Chilblains (Pernio)

Chilblains are a vasospastic inflammatory disorder that occurs several hours after of the skin of unprotected individuals has been exposed to a non-freezing cold in damp environment (temperate humid climates).

chilblains example

Chilblains are less common in countries where the cold is more extreme because the air is drier and people have specially designed living conditions and clothing.

They affect the body's exposed extremities, such as backs and sides of the toes and fingers, the face (nose, cheeks, earlobes) legs (heels, shins, thighs, and hips), wrists of babies. In severe cases lesions can progress to blistering or ulceration.

The color in people with dark skin shows marked darkening.

Chilblains can be uncomfortable but rarely cause any permanent damage. They normally heal within a few weeks if further exposure to the cold is avoided.

Symptoms of chilblains

Chilblains most often develop on the toes. Common symptoms include:

  • A burning or itching sensation on the skin which can become more intense if you go into a warm room.
  • Red, blue or white swollen patches
  • Intense itching
  • Possible secondary infection
  • Ulceration, in severe cases.
  • The affected skin may also swell and turn red or dark blue. In severe cases, the surface of the skin may break and sores or blisters can develop.
  • It's important not to scratch the skin as it can break easily and become infected.

When to seek medical advice

Most people don't need to seek medical advice if they have chilblains as they usually heal within a few weeks and don't cause any permanent problems.

However, see your GP podiatrist for advice if you have:

  • Severe or recurring chilblains
  • Chilblains that don't improve within a few weeks

You should also seek medical advice if you think your skin may have become infected.

However, see your GP podiatrist for advice if you have:

  • Swelling and pus forming in the affected area
  • Feeling generally unwell
  • A high temperature (fever) of 38C (100.4F) or above
  • Swollen glands

Causes of chilblains

The exact reason chilblains occur is not well-understood but cold (specifically, exposure to both mild nonfreezing cold and humidity), is the direct requirement for the development of symptoms. Chilblains are the result of an abnormal vascular reaction (arteliolar and venular constriction) to prolonged exposure to temperatures above freezing point when damp or humid conditions coincide, followed by too rapidly rewarming (e.g. warming cold hands in front of a fire or heater).On rewarming, venular constriction predominate on arteriolar constriction with exudation of fluid into the tissues. Minor trauma or tight clothing may also predispose to symptomatic pernio lesions in otherwise appropriate weather conditions.

When the skin is cold, the farthest blood vessels (small arteries and veins) (hands, feet, tip of the nose) near its surface get narrower (constriction). If the skin is then exposed to sudden warmth, in rewarming of cold skin, small blood vessels closest to the skin cannot handle their sudden expansion that occurs more quickly than nearby larger blood vessels can handle, resulting in a "bottleneck" effect and the blood leaking into nearby tissues causes inflammation, swelling and itching.

Our skin acts like a thermometer and helps sense the temperature outside and inside our body; it makes sure we are always perfectly warm at 37° Celsius (98.6° Fahrenheit) . When the temperature outside lowers, our skin tries to preserve our internal heat by sending signals to our farthest blood vessels in our hands, feet, and tip of our nose telling those vessels to squeeze tight; this slows the flow of hot blood to our most distant tissues and retains heat toward the center of our body. In chilblains, those distant “shut-off” areas begin to react abnormally to the lack of blood flow. The blood vessels closest to the skin surface, and with the least blood, wage a full inflammatory response asking the body to pay attention to them. Instead of helping the situation, the inflammation actually leads to the destruction of blood vessels and real damage to the skin above them.

Pernio can be idiopathic but chronic pernio may be secondary to various systemic diseases.

Some people are more at risk of chilblains than others. This includes people with:

  • Poor circulation
  • A family history of chilblains
  • Regular exposure to cold, damp or draughty conditions
  • A poor diet or low body weight
  • Lupus – a long-term condition that causes swelling in the body's tissues
  • Raynaud's phenomenon – a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes
  • People who smoke are more at risk of chilblains as nicotine constricts blood vessels
  • Chilblains can also occur on areas of the feet that are exposed to pressure, such as a bunion or a toe that's squeezed by tight shoes.

Treating 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.

chilblains treatment

Avoiding chronic exposure to cold temperatures is the first step in treating pernio.

Keeping both the affected extremities and the core body dry and warm are essential in preventing pernio.

Chilblains often get better on their own without treatment after a week or two. It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching. Your pharmacist may also be able to recommend a suitable product. If your chilblains are severe and keep returning, speak to your GP or podiatrist. They may recommend taking daily medication

Preventing chilblains

If you're susceptible to chilblains, you can reduce your risk of developing them by:

  • Limiting your exposure to the cold
  • Looking after your feet
  • Taking steps to improve your circulation

If your skin gets cold, it's important to warm it up gradually. Heating the skin too quickly, for example by placing your feet in hot water or near a heater, is one of the main causes of chilblains.

The following advice should help:

chilblain prevention
  • Keep active – this helps improve your circulation
  • Wear warm clothes and insulate your hands, feet and legs – wearing long johns, long boots, tights, leg warmers or long socks will help, and it's a good idea to wear a clean pair of socks if you get cold feet in bed
  • Avoid tight shoes and boots – these can restrict the circulation to your toes and feet
  • Wearing appropriate insulated, loose-fitting clothing
  • Avoiding exposure to damp, cold environments
  • Keeping always feet dry (moisture enhances cold injury)
  • Moisturise your feet regularly – this stops them drying out and the skin cracking
  • Eat at least one hot meal during the day – this will help warm your whole body, particularly in cold weather
  • Warm your shoes on the radiator before you put them on – make sure damp shoes are dry before you wear them; if your feet are already cold, make sure your shoes aren't too hot to avoid causing chilblains
chilblains avoid fire
  • Don’t toast your feet near a fire – If the skin gets cold, it's important to warm it up gradually. Heating the skin too quickly, for example by placing the feet in hot water or near a heater, is one of the main causes of chilblains.
  • Warm your hands before going outdoors – soak them in warm water for several minutes and dry thoroughly, and wear cotton-lined waterproof gloves if necessary; if your hands are already cold, make sure not to warm them up too quickly to avoid causing chilblains
  • Keep your house well heated – try to keep one room in the house warm and avoid drafts
  • If you are diabetic, regularly check your feet (or ask someone else to do this) – people with diabetes may not be able to feel their feet and could have infected chilblains without realising it
chilblains avoid fire

Complications of chilblains

If you have severe or recurring chilblains, there's a small risk of further problems developing, such as:

chilblains avoid fire
  • Permanent discolouration of the skin
  • Scarring of the skin
  • Infection from blistered or scratched skin
  • Ulcers forming on the skin

It's often possible to avoid these complications by:

  • Not scratching or rubbing the affected areas of skin
  • Not directly overheating the chilblains (by using hot water, for example)

You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing. The dressing should be changed every other day until the skin heals.

If the skin does become infected, antibiotics may be prescribed to treat the infection.