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  • Writer's pictureDr. Ndidi Ufondu, DPM

Chilblains: Symptoms, Causes & Prevention

Winter is here – and, unfortunately, so also are chilblains. As podiatrists, we frequently see patients complaining of painful, itchy lesions on their toes, heels, or other extremities that appear most often during cold winter months. These lesions are known as chilblains – an abnormal inflammatory condition of the small blood vessels in the skin that occurs in response to repeated exposure to cold but not freezing air.

Chilblains can be irritating and uncomfortable, but with proper understanding of the condition, preventative measures can be taken to try to reduce risk and alleviate symptoms if they do occur. In this complete guide to chilblains, we will cover the symptoms and appearance, causes and risk factors, prevention techniques, and treatment options to help keep your patients’ feet health and pain-free all winter long.

What Do Chilblains Look Like?

The most common symptom of chilblains is redness or purplish discoloration of the skin on the extremities, most often the toes, heels, ears, or fingers after exposure to the cold. These reddish lesions may be itchy, burning, painful, or inflamed with a bumpy texture. In severe cases, lesions may ulcerate or blister. Chilblain lesions are usually bilateral, meaning they appear on both left and right extremities.

Other symptoms may accompany the visible skin discoloration and inflammation, including:

  • Itching, burning sensation, or pain in affected areas

  • Tingling or numbness of skin

  • Blistering or ulceration in severe presentations

The feet – especially the toes – are the most frequent site for chilblains, as the hands have better circulation. However, any exposed extremity can develop lesions, especially body parts prone to sweating when coming back inside, like thighs or armpits.

While the lesions typically go away on their own after a few weeks, new ones may continue appearing throughout the winter months if exposure continues. Recurring chilblains over many years can cause permanently reddened skin or scarring.

What Causes Chilblains?

Chilblains occur from inflammation caused by the body’s attempts to warm up extremities after exposure to non-freezing cold temperatures. They most frequently develop in temps between 30-60°F when skin gets cold from lack of insulation against the weather but the cold is not severe enough to cause tissue damage from freezing.

Repeated exposure to variables that promote heat loss from skin can increase susceptibility. Common risk factors and causes include:

Poor Circulation

  • Poor circulation reduces ability to keep extremities warm

  • Conditions like peripheral artery disease or Raynaud’s can restrict blood flow

Low Core Body Heat

  • Low BMI or body fat reduces overall body warmth

  • Conditions affecting metabolism or temperature regulation

Constrictive Clothing or Footwear

  • Tight shoes, socks, gloves, etc. reduce blood flow

  • Getting feet/hands wet in socks/gloves promotes more heat loss

Exposure to Cold & Humidity

  • Spending time outdoors in cold, wet winter conditions

  • Cold indoor temperatures also increase risk

Perspiration with Cold Re-Exposure

  • Sweating then going back out in the cold causes rapid heat loss

So in essence, the cycle of cooling skin down then abruptly warming back up causes problems. With poor protection against the environmental conditions, the skin struggles to regulate blood flow and temperature, setting up inflammation. The result is the bothersome chilblain lesions.

Who Gets Chilblains?

While anyone can get chilblains when exposed to the elements, certain populations are more vulnerable to developing chronic or severe presentations:

  • Women, especially with Raynaud's phenomenon

  • The elderly

  • Individuals with chronic medical conditions affecting circulation like diabetes, anemia, PAD

  • People taking certain medications like beta blockers or vasoconstrictors

  • Those with a history of cold injury, frostbite, or chronic chilblains

  • Low BMI or very little body fat to insulate from the cold

For many patients, chilblains continue being an annual cold-weather nuisance but for high-risk individuals, prevention and prompt treatment are key to avoid complications. Severe or ulcerating lesions can allow infection entry leading to cellulitis or, in diabetic patients, potential amputation if unchecked.

Managing medical conditions and maintaining a healthy circulation and weight offer the best defense against developing chilblains.

How To Prevent Chilblains

While not always possible to control the weather conditions, preventing chilblains centers on keeping the skin warm and dry in cold environments and avoiding extreme shifts up and down in temperature. Recommendations include:

Wear Insulated Boots & Socks

Having properly insulated, waterproof boots and wool or synthetic socks that wick moisture away from the skin is key to keeping feet warm and dry whenever out in the cold. The best winter footwear have good traction for slippery conditions as well.

