Chilblains

Definition

Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin that occur in response to sudden warming from cold temperatures. Also known as pernio, chilblains can cause itching, red patches, swelling and blistering on extremities, such as on your toes, fingers, ears and nose.

Chilblains may get better on its own, especially as the weather gets warmer. Chilblains usually clear up within one to three weeks, though they may recur seasonally for years. Treatments typically consist of lotions and medication. While Chilblains don't usually result in permanent injury, they 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.

Symptoms

Signs and symptoms of chilblains may include:

• Small, itchy red areas on your skin, often on your feet or hands
• Possible blistering
• Swelling of your skin
• Burning sensation on your skin
• Changes in skin color from red to dark blue, accompanied by pain
• Possible ulceration

When to see a doctor

Some people with chilblains never need to see a doctor — they simply use lotions to help with the pain and itching. However, if the pain becomes too severe or the affected skin begins to look as if it might be infected, a doctor can help you treat it more effectively. Also, make sure to seek medical attention if your skin doesn't improve after a week or two.

If you have poor circulation or diabetes, see a doctor immediately after discovering chilblains to prevent possible complications.

Causes

The exact reason chilblains occur is unknown. They may be an abnormal reaction of your 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, resulting in a "bottleneck" effect and the blood leaking into nearby tissues.

Risk factors

Factors that may increase your risk of chilblains include:

• Exposure of skin to cold. Skin that's exposed to cold, damp conditions is more likely to develop chilblains.
• Being female. Women are more likely to get chilblains, though why is not known.
• Being underweight. People who weigh about 20 percent less than is expected for their height have an increased risk of chilblains.
• Where you live. Ironically, chilblains are less likely in colder and drier areas because the living conditions and clothing used in these areas are more protective against cold. But, if you live in an area with high humidity and low, but not freezing, temperatures, your risk of chilblains is higher.
• The time of year. Chilblains are more common from early winter to spring. Chilblains often disappear completely in the spring.
• Having poor circulation. People with poor circulation tend to be more sensitive to changes in temperature, making them more susceptible to chilblains.
• Having been diagnosed with Raynaud's phenomenon.People with Raynaud's phenomenon, another cold-related condition that affects the extremities, are more susceptible to chilblains. Either condition can result in sores, but Raynaud's causes different types of color changes on the skin.

Complications

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.

Treatments and drugs

Treatment options for chilblains include:

• Corticosteroid creams. Topical corticosteroids can help relieve itching and swelling.
• Prescription medication. A blood pressure lowering drug called nifedipine (Adalat CC, Procardia) is sometimes used to treat the cause of chilblains, since it can help open up blood vessels. Another medication that helps improve blood flow that may be prescribed for chilblains is pentoxifylline (Trental).
• Infection prevention. If your skin has broken, treatment also includes cleaning and protecting your wounds to prevent infection.

Lifestyle and home remedies

Chilblains usually clear up after one to three weeks. In the meantime, you can take steps to ease your symptoms, including:

• Avoiding cold exposure whenever possible
• Keeping your affected skin warm, but away from sources of heat
• Using lotions to alleviate itching and swelling
• Making sure the affected skin is cleaned with an antiseptic and bandaged to prevent infection
• Avoiding scratching

Prevention

To prevent chilblains:

• Avoid or limit your exposure to cold.
• Dress in warm layers of clothing.
• Cover all exposed skin as completely as possible when going outside in cold weather.
• Make sure you keep your hands, feet and face warm.
• Keep your home and workplace comfortably warm.

If your skin is exposed to cold, it's helpful to rewarm it gradually, since sudden rewarming of cold skin may worsen chilblains.