Chilblains

Symptons and Diagnosis

  • Chilblains, also known as pernio and perniosis, are small red or sometimes purple lumps that form on the skin as an abnormal response to cold.
  • Chilblains form on the extremities, most commonly on the toes and other areas of the feet.
  • The lumps are usually painful and very itchy and some patients complain of a burning sensation.
  • On examination the lumps are often tender to touch.

Causes

  • Chilblains are caused by the constriction and subsequent expansion of blood vessels when the skin is exposed to cold temperatures and then warmed.
  • It is thought that warming the body too fast after exposure to cold is more likely to cause chilblains as the blood vessels fail to adjust to the rapid increase in blood flow and leak fluid into the surrounding tissue causing inflammation that leads to chilblains.
  • Chilblains will usually appear within a few hours of exposure to cold.
  • Chilblains can affect anyone and are common in otherwise healthy patients.


Risk Factors

  • Chilblains are more common in women than in men.
  • Children and the elderly are more likely to suffer from chilblains than the general population.
  • Patients with pre-existing circulatory problems, such as diabetes or Raynaud’s syndrome, are at increased risk, as are people who smoke.
  • Cold, damp conditions are more likely to lead to chilblains than climates with low humidity regardless of temperature.
  • Under weight patients have a higher risk.
  • A family history of chilblains increases the risk of the condition.

Treatment

  • Chilblains aren’t serious and have no long-term effects. The condition can usually be treated at home.
  • Symptoms usually persist for 7–14 days and then resolve, although if a blister forms around the chilblain, it may take longer to heal.
  • Although there are no creams or lotions available to treat the chilblains themselves, corticosteroid creams can be effective to ease itching and inflammation and antiseptic creams should be administered to prevent infection on broken skin.
  • For chronically recurring cases of chilblains, nifedipene can be prescribed to dilate the small blood vessels and can be useful as a preventative measure.
  • Patient education should include a reminder to avoid scratching to prevent potential scarring.
  • Medical attention is sometimes required if an ulcer forms on the site of the chilblain.  Although the formation of ulcers is rare, treatment is required to reduce the risk of infection.  Standard wound care methods should be delivered to patients at risk of infection.