Chilblains

What are chilblains and what causes them?

Chilblains (sometimes called pernio) are small, itchy, painful, red swellings on the skin. Chilblains are thought to be caused by an abnormal skin reaction to cold. They tend to occur on the 'extremities' that more easily become cold. That is, the toes, fingers, nose, and earlobes. However, other areas of skin sometimes develop chilblains when they become cold. For example, the heels, lower legs and thighs (especially in horse riders).

Chilblains are common. It is thought that about 1 in 10 people in the UK get chilblains at some stage in their life. It is not clear why some people get chilblains when their skin gets cold. It is probably due to 'poor circulation' in the extremities (toes, fingers, etc). The tiny blood vessels under the skin narrow (constrict) when the skin becomes cold. The blood supply to areas of skin may then become very slow. As the skin re-warms there is some leakage of fluid from the blood vessels into the tissues. In some way this causes areas of inflammation and swelling leading to chilblains.

The speed (rate) of temperature change may play a part. Some people get chilblains if they warm up cold skin too quickly. For example, with a hot water bottle or by sitting very close to a fire.

Some people with poor circulation and with other problems of their blood vessels are more prone to developing chilblains. However, most chilblains occur in people who are otherwise healthy.

What are the symptoms of chilblains?

Chilblains occur several hours after being exposed to the cold. You may get just one chilblain but often several develop. They may join together to form a larger swollen, red area of skin.

• Chilblains are very itchy. A burning sensation is also typical.
• They are usually red to start with but may become purple.
• Pain and tenderness over the chilblains often develops.
• In some cases the skin over a chilblain may blister which may delay healing.
• Sometimes the skin breaks down to leave a small ulcer which is prone to infection.

Each chilblain typically lasts about seven days, and then gradually goes away over a week or so. Some people get recurring bouts of chilblains each winter.

Can you prevent chilblains?

If you are prone to chilblains then trying to prevent them is sensible.

• Keep your hands and feet warm when out in cold weather by using warm gloves and socks. Consider special heated gloves and socks if chilblains are a recurring problem.
• If possible, exercise vigorously before going out into the cold. The theory is that this will improve the circulation to the hands and feet. There is no clear evidence to confirm that this works but it is traditional advice.
• Do not heat the skin quickly after being out in the cold with hot water bottles, etc. Gradually warm up.
• Side-effects to some drugs may constrict (narrow) tiny blood vessels. This may be enough to make you prone to recurring chilblains. For example, beta-blocker drugs can have this effect. Tell your doctor if you become prone to chilblains since starting any medication.

What is the treatment for chilblains?

• Keep the affected areas warm. This means staying out of the cold, or wearing warm gloves, socks, etc, when outdoors.
• No other treatment is normally needed as they usually go away by themselves.
• A range of soothing creams and lotions (such as calamine lotion) can be bought from a pharmacy. These may ease the soreness until symptoms go.
• A steroid cream rubbed onto the chilblains may reduce itch and soreness.
• Medication is sometimes used to prevent chilblains in people who have recurring chilblains. A drug called nifedipine can dilate (open wide) the small blood vessels and may help to prevent chilblains.

© EMIS and PIP 2006   Updated: May 2006