Chilblains are also known as pernio or chill burns. It is a medical condition that occurs when a predisposed individual is repeatedly exposed to cold but not freezing air resulting to painful inflammation of small blood vessels in the skin. Damage to capillary beds in the skin causes blood to perfuse into the nearby tissue too quickly, resulting in redness, itching, inflammation, and blisters. It can be idiopathic, but may also be a manifestation of another serious medical condition like – Raynaud’s disease, erythromelalgia, frostbite, trench foot, as well as connective tissue diseases (lupus or vasculitis), etc.
Chilblains usually clear up within one to three weeks, especially if the weather gets warmer. There may be recurrences seasonally for years. Treatment involves protecting yourself from the cold and using lotions to ease the symptoms. It do not usually result in permanent injury, but the condition can lead to infection, which may cause severe damage if left untreated.
The best approach to chilblains is to avoid developing them by limiting your exposure to cold, dressing warmly and covering exposed skin.
NOTE: In infants, chilblains together with severe neurologic disease and unexplained fevers occurs in Aicardi–Goutières syndrome, a rare inherited condition. Ulcerated chilblains are referred to as kibes.
Signs & Symptoms of chilblains
Signs and symptoms may include:
- Small, itchy red areas on your skin, often on the feet or hands
- Possible blistering or skin ulcers
- Swelling of the skin
- Burning sensation on the skin
- Changes in skin color from red to dark blue, accompanied by pain.
The areas most affected are the toes, fingers, earlobes, nose which could cause:
- Blistering of affected area
- Burning and itching sensation in extremities
- Dermatitis in extremities
- Ulceration (severe cases only)
- Erythema (blanchable redness of the skin)
- Pain in affected area
- Skin discoloration, red to dark blue
The exact cause of chilblains is still unknown, but may be an abnormal reaction of the body to cold exposure followed by rewarming. Rewarming of cold skin can cause small blood vessels under the skin to expand more quickly than nearby larger blood vessels can handle. This results in a bottleneck effect and the blood leaking into nearby tissues.
Who is at risk
Certain factors may increase the risk of developing chilblains. These factors include:
- Clothing: Clothing that is tight or exposes skin to the cold. Wearing tight-fitting clothing and shoes in cold, damp weather may make you more susceptible to chilblains. Also, skin that is exposed to cold, damp conditions is more likely to develop chilblains.
- Gender: Women are more likely to get chilblains than men.
- Weight: People who weigh about 20 percent less than is expected for their height have an increased risk of chilblains.
- Environment and season: Chilblains are less likely in colder and drier areas because the living conditions and clothing used in these areas are more protective against cold. Your risk of chilblains is higher if you live in an area with high humidity and cold, but not freezing, temperatures. They are more common from November to April.
- Blood circulation: People with poor circulation tend to be more sensitive to changes in temperature, making them more susceptible to chilblains.
- Underlying disease: People with Raynaud’s disease are more susceptible to chilblains. Either condition can result in sores, but Raynaud’s causes different types of color changes on the skin.
- Autoimmune disorder: Lupus – an autoimmune connective tissue disease is the most common autoimmune disorder associated with chilblains.
It can be diagnosed by basic physical examination or through your cold exposure history. In rare cases, doctors may decide to do a biopsy of the affected area. This involves removing a small tissue sample and looking at it under a microscope for signs of any underlying condition, such as skin cancer.
If you’ve had chilblains before, you will likely recognize them on your own. However, if you’ve never had them before, it’s best to check in with your doctor to make sure it’s not something else, such as cold urticaria or vasculitis.
Chilblains usually go away on their own within one to three weeks. In many cases symptoms will start to diminish as you warm up. If you have ongoing itching, your doctor might prescribe corticosteroid cream to reduce inflammation. If you have poor circulation or diabetes, your chilblains may not heal well.
In some cases, your doctor might also prescribe blood pressure medications to help open up the small vessels near your skin’s surface. This will also help to reduce inflammation and pain.
Contact your doctor if your symptoms last for more than three weeks, the pain is severe, or you don’t seem to be getting any better.
Home Remedy for chilblains
While it is usually best to let chilblains run their course, there are a few things you can do at home to ease your symptoms. As soon as you notice symptoms, try to slowly warm up the affected area by putting it under a blanket. Avoid applying direct heat because warming up the area too rapidly can make your symptoms worse.
In addition, avoid massaging or rubbing the area. While this might seem like a good way to slowly warm the area, it can increase irritation and inflammation. As your chilblains heal, apply a gentle, unscented lotion to the area to keep your skin moisturized. This is especially important if your chilblains have blisters. Keeping your skin clean and moisturized will reduce your risk of developing an infection.
NOTE: While battling the disease do not do the following:
- Do not put your feet or hands on a radiator or under hot water to warm them up.
- Do not smoke or have drinks that have caffeine in them – this can affect the flow of blood in your fingers and toes.
- Do not scratch or pick at your skin.
Chilblains may cause complications if your skin blisters. If that happens, you may develop ulcers and infections. Besides being painful, infections are potentially life-threatening if left untreated. See a doctor if you suspect infection.
How to prevent chilblains
To prevent chilblains:
- Avoid or limit your exposure to cold.
- Dress in layers of loose clothing and wear mittens and warm, water-resistant footwear.
- Cover all exposed skin as completely as possible when going outside in cold weather.
- Keep your hands, feet and face dry and warm.
- Keep your home and workplace comfortably warm.
- Keep affected area warm, and avoid any extreme temperature changes (including very hot water).
- Keep affected area dry.
- Wear warm shoes, socks and gloves.
- Wear a hat and a scarf to protect the ears and the nose.
- Avoid tight fitting socks/shoes.
- Exercise at least four times a week to improve circulation.
- Quit smoking, as it damages circulation.
If your skin is exposed to cold, it’s helpful to rewarm it gradually because sudden rewarming of cold skin may worsen chilblains.