ConditionSkin, hair & nails
Chilblains (Pernio)
Chilblains, or pernio, are small, itchy, painful red or purple swellings that appear on the toes, fingers, ears or nose a few hours after exposure to cold, damp, non-freezing conditions. They happen when small blood vessels react abnormally to cold and then rewarming. Most heal on their own in 1 to 3 weeks if you keep the skin warm and dry. Chilblains that keep recurring, last beyond the cold season, or come with joint pain or rashes can be linked to lupus or circulation problems and should be checked.
Also called: Pernio, perniosis, chilblain, cold-induced inflammation, COVID toes (pernio-like lesions)
At a glance
- What it is
- Inflammation of small blood vessels in the skin triggered by cold, damp conditions.
- Where
- Toes most often; also fingers, heels, ears, nose and, with tight clothing, thighs.
- Symptoms
- Itchy, burning, red or purple swellings 12 to 24 hours after cold exposure.
- Who gets it
- More common in women, people with low body weight, smokers, and those with poor circulation or lupus.
- Treatment
- Keep warm and dry, avoid rapid rewarming, and in persistent cases prescription nifedipine or steroid creams.
- Outlook
- Usually heal in 1 to 3 weeks without scarring.
When to get help
See a doctor within a day or two
- Chilblains that blister, ulcerate, turn black or ooze pus, or with spreading redness and fever (possible infection)
- Skin that is hard, white, waxy or numb after freezing cold (possible frostbite)
- Severe pain or color change in toes or fingers if you have diabetes or poor circulation
Book a routine appointment
- Chilblains that recur every winter, last more than 3 weeks, or persist into warmer months
- Chilblains with joint pain, rashes, mouth ulcers, hair loss or fatigue (possible lupus)
- Chilblains in a child, or with fingers that turn white then blue in the cold (Raynaud's)
Usually safe to manage at home
- Itchy red or purple bumps on toes after cold, damp weather that are slowly improving
What causes chilblains
Exposure to cold narrows small blood vessels near the skin. In people prone to chilblains, rewarming makes these vessels leak and become inflamed, causing swelling, redness and itch. The condition is linked to damp cold above freezing, not to freezing temperatures, which is why it is common in cool, humid climates.
Risk factors:
- cold, damp homes or workplaces; wet socks and gloves
- tight shoes or clothing that restricts blood flow
- low body weight
- female sex
- smoking
- Raynaud's phenomenon
- lupus and other autoimmune conditions (chilblain lupus)
- blood disorders that cause sludging in cold, such as cryoglobulinemia, and rarely some inherited conditions
- warming cold skin rapidly, for example with a heater or hot water bottle
During the COVID-19 pandemic, many young people developed pernio-like lesions on the toes ("COVID toes"). These were usually mild and resolved on their own.
Symptoms
Symptoms develop 12 to 24 hours after exposure:
- small red, purple or bluish swellings or patches, usually on the toes
- intense itching and burning, often worse when coming into the warm
- tenderness or pain
- swollen, shiny skin
- in severe cases, blisters, ulcers or cracks
Chilblains vs frostbite vs Raynaud's
| Chilblains | Frostbite | Raynaud's | |
|---|---|---|---|
| Temperature | Cold, damp, above freezing | Below freezing | Any cold or stress |
| Onset | Hours after exposure | During exposure | Minutes |
| Appearance | Red-purple, itchy swellings | White or gray, hard, waxy, numb skin | Fingers turn white, then blue, then red |
| Duration | 1 to 3 weeks | Damage may be permanent | Minutes to an hour per attack |
| Main symptom | Itch and burning | Numbness, then pain on rewarming | Numbness and tingling, then throbbing |
Diagnosis
Chilblains are diagnosed from their appearance and the history of cold exposure. A doctor may check for underlying causes if chilblains are severe, persistent or recurrent, or appear with other symptoms. Tests may include a blood count, antinuclear antibodies (for lupus), cryoglobulins and other blood tests. A skin biopsy is rarely needed.
Treatment
Self-care
- Warm up gradually. Avoid putting cold feet near heaters or into hot water, which makes chilblains worse.
- Keep the area warm and dry. Wear warm, dry socks and gloves.
- Do not scratch. Calamine lotion or witch hazel can soothe itching. Ask a pharmacist about suitable creams.
- Protect broken skin with an antiseptic and a clean dressing.
- Stop smoking, which narrows blood vessels.
Medical treatment
- Nifedipine: a blood pressure medicine that relaxes blood vessels, prescribed for severe or recurrent chilblains. It can also be taken through the winter to prevent them.
- Topical steroids: for inflammation and itch.
- Antibiotics: if the skin becomes infected.
- Treating underlying conditions, such as lupus.
Complications
- skin infection, sometimes cellulitis
- ulcers that heal slowly
- skin discoloration or, rarely, scarring
- recurrent chilblains every winter
Prevention
- Dress warmly in layers, with thermal socks, gloves, hats and waterproof footwear.
- Keep your home warm, ideally at least 18 °C (64 °F).
- Change out of wet socks and gloves promptly.
- Avoid tight footwear.
- Exercise to improve circulation.
- Warm your hands and feet before going out into the cold.
Frequently asked questions
What causes chilblains?
Chilblains are caused by an abnormal reaction of small blood vessels to cold, damp conditions followed by rewarming. The vessels leak and become inflamed. Risk is higher in women, people with low body weight, smokers, and those with Raynaud's or lupus.
How long do chilblains last?
Most chilblains heal within 1 to 3 weeks if you keep the area warm and dry and avoid further cold exposure. They can recur each winter. Chilblains that last longer than 3 weeks or persist into warm weather should be checked by a doctor.
What is the difference between chilblains and frostbite?
Chilblains result from damp cold above freezing and cause itchy, red-purple swellings hours later. Frostbite happens when tissue freezes below 0 °C (32 °F), causing hard, white or gray, numb skin, and can cause permanent damage. Frostbite needs urgent care.
How do you get rid of chilblains fast?
Warm the area slowly, keep it dry and warm, avoid scratching, and use soothing lotions. Do not apply direct heat. For severe or recurring chilblains, a doctor can prescribe nifedipine or a steroid cream to speed healing.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Chilblains
- NHS: Chilblains
- MedlinePlus: Chilblains
- British Association of Dermatologists: Chilblains patient information
- American Academy of Family Physicians: Cold injuries