Chilblains: Causes, Symptoms, and Best Treatment Options

Introduction

Chilblains, also known as pernio, is a condition that has been recognized for centuries, particularly in colder climates. It occurs when the skin reacts to sudden temperature changes, especially when moving from cold to warm environments. While not life-threatening, chilblains can cause significant discomfort and may lead to complications if left untreated. This article provides a comprehensive overview of chilblains, including its causes, symptoms, risk factors, and treatment options. Understanding the condition can help patients manage symptoms and prevent future occurrences.

This article will cover key areas such as risk factors for developing chilblains, symptoms to watch for, diagnostic tests, medications, procedures, and home remedies to alleviate symptoms.

What Are Chilblains?

Chilblains are small, itchy, and painful red or purple swellings that develop on the skin, typically affecting the fingers, toes, ears, or nose. They result from an abnormal response to cold exposure, where blood vessels constrict and then rapidly expand when exposed to warmth. This sudden change causes inflammation and damage to small blood vessels, leading to the characteristic symptoms of chilblains.

Chilblains usually develop within hours of cold exposure and can last for days to weeks. In some cases, they may progress to form blisters or ulcers, increasing the risk of infection. While more common in colder climates, chilblains can also occur in milder temperatures if the skin is exposed to cold and then rapidly warmed.

Research shows that chilblains are more prevalent in women than men and tend to affect individuals with poor circulation or those who are underweight. Although relatively common, especially in colder regions, chilblains are often underreported, as many people mistake them for other skin conditions.

Risk Factors for Developing Chilblains

Lifestyle Risk Factors

Certain lifestyle factors can increase the likelihood of developing chilblains. Prolonged exposure to cold, damp environments is a significant risk factor. People who spend a lot of time outdoors in cold weather, such as construction workers, farmers, or outdoor sports enthusiasts, are at higher risk. Wearing tight or restrictive clothing, especially shoes that limit circulation to the extremities, can also contribute to chilblains.

Smoking is another lifestyle factor that increases the risk. Smoking constricts blood vessels, reducing circulation to the skin and making it more susceptible to damage from temperature changes. Smokers are more likely to experience severe or recurrent chilblains.

Medical Risk Factors

Several medical conditions can predispose individuals to chilblains. People with poor circulation, such as those with peripheral artery disease (PAD) or Raynaud’s phenomenon, are at higher risk. These conditions affect blood flow to the extremities, making it harder for the body to regulate temperature, which increases the likelihood of chilblains.

Autoimmune conditions like lupus can also raise the risk. In these cases, the immune system attacks healthy tissues, including blood vessels, leading to inflammation and poor circulation. Additionally, people with diabetes may be more prone to chilblains due to nerve damage and circulation issues associated with the disease.

Genetic and Age-Related Risk Factors

Genetics can also play a role in the development of chilblains. A family history of the condition may make some individuals more susceptible. Age is another factor, as chilblains are more common in children and the elderly. Children may be more prone because their bodies are still developing and may not regulate temperature as effectively as adults. Older adults may experience reduced circulation due to age-related cardiovascular changes, increasing their risk.

Women are more likely to develop chilblains than men, possibly due to hormonal differences that affect circulation. Additionally, people with a lower body mass index (BMI) may be at higher risk because they have less body fat to insulate against the cold.

Clinical Manifestations

Redness

Redness, or erythema, is one of the most common symptoms of chilblains, occurring in about 90% of cases. It results from inflammation of small blood vessels in response to cold exposure. When the skin is exposed to cold, blood vessels constrict to conserve heat. In chilblains, the vessels don’t return to normal quickly when rewarmed, leading to blood leakage into surrounding tissues, causing red discoloration. Redness is often the first sign of chilblains and can be more pronounced in individuals with poor circulation or frequent exposure to cold, damp environments.

Swelling

Swelling, or edema, occurs in about 80% of chilblains cases. It results from fluid accumulation in tissues due to inflammation and blood leakage from small vessels. Swelling typically affects the fingers, toes, ears, or nose—areas most exposed to cold. The severity of swelling depends on the extent of inflammation. It can make the affected areas feel tight and uncomfortable, worsening if untreated. Individuals with conditions like Raynaud’s phenomenon or poor circulation are more prone to significant swelling.

Itching

Itching is reported in about 70% of chilblains patients. It results from skin irritation due to inflammation and swelling. The itching can range from mild to severe and often worsens when the affected areas are warmed after being cold. Scratching can lead to further irritation and skin damage, so it’s important to resist the urge to scratch. Itching is more common in the early stages of chilblains and may subside as the condition progresses or inflammation decreases.