Use Hand & Foot Warmers

Disposable hand and toe warmers that offer up to 10 hours of heat through a chemical reaction help provide an extra layer of warmth right against the skin. These affordable items can be tossed in boots, gloves, or pockets whenever venturing out into winter weather.

Take Breaks to Warm Up Indoors

When spending extended time outdoors in cold conditions, schedule regular breaks to come inside and fully warm up hands, feet, and body core temperature. Don't rush right back out before fully recovering.

Wear Layers Outdoors

Having proper insulation with coats, scarves, pants, and layers protects the whole body from losing too much heat when exposed to winter conditions. Light, moisture-wicking base layers under insulating outerwear work best.

Keep Indoor Temperatures Moderate

Prevent excessive heat loss from skin by keeping indoor home and work spaces at a reasonably warm and comfortable temperature around 68-70°F.

Avoid Severe Temperature Shifts

Try not to go straight from overheated buildings into the freezing outdoors or vice versa without allowing skin to adjust more moderately and adding/removing layers.

Following this practical cold-weather advice reduces risk of excessive skin cooling and reheating that leads to chilblains for most people. However, those predisposed may still need medical intervention to treat lesions and pain if they do occur.

Chilblains Treatment Options

While preventative measures are preferred, once bothersome chilblains develop there are treatment options we may recommend for symptom relief and healing of any damaged skin:

Topical Steroids & Antidepressants

Applying topical steroid creams directly on lesions reduces inflammation while topical antidepressants like doxepin ease pain and itching sensations. These are often prescribed for 2-3 weeks.

Oral Medications

For patients with frequent severe bouts of chilblains, we may prescribe oral medications to improve circulation like calcium channel blockers, glyceryl trinitrate, or pentoxifylline used short-term during peak cold months.

Keep Lesions Clean & Covered

Gently cleaning affected areas then covering with lightweight non-stick dressings prevents infection while providing padding from friction that aggravates lesions.

Avoid Re-Exposure to Cold & Humidity

It’s critical to keep feet especially protected with well-insulated shoes/socks anytime out in cold, damp conditions to allow existing lesions to heal and prevent new ones forming.

Consider Testing for Associated Conditions

For patients with recurrent severe presentations, testing for connected conditions like lupus, rheumatoid arthritis, blood disorders, or cryoglobulinemia may be warranted, as chilblains can be an early sign. Treating associated illnesses can reduce lesions.

Following post-chilblain care instructions speeds healing of any damaged skin and keeps patients more comfortable. Preventing repeat bouts whenever possible is the ultimate goal.

Key Takeaways

  • Chilblains are painful inflammatory lesions that appear after exposure to non-freezing cold temperatures, usually on the feet.

  • Red, itchy, blistering lesions occur when extremities cool down then attempt to rewarm quickly. Inflammation and damage result.

  • The elderly, those with chronic illnesses, females, and people with less body fat more commonly get chronic or severe chilblains.

  • Keeping skin covered with warm, dry layers and socks/shoes is key to prevention.

  • Topical creams, medications, wound care, and avoiding re-exposure aids healing of lesions if they do form.

  • Testing for associated autoimmune or vascular conditions may be warranted in recalcitrant cases.

Frequently Asked Questions

Are chilblains contagious?

No, chilblains themselves are not contagious nor directly caused by infection. However, scratching at lesions can allow bacteria entry leading to possible skin infection, which requires appropriate treatment.

Is there a permanent cure for chronic chilblains?

Unfortunately, there is no definitive “cure” for patients who experience repeat bouts of chilblains every winter season. However, managing any underlying medical conditions, maintaining good circulation, and staying warm and dry to prevent lesions from forming can help reduce their frequency and severity.

How long do chilblains last before healing?

Most mild chilblain lesions resolve on their own within 1-3 weeks. With proper wound care and avoiding re-exposure to cold, damp environments, damaged skin should heal well. However, some patients experience chronic lesions over many months or recurring ones in subsequent years if exposure continues.

When should I seek medical treatment for chilblains?

See a doctor promptly if lesions are severe with blistering/ulceration to prevent infection. Also seek care if they’re very painful, last longer than 3 weeks, or keep recurring to determine if an underlying condition needs treatment. Monitoring circulation and sensation in extremities is important, especially for diabetics.


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