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Dr. Nadheer K M (AIIMS)MBBS

March 17, 2020

March 17, 2020


While some people enjoy the cold air of winters, for others, winters can bring itchiness and pain in the form of chilblains. Chilblains are medically known as perniosis and are the reaction of the skin to the cold. 

Chilblains are small, reddish-purple or dark blue, itchy blister-like swellings present on some parts of the skin which appear on exposure to cold temperatures. They mostly appear on the body's extremities such as the fingers, toes, heels, earlobes and tip of the nose.

Chilblains can be prevented by avoiding cold temperatures, wearing warm clothes, keeping the extremities covered, dipping hands and feet in warm water and staying away from damp environments.

Chilblains usually resolve on their own after a week or two but if they start oozing pus or ulcerate, then immediate medical attention would be required.

Symptoms of chilblains

The symptoms of chilblains are:

  • Bluish-red coloured lesions (acrocyanosis) seen on extremities such as the fingers, toes, lower legs, heels, ears and nose
  • Pain and itching in the skin of that area
  • Burning sensation on the affected area
  • Swelling of the skin after coming in a warmer environment
  • Blister like lesions may be seen in some cases which ulcerate on rubbing or scratching

Causes of chilblains

The reasons behind the appearance of chilblains are:

  • Change in temperature: When your skin is exposed to a cold environment, the blood vessels come closer to the surface and become narrower. When you move closer to a heat source, say an electric heater, your blood vessels become wider and blood rushes through the vessels. If this shift from cold to warm happens very quickly, the blood vessels near the surface of the skin do not get time to adjust accordingly and start leaking the blood into the surrounding tissue. This causes the swelling and itchiness associated with chilblains.
  • Tight shoes: Chilblains can result from wearing tight or ill-fitted shoes. These shoes constrict the blood vessels, thus hindering proper blood supply to the extremities.
  • Poor blood circulation: Diseases like peripheral artery disease (PAD) and varicose veins hamper the blood circulation of the body. This can make people with these conditions prone to chilblains during winters.
  • Systemic Lupus Erythematosus (lupus): Chilblain lupus is a condition in which people with lupus get chilblains. The person may also have other symptoms like itching and excessive sweating.
  • Raynaud’s phenomenon: Raynaud’s phenomenon is a condition in which the extremities - like fingers or toes - turn pale all of a sudden due to restriction of blood flow. They are prone to get chilblains easily.

How to prevent chilblains

You can prevent chilblains by practising these measures:

  • If you are susceptible to chilblains, try and avoid exposure to the cold as much as possible.
  • You should wear clothing like gloves, socks and scarves which will protect your feet, hands, and ears from the cold. Socks made with natural wool will not only provide you with warmth but will also allow your feet to breathe.
  • Whenever you come back home from a cold environment, do not immediately expose your hands and feet to the warmth of a heater or blanket, as it may trigger chilblains.
  • Exercise regularly as this will improve your blood circulation.
  • You may soak your hands and feet in warm water once or twice a week to reduce any swelling or inflammation, and also to improve your blood circulation.
  • Make sure that you take plenty of fluids, including limited amounts of tea and coffee to stay warm. Eat a nutritious diet. You may take vitamin C supplements to maintain the moisture of the skin.
  • Quit smoking as the nicotine in your cigarettes constricts the blood vessels and hampers your blood circulation. This can make you prone to chilblains. 
  • Dry your hands and feet completely after you have taken a bath. You should also apply an emollient (creams for soothing the skin) to avoid any cracking of the skin.
  • Try and avoid wearing tight shoes and boots to prevent the constriction of blood vessels, which can hamper the blood circulation to your toes and feet.
  • You can warm up your shoes and socks by placing them at a safe distance from the heater before putting them on. If in case your feet are too cold, do not heat up your shoes or else it would lead to chilblains.

Treatment of chilblains

Chilblains often get better on their own after a week or two without treatment. Additionally, there are certain things you can do in order to treat chilblains:

  • Soothing lotions like calamine or witch hazel can help to relieve itching. 
  • You can take paracetamol or ibuprofen to relieve pain.
  • Wear warm socks and gloves to maintain the temperature of the extremities.
  • Your doctor can also prescribe you some calcium channel blockers like nifedipine in order to prevent the blood vessels from constricting.

But if the chilblains keep occurring again and again or get filled with pus, then you must seek medical help. You also need to go to the doctor if you get a fever or have diabetes.

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