Chilblains

What are chilblains and what causes them?

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

Chilblains are common. It is thought that about 1 in 10 people in the UK gets chilblains at some stage in their life. It is not clear why some people get chilblains when their skin gets cold. 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.

For a list of websites that contain pictures of skin conditions including chilblains see www.patient.co.uk/showdoc/1097/

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 develop.
• In some cases the skin over a chilblain may blister which may delay healing.
• Occasionally, the skin breaks down to leave a small ulcer which is prone to infection.

Typically, each chilblain 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 by doing the following 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.
• Keep your head and ears warm by wearing a hat and scarf.
• You should keep as warm as possible in the cold. Wearing several loose layers is ideal to trap body heat. You should also keep as dry as possible.
• After being out in the cold, do not heat the skin quickly 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 following starting any medication.

What is the treatment for chilblains?

Although chilblains are uncomfortable, they do not usually cause any permanent damage. They will usually heal on their own if any further exposure to the cold is avoided.

• 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 creams and lotions can be bought from a pharmacy. However, there is no evidence that any of these are of benefit so they are therefore not recommended.
• Steroid creams are no longer recommended for the treatment (or prevention) of chilblains.
• If you smoke then you should try and stop, as smoking can make chilblains worse.
• 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.

References

• Chilblains, Clinical Knowledge Summaries (November 2009)
• Almahameed A, Pinto DS; Pernio (chilblains). Curr Treat Options Cardiovasc Med. 2008 Apr;10(2):128-35. [abstract]