Pain

Pain is experienced by approximately 60% of individuals with chilblains. It is typically described as a burning or aching sensation caused by inflammation and swelling of small blood vessels. The pain may be constant or worsen when the affected areas are touched or exposed to warmth. In some cases, the pain can be severe enough to interfere with daily activities. Pain is more likely in severe cases of chilblains or when complications like blistering or ulceration develop.

Blistering

Blistering occurs in about 40% of chilblains cases, especially in more severe or prolonged cases. Blisters form when inflammation and swelling cause the outer skin layers to separate, allowing fluid to accumulate between them. Blisters can be painful and increase the risk of infection if they rupture. Blistering is more common in individuals who continue to be exposed to cold or have underlying conditions affecting circulation. Proper care of blisters is essential to prevent complications.

Burning Sensation

A burning sensation is reported by around 50% of chilblains patients. It is often described as a tingling or stinging feeling in the affected areas, caused by nerve irritation due to swelling and blood vessel damage. The burning sensation may be more noticeable when the affected areas are warmed after being cold. This symptom can be particularly uncomfortable and may persist even after other symptoms, such as redness and swelling, have subsided.

Discoloration

Discoloration, ranging from red to purple or blue, occurs in about 65% of chilblains cases. It results from blood pooling in small vessels due to inflammation and poor circulation. Discoloration may worsen when the affected areas are exposed to cold or rewarmed. In some cases, discoloration may persist even after other symptoms resolve, particularly in individuals with underlying circulatory issues.

Numbness

Numbness is experienced by approximately 30% of chilblains patients. It occurs when inflammation and swelling compress the nerves in the affected areas, leading to a loss of sensation. Numbness is more common in severe cases of chilblains or in individuals with underlying conditions affecting nerve function, such as diabetes. Numbness increases the risk of injury to the affected areas, as individuals may not feel pain or discomfort.

Tenderness

Tenderness is reported in about 55% of chilblains cases. It results from inflammation and swelling of tissues, making the affected areas sensitive to touch. Tenderness may be more pronounced in areas where the skin is thin, such as the fingers, toes, or ears. It may worsen when the affected areas are exposed to warmth or pressure. In some cases, tenderness may persist even after other symptoms resolve.

Ulceration

Ulceration is a less common but more serious symptom of chilblains, occurring in about 10% of cases. Ulcers form when the skin breaks down due to prolonged inflammation and poor circulation. Ulcers can be painful and increase the risk of infection if not properly treated. Ulceration is more likely in individuals with severe or untreated chilblains, particularly those with underlying conditions affecting circulation, such as diabetes or peripheral artery disease.

Diagnostic Evaluation

Diagnosing chilblains is primarily based on clinical evaluation, patient history, and diagnostic tests. A healthcare provider will ask about your symptoms, including when they started, how long they last, and whether they are triggered by cold exposure. A physical examination will assess the affected areas for signs of redness, swelling, and other symptoms. In some cases, additional tests may be ordered to rule out other conditions with similar symptoms, such as frostbite, lupus, or Raynaud’s phenomenon. These tests help confirm the diagnosis and guide appropriate treatment.

Skin Biopsy

Test Information

A skin biopsy involves removing a small sample of skin from the affected area for examination under a microscope. This test is typically performed in a healthcare provider’s office or clinic. The area is numbed with a local anesthetic, and a small piece of skin is removed using a scalpel or punch biopsy tool. The sample is then sent to a laboratory, where it is examined for signs of inflammation, blood vessel damage, or other abnormalities. A skin biopsy helps differentiate chilblains from other skin conditions with similar symptoms, such as lupus or vasculitis.

Results that Indicate Chilblains

In chilblains, a skin biopsy typically shows inflammation of small blood vessels (vasculitis) and damage to surrounding tissues. The biopsy may also reveal blood clots or other signs of poor circulation. If the biopsy results are consistent with chilblains, your healthcare provider will confirm the diagnosis and recommend treatment. If the biopsy does not show signs of chilblains, your provider may consider other diagnoses, such as frostbite, lupus, or another inflammatory condition. Further testing may be needed to determine the cause of your symptoms.

Blood Tests

Test Information

Blood tests are often ordered to rule out underlying conditions that may contribute to chilblains, such as autoimmune disorders or blood clotting abnormalities. Common blood tests include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA) test. These tests are performed by drawing a small blood sample from a vein, usually in your arm. The blood is then analyzed in a laboratory to check for signs of inflammation, infection, or other abnormalities. Blood tests are important in diagnosing chilblains because they can help identify underlying conditions that may need to be treated alongside chilblains.

