Chilblains

Also called Perniosis

Painful itchy swellings from cold, damp weather. Warming up too fast is what causes them, not the cold itself.

What it is

Small, itchy, painful red or purple swellings on the fingers, toes, ears or nose, appearing hours after exposure to cold.

The mechanism is worth knowing because it dictates the prevention. Small blood vessels constrict in the cold and then, on rapid rewarming, dilate suddenly and leak fluid into the tissue. **It is the fast rewarming that causes them**, which is why putting cold hands straight onto a radiator or into hot water is the classic trigger.

They are more common in cold damp weather rather than in extreme cold, which is why the UK climate produces them, and in people with poor circulation, Raynaud's phenomenon, low body weight, and in smokers.

They usually clear in one to three weeks. Broken chilblains can become infected.

Persistent, severe or unusual chilblains, especially in a young person or out of season, warrant assessment for an underlying condition such as lupus, a vasculitis, or a blood disorder.

They are not frostbite, which is freezing of tissue and a different, more serious injury.

Signs you might notice

Small red or purple swellings, usually on toes and fingers, sometimes ears, nose or heels.

Burning, itching or pain, often worse when coming into a warm room.

Swelling and a shiny surface.

Sometimes blisters or ulcers, which can become infected.

Appearing hours after cold exposure and lasting one to three weeks.

See a GP for: chilblains that are not healing, breaking down or looking infected; chilblains in someone with diabetes or poor circulation; severe or recurring ones; or ones appearing outside cold weather.

Urgent: spreading redness with fever, or a blackening toe, which suggests cellulitis or circulation failure.

How it can affect day-to-day life

The instinct to warm up quickly is exactly wrong, and it is the piece of advice that changes outcomes.

Prevention is about the whole body rather than the extremities: keeping the core warm keeps blood flowing to the hands and feet. Layers, a hat, and warm footwear matter more than gloves alone.

Damp is as important as cold. Wet feet in mild weather cause more chilblains than dry cold.

Tight shoes restrict circulation and worsen them; so does sitting still for long periods in a cold room.

For older people in cold housing, chilblains are a visible marker of an under-heated home, and are worth treating as a prompt about heating, benefits and fuel costs. See hypothermia.

For anybody with diabetes or neuropathy, a broken chilblain on a toe is a foot wound and should be treated with the urgency of one. See podiatry.

Supporting someone well

Warm up slowly. No radiators, hot water bottles or hot water on cold hands and feet.

Keep the whole body warm: layers, a hat, warm socks, and heating the room.

Keep feet dry, change out of damp socks and shoes, and wear roomy footwear.

Do not scratch; keep nails short and use a soothing cream.

Stop smoking, which constricts the small vessels this depends on.

Keep moving to maintain circulation.

Get broken skin seen, especially in diabetes or poor circulation.

For persistent or severe chilblains, ask about an underlying cause.

Treat a cold home as the real problem where that is what is going on.

Where to get help

A pharmacist for soothing creams and advice.

A GP practice for chilblains that break down, become infected, or keep recurring.

Age UK on 0800 678 1602 for winter warmth and heating costs.

Scleroderma and Raynaud's UK for related circulation problems.