Chilblains are itchy and/or tender red or purple bumps that occur as a reaction to cold. The condition is also known as pernio and is a localized form of vasculitis.

Chilblains occur several hours after exposure to the cold in temperate humid climates. They are sometimes aggravated by sun exposure. Cold causes constriction of the small arteries and veins in the skin and re-warming results in leakage of blood into the tissues and swelling of the skin.

Chilblains are less common in countries where the cold is more extreme because the air is drier and people have specially designed living conditions, clothing and shoes. Children and the elderly are most often affected.

Chilblains are more likely to develop in those with poor peripheral circulation (ie. blue-red mottled skin) on the limbs.

Contributing factors include:

• A familial tendency
• Peripheral vascular disease due to diabetes, smoking, hyperlipidemia
• Poor nutrition (anorexia nervosa)
• Hormonal changes – chilblains can improve during pregnancy
• Connective tissue disease (lupus erythematosus)
• Bone marrow disorders

Common sites for chilblains are:

• Backs and sides of the fingers and toes
• Heels
• Lower legs
• Thighs especially in horse riders
• Wrists of babies
• Over fatty lumps (lipomas)
• Nose
• Ears

Each chilblain comes up over a few hours as an itchy red swelling and subsides over the next 7-14 days. In severe cases blistering, pustules, scabs and ulceration can occur. Occasionally the lesions may be ring-shaped. They may become thickened and persist for months.

In children recurrences each winter for a few years are common but complete recovery is usual. Chilblains in elderly people have a tendency to get worse every year unless precipitating factors are avoided.

Treatment

Unfortunately chilblains respond poorly to treatment. The following medications may be useful:

• A potent topical steroid applied for a few days may relieve itch and swelling.
• Antibiotic ointment or oral antibiotics may be necessary for secondary infection.
• Vasodilators such as calcium channel blockers.

Prevention

The hands and feet must not be allowed to get cold.

DO NOT SMOKE!

The following measures may help to keep you warm:

• Insulated and heated home and workplace.
• Warm clothing especially gloves, thick woollen socks and comfortable protective footwear. Keep the head and neck warm with hat and scarf.
• Before going outside, soak hands in warm water for several minutes to warm hands through then dry thoroughly.
• Exercise before going outside in cold weather.
• Wear cotton-lined waterproof gloves for wet work
• Apply sunscreen to exposed skin even on cloudy days.