avoid massaging or rubbing the area as this can increase inflammation and irritation. As chilblains start to heal, apply moisturiser which will stop your skin from splitting and decrease the chance of infection.

If you suffer from severe and reoccurring chilblains your doctor may prescribe you a preventative drug.

Always contact your doctor if your symptoms last for more than three weeks, if the pain is severe or if the chilblains don’t seem to be getting any better.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.