Chilblains

Winter is with us and unfortunately so is the risk of developing chilblains. Chilblains, also known as pernio, are small patches of inflamed skin, typically red or bluish. Chilblains form on the extremities – small toes are most prone but they can develop on the heels, legs, fingers, nose or ears. They may feel itchy, tender or painful. In extreme cases the surface of the skin may break and sores (ulcers) may develop. Chilblains develop when the capillaries, the tiny blood vessels under the skin, constrict under cold damp conditions reducing the flow of blood. When the skin warms up, particularly if rapidly, fluid escapes into the tissue causing an inflammatory response.

Anyone can develop chilblains but you are more at risk if you are a smoker, have a low BMI (body mass index), female (they are more common in women than men) and in people with poor circulation and other health problems involving their blood vessels, such as peripheral arterial disease, Raynaud’s Syndrome, Lupus and various anaemias.

The best way to prevent chilblains is to keep your legs, feet and body warm, especially if your circulation is poor and your mobility is limited. The whole body, rather than just the feet, needs to be kept warm. Wearing Long Johns, trousers, long boots, tights, leg warmers, long socks and gloves will help. Multiple thin layers are better than one thick layer.

You may reduce your risk by:

  • Avoiding cold, damp environments as much as possible.
  • Exercising regularly to improve your blood circulation, chairside exercise can help if your mobility is restricted.
  • Stop smoking – nicotine causes the blood vessels to constrict, which can make chilblains worse
  • Avoid wearing tight footwear as pressure on the skin will further constrict the capillaries.
If you have developed chilblains do not scratch them, instead use soothing lotions such as witch hazel and calamine on them to reduce some of the discomfort. Keep your feet warm and well moisturised if the skin is intact. Most of the time, chilblains heal in 2-3 weeks.
There are some other conditions with similar symptoms. Some of these conditions can be severe. Our Podiatrists can help with a diagnosis and referral where appropriate.
These conditions include:
  • Frostbite – occurs when your skin freezes during exposure to freezing temperatures. Frostbite symptoms can include pain, numbness, swelling, blisters and skin discolouration.
  • Cellulitis – a bacterial infection of your skin and the tissue beneath your skin.
  • Contact dermatitis – a rash on your skin that develops when you come into contact with something you’re allergic to or something that irritated your skin. The rash can swell and be itchy and painful
  • Blood clots (embolisms) in your toes and feet causing a blockage in the blood vessel, potentially very serious.
  • Raynaud’s phenomenon (white finger or toe)- an abnormal reaction to cold when the capillaries constrict for long periods.

When to seek help

The Complications of pernio are similar to other vasospastic conditions, breaks in the integrity of the skin, tissue breakdown, ulceration and of course broken skin risks infection. If the skin around the chilblain has broken, apply a sterile dressing and consult one of our podiatrists for wound care, particularly if you have diabetes or an underlying health condition. It’s important to keep nails short and smooth. Our podiatrists can help to reduce the painful symptoms by ensuring that the nails are kept short so that inflamed skin is not subjected to pressure or pierced by the nail

If you are at high risk of developing chilblains you may find that they return every year when the weather changes or last throughout the winter. If this is the case, medication such as Nifedipine, a calcium channel blocker which works by relaxing blood vessels thus improving circulation and used to manage angina, high blood pressure and Raynaud’s phenomenon, may be prescribed to prevent the development of chilblains.
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