Chilblains

Overview

Chilblains (CHILL-blayns) is a condition that causes inflamed swollen patches and blistering on the hands and feet. It's caused by exposure to damp air that's cold but not freezing. Symptoms may show up a few hours after being in the cold.

Chilblains can be prevented by limiting your time in the cold, dressing warmly and covering exposed skin. If you do get chilblains, keeping the skin warm and dry can help ease the symptoms.

Chilblains, also known as perniosis, usually clears up in 2 or 3 weeks, especially if the weather gets warmer. You may get the symptoms each cold season for years.

The condition doesn't usually result in permanent injury.

Symptoms

Symptoms of chilblains include:

• Small, itchy areas on your skin, often on your feet or hands.
• Sores or blistering.
• Swelling.
• Pain or stinging.
• Changes in skin color.

When to see a doctor

Seek medical care for chilblains if you:

• Have symptoms that are long lasting or go away then flare.
• Think you might have an infection.
• Have symptoms that aren't improving after two weeks of home care.
• Have symptoms that extend into the warm season.
• Aren't sure whether you were in below-freezing temperatures, as you might have frostbite.

Causes

The exact cause of chilblains is unknown. They may be an unusual reaction of your body to cold 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.

Risk factors

The following factors increase the risk of chilblains:

• Wearing clothing and shoes that are tight or expose skin to the cold. Wearing tightfitting clothing and shoes in cold, damp weather may make you more susceptible to chilblains.
• Being a young woman. This condition is most common in females between the ages of 15 and 30.
• Being underweight. This condition is most common in people with a low body mass.
• Living in cold, humid areas. Your risk of chilblains is higher if you live in an area with high humidity and cold but not freezing temperatures.
• Having certain medical conditions. These include Raynaud's phenomenon, connective tissue disease and SARS-CoV-2.

Complications

Chilblains symptoms that are long-lasting and develop after repeated exposure to cold and damp conditions can cause scarring and thin skin.

Prevention

To prevent chilblains:

• Avoid or limit your exposure to the cold.
• When you come in from the cold, rewarm the skin gradually.
• Dress in layers of loose clothing and wear mittens, a scarf and a hat, and warm, water-resistant footwear.
• Cover all exposed skin as completely as possible when going outside in cold weather.
• Keep your hands, feet and face dry and warm.
• Keep your home and workplace comfortably warm.
• Don't smoke.

Diagnosis

To diagnose chilblains, your health care provider will look at the affected skin and talk with you about your symptoms and any recent cold exposure. Tell your health care provider if you're not sure whether you were in below-freezing temperatures. If you were, you might have frostbite.

To rule out other conditions, you may need blood tests. Or your health care provider may take a small sample of the affected skin to have it examined under a microscope in a laboratory. This test is called a skin biopsy.

Treatment

Chilblains can be treated at home with self-care, including keeping your hands and feet warm and dry. If your chilblains symptoms don't clear up with self-care, your health care provider may suggest medicine, including:

• A topical corticosteroid. If your chilblains symptoms include sores, applying a corticosteroid such as triamcinolone 0.1% cream might help clear them up.
• Blood pressure medicine. For symptoms that don't respond to other treatment, your health care provider might prescribe a blood pressure medicine such as nifedipine (Procardia). It's a type of calcium channel blocker that treats chilblains by improving blood flow.

Lifestyle and home remedies

Chilblains symptoms usually clear up in 2 or 3 weeks after cold exposure. In the meantime, try the following tips to ease your symptoms:

• Rewarm the skin slowly and gently, without massaging, rubbing or applying direct heat.
• Avoid cold exposure whenever possible.
• Keep the affected skin dry and warm, but away from sources of heat.
• Apply lotion to alleviate itching, such as hydrocortisone cream available in drugstores.
• Keep any blisters and sores clean and covered.
• Avoid scratching the affected skin.
• If you smoke, try to quit, as smoking can narrow your blood vessels and slow wound healing.

Preparing for an appointment

You may start by seeing your primary care provider. Or you may be referred to a doctor who specializes in skin conditions called a dermatologist or one who specializes in blood vessels called a cardiologist.

Here's some information to help you get ready for your appointment.

What you can do

• List any symptoms you've noticed.
• List your key medical and personal information, including any major stressors, recent life changes or vacations to places with weather that differs from where you live.
• List all medications, vitamins and supplements you take, including doses.
• List questions to ask your health care provider.

For chilblains, some basic questions to ask your health care provider include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• Do I need any tests?
• Is this condition short term or long lasting?
• What treatments do you recommend?
• What side effects can I expect from treatment?
• What are the alternatives to the primary approach that you're suggesting?
• Do I need to restrict my activities in any way?
• I have other health conditions. How can I best manage them together?
• Do you have any brochures or other printed material I can take with me? What websites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• When did you first notice your symptoms?
• Do your symptoms get worse in response to quick changes in temperature?
• Does anything seem to improve your symptoms?
• Have you ever had these symptoms before?
• Have you been diagnosed with Raynaud's phenomenon?

What you can do in the meantime

Try to keep the affected area warm and dry.