Results that Indicate Chilblains

Blood tests do not directly diagnose chilblains but provide important information about your overall health. For example, an elevated ESR or the presence of ANA antibodies may suggest an underlying autoimmune disorder, such as lupus, which can cause symptoms similar to chilblains. If your blood tests are normal, it is more likely that your symptoms are due to chilblains rather than another condition. However, if your blood tests show abnormalities, your healthcare provider may recommend further testing or refer you to a specialist for additional evaluation.

Capillaroscopy

Test Information

Capillaroscopy is a non-invasive test that examines the small blood vessels (capillaries) in the skin, usually at the base of the fingernails, using a special microscope. This test is performed in a healthcare provider’s office or clinic and does not require special preparation. During the test, a drop of oil is placed on the skin, and the capillaries are viewed under the microscope. Capillaroscopy is important in diagnosing chilblains because it allows healthcare providers to assess the health of small blood vessels and detect abnormalities contributing to your symptoms.

Results that Indicate Chilblains

In chilblains, capillaroscopy may reveal dilated or damaged capillaries and areas of poor blood flow. These findings are consistent with the inflammation and blood vessel damage that occur in chilblains. If the capillaroscopy results suggest chilblains, your healthcare provider will confirm the diagnosis and recommend treatment. If the results are normal, your provider may consider other possible causes of your symptoms, such as Raynaud’s phenomenon or another circulatory disorder. Further testing may be needed to determine the underlying cause of your symptoms.

Cold Stimulation Test

Test Information

The cold stimulation test, also known as the cold challenge test, assesses how your blood vessels respond to cold temperatures. During this test, your hands or feet are exposed to cold water or air for a short period, usually around 10 minutes. After cold exposure, the temperature of your skin is measured to see how quickly it returns to normal. This test is important in diagnosing chilblains because it helps determine whether your blood vessels overreact to cold exposure, a key feature of chilblains.

Results that Indicate Chilblains

In chilblains, the cold stimulation test may show a delayed return to normal skin temperature after cold exposure, indicating that your blood vessels are not functioning properly. This delayed response is consistent with the poor circulation and blood vessel damage seen in chilblains. If the test results suggest chilblains, your healthcare provider will confirm the diagnosis and recommend treatment. If the test results are normal, your provider may consider other possible causes of your symptoms, such as Raynaud’s phenomenon or another circulatory disorder.

What if All Tests are Negative but Symptoms Persist?

If all tests come back negative but your symptoms persist, it is important to continue working with your healthcare provider to determine the underlying cause. In some cases, chilblains may be diagnosed based on clinical evaluation alone, especially if your symptoms are consistent with the condition and other potential causes have been ruled out. Your provider may recommend lifestyle changes, such as avoiding cold exposure and improving circulation, as well as treatments to manage your symptoms. If your symptoms do not improve, further testing or referral to a specialist may be necessary.

Treatment Options for Chilblains

Medications for Chilblains

Topical Corticosteroids

Topical corticosteroids are anti-inflammatory creams or ointments applied directly to the skin to reduce swelling, redness, and itching caused by chilblains.

These medications are commonly used in mild to moderate cases to relieve discomfort and inflammation. Typically applied once or twice daily, they are often the first-line treatment for managing symptoms.

Patients may notice improvements in itching and swelling within a few days to a week of consistent use.

Oral Corticosteroids

Oral corticosteroids are taken by mouth to reduce inflammation throughout the body and are more potent than topical options.

These are generally reserved for severe chilblains that don’t respond to topical treatments. They are prescribed for short-term use to control significant inflammation and prevent complications.

Patients may experience relief from severe symptoms within a few days, but long-term use is avoided due to potential side effects.

Antihistamines

Antihistamines block histamine, a substance that causes allergic reactions and itching.

These medications help alleviate itching and discomfort, especially when itching is severe. Typically taken orally, they can be used alongside other treatments.

Patients usually experience relief from itching within a few hours, although antihistamines do not address underlying inflammation.

Vasodilators

Vasodilators widen blood vessels, improving blood flow to affected areas.

These drugs are used when poor circulation significantly contributes to chilblains, often prescribed for recurrent or severe cases, particularly in cold weather.

Improved circulation can reduce the frequency and severity of chilblains, though noticeable changes may take several days to weeks.

Pain Relievers

Pain relievers like acetaminophen or ibuprofen are over-the-counter medications used to manage pain and discomfort.

These medications are taken as needed to alleviate pain associated with chilblains, especially when discomfort is significant.

