Chilblains
Itchy, swollen skin patches triggered by cold
Quick Facts
- Type: Cold-related skin reaction
- Common sites: Toes, fingers, ears, nose
- Trigger: Rapid warming after cold exposure
- Usual course: Heals in 1 to 3 weeks
Overview
Chilblains, also called pernio, are small, itchy, swollen patches of skin that develop as an abnormal reaction to cold. They most often appear on the toes and fingers, but can also affect the ears, nose, and other exposed areas. The patches are usually red or purple, may feel tender or burning, and tend to itch, especially as the skin warms up.
Chilblains are thought to happen when small blood vessels in the skin narrow in the cold and then warm up too quickly, causing fluid to leak into nearby tissue and producing inflammation. They are uncomfortable but usually harmless, and most clear up on their own within one to three weeks. They are most common in cold, damp climates and in people who are not used to the cold.
Symptoms
Chilblains usually appear a few hours after cold exposure. Typical features include:
- Small, itchy red or purple patches, often on toes and fingers
- Burning or tender sensation, especially as the skin warms
- Swelling of the affected skin
- A change in skin color from red to dark blue as they fade
- In more severe cases, blistering or, rarely, small open sores
The itching and burning often become more noticeable when moving from a cold environment into a warm room. Most chilblains heal without scarring, but repeated or severe ones may need medical attention.
Causes
Chilblains are an overreaction of the skin's small blood vessels to changes in temperature. When skin is cold, the tiny vessels narrow; if it then warms quickly, the vessels widen unevenly and fluid leaks into the surrounding tissue, causing swelling and inflammation.
- Cold, damp weather: The main trigger, particularly when skin is repeatedly chilled.
- Rapid rewarming: Warming cold skin too fast, such as putting cold feet near a heater.
Some people are more prone because of poor circulation or underlying conditions. In a minority of cases, chilblains are linked to other disorders that affect blood vessels.
Risk Factors
- Living in a cold, damp climate
- Poor circulation in the hands and feet
- Being underweight or having a low body weight
- Wearing tight or damp footwear and clothing
- Conditions such as Raynaud's phenomenon or some autoimmune disorders
- Smoking, which narrows blood vessels
Diagnosis
Chilblains are usually diagnosed by their appearance and a history of cold exposure:
- Examination: A health professional looks at the affected skin and asks about recent cold conditions.
- Reviewing patterns: Chilblains that are frequent, severe, occur outside cold weather, or do not heal may prompt tests for underlying conditions.
- Further tests: Occasionally blood tests or a skin biopsy are done to rule out other causes when the picture is unusual.
Treatment
Most chilblains heal on their own. The main goals are to relieve symptoms and protect the skin.
- Warm gradually: Rewarm cold skin slowly rather than with direct heat, which can make symptoms worse.
- Soothe itching: Gentle moisturizers or soothing lotions can help; a doctor may suggest a topical steroid cream for itch and inflammation.
- Avoid scratching: Scratching can break the skin and lead to infection.
- Keep warm and dry: Protect affected areas and keep them dry.
- Medication: For severe or recurrent cases, a doctor may prescribe a medicine that improves blood flow.
If a chilblain blisters or breaks, keep it clean and watch for signs of infection.
Prevention
- Keep hands, feet, ears, and nose warm and dry in cold weather
- Wear layers, warm socks, and gloves; choose footwear that is not too tight
- Avoid sudden warming of cold skin near fires or heaters
- Keep your home comfortably warm
- Stay active to support good circulation
- Avoid smoking, which narrows blood vessels
When to See a Doctor
See a doctor if your chilblains are severe, keep coming back, do not heal within a few weeks, or appear when it is not cold. Seek prompt care if you notice:
- Blisters or skin that breaks down
- Spreading redness, warmth, swelling, or pus, which can signal infection
- Fever along with the skin changes
Recurrent or unusual chilblains may need evaluation for an underlying circulation or autoimmune condition.
Frequently Asked Questions
What causes chilblains?
Chilblains happen when the small blood vessels in the skin react abnormally to cold and then warm up too quickly. Fluid leaks into nearby tissue, causing itchy, swollen red or purple patches, most often on toes and fingers.
Are chilblains serious?
They are usually harmless and clear up within one to three weeks. However, severe chilblains can blister or become infected, and frequent or unusual ones may point to an underlying circulation or autoimmune condition.
How can I prevent chilblains?
Keep your hands, feet, ears, and nose warm and dry, dress in layers, avoid warming cold skin too quickly near heaters, and keep your home comfortably warm. Staying active and not smoking also helps circulation.
Should I warm chilblains by a fire or heater?
No. Warming cold skin too quickly with direct heat can make chilblains worse. Instead, rewarm gradually at room temperature and keep the area warm and dry.
When should I see a doctor about chilblains?
See a doctor if they are severe, keep returning, do not heal in a few weeks, or appear when it is not cold. Get prompt care if the skin blisters, breaks down, or shows spreading redness, pus, or fever.
References
- Mayo Clinic. Chilblains — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Cold-related conditions.
- National Health Service (NHS). Chilblains.
- American Academy of Dermatology. Cold weather and your skin.