Chilblains

Overview

By Sarah Maurer

Skiing, sledding and enjoying the outdoors are great ways to stay in shape during the colder months. But if you do venture out, it's important to protect your skin from injury. Most people have heard of frostbite, but cold can also cause another painful condition called chilblains.

chilblains on toes (source: james heilman md)Chilblains are patches of skin in which the capillaries (tiny blood vessels) have been injured by chilling and rewarming. They're typically red, swollen, itchy and painful. Chilblains most commonly affect the nose, fingers, toes, heels and ears.

Chilblains usually aren't dangerous, but they can be very painful and unpleasant. The condition also makes the skin susceptible to infection, which can cause serious illness and permanent tissue damage. Because chilblains cause permanent damage to the capillaries, they tend to recur (come back) if your skin gets really cold again.

Experts aren't sure how common chilblains are in the United States. In England, which has a cold damp climate, about ten percent of the population develop the condition each year.

Risk factors for chilblains include:

  • Being female
  • Low body weight
  • Family history
  • Smoking
  • Certain medical conditions, including lupus disease, diabetes, Celiac disease, and Raynaud's disease.

Causes

Chilblains usually appear after skin is exposed to cold, damp air for several hours. They typically develop in temperatures between 32 and 60 degrees F. (Interestingly, they're rare in extremely cold climates, which tend to be drier.)

No one is sure exactly how chilblains form, but experts believe they're an abnormal reaction to rewarming. When the skin is cold, the capillaries get narrow. Sudden warming causes blood to rush toward these constricted vessels before they can open again. The excess blood leaks into surrounding tissue, causing pain and swelling.

Symptoms

The first signs of chilblains are small patches of itchy, red skin that appear on the skin 12 to 24 hours after exposure to cold and rewarming.
These may be accompanied by:

  • Pain or burning
  • Swelling
  • Discolored skin (ranging from red to dark blue)
  • Blistering or ulceration (in severe cases).

Diagnosis and Treatment

Home Care

It's usually fine to treat chilblains at home if symptoms aren't too bad. Keep the affected body part warm, but not too hot. (Don't place the area against a heat source like a stove and heating pad.) Avoid scratching the chilblain and use over-the-counter lotion to combat itching. If skin is broken, clean the affected area with antiseptic, keep it bandaged, and change the bandage every other day.

See your primary care provider if you notice the following infection symptoms:

  • Pus in the affected areas
  • Feeling tired or generally unwell
  • Fever above 100.4 degrees F
  • Swollen glands.

Other reasons to seek medical attention:

  • Pain is severe
  • Condition doesn't improve in a week or two
  • You have poor circulation due to diabetes or another medical condition.

Diagnosis

Most cases of chilblains can be treated by a primary care provider. A history and physical exam are usually enough to diagnose the problem.

Chronic (long-term, recurring) chilblains can be a sign of another illness such as lupus disease or leukemia. To help diagnose any underlying medical conditions, your doctor may order:

  • Blood tests. Blood is drawn through a needle and analyzed in a lab.
  • Punch biopsy. A small piece of skin is removed and viewed under a microscope.

To help heal chilblains and prevent recurrences, your doctor may prescribe:

  • Corticosteroid creams. These powerful anti-inflammatory medications can be rubbed on the injured area to reduce swelling and itching.
  • Nifedipine. This blood pressure medicine relaxes the blood vessels and promotes healthy circulation. It helps to prevent seasonal recurrences of chilblains.
  • Wound care. If the affected area is blistered or ulcerated, it should be cleaned regularly, treated with antiseptic and protected with a dressing to prevent infection.

Prognosis

If no infection is present, chilblains should clear up without treatment in one to three weeks.

Prevention

The best way to prevent chilblains is to avoid exposing your skin to the cold. Some tips:

  • Dress appropriately for cold weather. Layered clothing provides the best insulation.
  • In very cold weather, cover all skin, especially your hands, feet, and face.
  • Wear a hat to minimize heat loss.
  • Restricted circulation can increase the risk of chilblains, so choose cold-weather clothing and footwear that fits well.
  • Before going out into the cold, warm up your hands and feet.
  • If skin does get chilled, rewarm it slowly.
  • Stop smoking. This will improve your circulation, which tends to decrease the risk of chilblains.

Sources

  • Chilblains (Dec. 6, 2012). Mayo Foundation for Medical Education and Research. Retrieved Nov. 18, 2015, from http://www.mayoclinic.org/diseases-conditions/chilblains/basics/definition/con-20033727.
  • Chilblains (Jan. 9, 2015). National Health Service (UK). Retrieved Nov. 18, 2015, from http://www.nhs.uk/conditions/chilblains/pages/introduction.aspx.
  • Cold Stress (July 30, 2014). The National Institute for Occupational Safety and Health. Retrieved Nov. 18, 2015, from http://www.cdc.gov/niosh/topics/coldstress/.
  • Pernio (Nov. 17, 2014). Medscape. Retrieved Nov. 18, 2015, at http://emedicine.medscape.com/article/1087946-overview.