Pain relief is typically felt within 30 minutes to an hour, but these drugs do not treat the underlying cause of chilblains.

Calcium Channel Blockers

Calcium channel blockers relax the muscles of blood vessels, improving circulation.

These medications are sometimes prescribed for severe or recurrent chilblains, particularly when other treatments have been ineffective. They are taken orally to improve blood flow to the extremities.

Patients may notice a reduction in the frequency and severity of chilblains after several weeks of use.

Nitroglycerin Ointment

Nitroglycerin ointment is a topical medication that dilates blood vessels to improve circulation.

This ointment is applied directly to affected areas and is used in cases where poor circulation contributes to chilblains. It is typically used in more severe or recurrent cases.

Patients may experience improved blood flow and reduced symptoms within a few days, though side effects like headaches can occur.

Aloe Vera

Aloe vera is a natural plant extract known for its soothing and anti-inflammatory properties.

Applied topically, aloe vera gel can reduce inflammation, soothe itching, and promote healing. It is often used as a complementary treatment alongside other medications.

Patients may experience relief from itching and discomfort within a few hours, though visible improvement in skin condition may take several days.

Emollients

Emollients are moisturizing creams or ointments that help keep the skin hydrated and prevent cracking.

These are used to protect the skin from further damage and soothe dry, irritated skin caused by chilblains. They are typically applied several times a day.

Regular use of emollients can improve skin texture and reduce discomfort within a few days.

Warm Compresses

Warm compresses, soaked in warm water, are applied to affected areas to increase blood flow and relieve discomfort.

They are often a first-line treatment for mild chilblains and can be applied several times a day to reduce swelling and promote circulation.

Patients may experience immediate relief from discomfort, though consistent use is necessary for lasting improvement.

Procedures for Severe Chilblains

In most cases, chilblains do not require invasive procedures. However, in rare instances where ulcers or infections develop, minor surgical interventions may be needed to drain fluid or remove damaged tissue. These procedures are typically performed by a healthcare provider and are reserved for severe cases that do not respond to other treatments.

Improving Chilblains and Seeking Medical Help

In addition to medical treatments, several home remedies can help alleviate chilblains symptoms and prevent them from worsening:

1. Warm Compresses: Applying warm compresses to affected areas can improve circulation and reduce discomfort.
2. Moisturizing Creams: Regularly applying moisturizing creams can prevent the skin from becoming dry and cracked, which can worsen chilblains.
3. Avoiding Cold Exposure: Limiting exposure to cold temperatures is crucial in preventing chilblains from developing or worsening.
4. Wearing Warm Clothing: Dressing in layers and wearing warm socks and gloves can help protect extremities from cold weather.
5. Elevating Affected Areas: Elevating hands or feet can reduce swelling and improve circulation.
6. Gentle Massage: Massaging affected areas can promote blood flow and relieve discomfort.
7. Using Protective Footwear: Wearing well-fitting, insulated shoes can protect feet from cold and damp conditions.
8. Maintaining Good Circulation: Regular exercise and avoiding tight clothing can improve circulation and reduce the risk of chilblains.
9. Dietary Adjustments: A balanced diet rich in vitamins and minerals supports overall skin health and circulation.

If home remedies and over-the-counter treatments do not provide relief, or if symptoms worsen, it is important to seek medical help. Telemedicine offers a convenient way to consult with a healthcare provider from the comfort of your home. Through telemedicine, you can receive a diagnosis, discuss treatment options, and get prescriptions without needing to visit a clinic in person.

Living with Chilblains: Tips for Better Quality of Life

Living with chilblains can be uncomfortable, but there are steps you can take to manage the condition and improve your quality of life:

1. Stay warm by dressing in layers and protecting your extremities from cold weather.
2. Keep your skin moisturized to prevent cracking and irritation.
3. Engage in regular physical activity to promote good circulation.
4. Take breaks to elevate your feet or hands if you experience swelling.
5. Monitor your symptoms and seek medical advice if they worsen or do not improve with home care.

By following these tips and working closely with your healthcare provider, you can effectively manage chilblains and reduce the risk of complications.

Conclusion

Chilblains are a common condition caused by exposure to cold and damp conditions, leading to inflammation, itching, and discomfort. While chilblains can be painful, they are generally not serious and can be managed with a combination of medications, home remedies, and lifestyle changes.

Early diagnosis and treatment are important to prevent complications and reduce the severity of symptoms. If you are experiencing persistent or worsening symptoms, our telemedicine practice is here to help. Schedule a virtual consultation with one of our healthcare providers to discuss your symptoms and receive personalized treatment recommendations.

James Kingsley

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