Chilblains

Chilblains are itchy and/or tender red or purple bumps that occur as a reaction to cold. The condition is also known as pernio or perniosis, and is a localised form of vasculitis. Chilblains are common in Australia for two reasons. Firstly our clothes and housing are not well designed for the cold winter months, and secondly we have a higher humidity than those that have more extreme temperatures of cold.

Children and the elderly are most often affected. In children, recurrences each winter for a few years are common but complete recovery in the warmer months is normal.

Symptoms

• Ulceration of the digits and toes
• Red nose
• Skin redness
• Inflammation of the fingers, toes or earlobes

Each chilblain comes up over a few hours as an itchy red swelling and subsides over the next 7-14 days. In severe cases blistering, pustules, scabs and ulceration can occur. Occasionally the lesions may be ring-shaped. They may become thickened and persist for months.

Cause of chilblains
Chilblains are caused due to blood vessel shut-down in cold conditions and humidity. The cold exposure damages capillary beds in the skin, which in turn can cause redness, itching, blisters, and inflammation. The cold causes constriction of the small arteries and veins in the skin. When these areas are warmed up again, it can result in leakage of blood into the tissues and swelling of the skin. This "bruising" is called a chilblain. They occur several hours after exposure to the cold in temperate humid climates and in some cases can be aggravated by exposure to the sun.

Contributing factors include:

• Genetics and family history
• Poor peripheral circulation such as with peripheral vascular disease such as from diabetes, smoking, hyperlipidaemia
• Poor health, poor nutrition or low body weight
• Hormonal changes: chilblains are often reported to improve during pregnancy
• Connective tissue disease such as lupus erythematosus
• Raynaud phenomenon, systemic sclerosis

Chilblains in elderly people have a tendency to get worse every year unless precipitating factors are avoided


Treatment
The best treatment is prevention, and chilblains can be prevented by keeping the feet and hands warm in cold weather.
Other treatments may include:

• Keeping the area involved warm and if the area gets cold, you must make sure not to warm it up too quickly.
• Topical corticosteroid cream applied accurately for a few days to relieve itch and swelling
• Antibiotic ointment or oral antibiotics for secondary infection if required

Prevention
The following measures may help to keep you warm:

• If you feel cold, it means your probably getting cold, so warm up before you cool down.
• Wear warm clothing including gloves, thick socks and comfortable footwear. And if needed, carry around a warm wheat bag with you as a form of portable heater.
• Avoid medicines that might constrict blood vessels: these include caffeine, decongestants and diet aids.
• When you start to get cold, soak hands or feet in warm water for several minutes to warm hands through then dry thoroughly. This will help keep your body temperature up.
• Keep active so that the blood flow keeps pumping; especially before and during out door activities

Related articles
Cold Feet
The Diabetic Foot
Childrens feet
Common Skin Problems
Podiatry

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