Winter is here. And so are chilblains. With the Canberra climate dropping into the freezing zone I have had multiple clients come in with chilblains. For some of these people I’m the first person to tell them they have chilblains, others are familiar with them from previous winters. This article is for those who have suffered chilblains for years and for those who are new to this condition.
Here is the overview of the article:
- What are chilblains?
- What are the causes of chilblains?
- How are chilblains diagnosed?
- How to prevent chilblains
- Treatment of chilblains
What are Chilblains?
The technical term for chilblains is perniosis. They are lesions of the skin that occur after exposure to the cold and sometimes humidity during the colder months of the year. The lesions are an abnormal, inflammatory response to the cold and they are
- Tender to touch
- Red but sometimes blue or purplish
- Sometimes swollen
- Sometimes itchy or have a burning sensation
- Associated with blistering and ulceration in severe cases
They occur on distal extremities of the body, particularly the fingers and toes but ears, nose and face can be affected. The rate of occurrence varies with climates, approximately 10% of the population in England can have chilblains in their winters.
Chilblains occur more frequently in women, children and the elderly. Younger people’s chilblains tend to resolve spontaneously in 7-14 days; the elderly are more likely to need medical intervention as discussed below. In rare cases, chilblains can occur throughout the year. This is often associated with an underlying chronic condition.
Interestingly, I have had a few of my clients get chilblains in the winter after losing significant amounts of weight. This includes people who were once obese or overweight to people who have gone from a normal Body Mass Index (BMI) to a low BMI.
What are the Causes of Chilblains?
We don’t know exactly how a chilblain forms and why some individuals are more prone than others but we have some theories.
One theory is that the nerve endings that tell your brain if your extremities are cold or hot are not working properly. That means the brain isn’t getting the information it needs to open up the blood vessels and protect the area from damage. Another theory is these individuals have an abnormal inflammatory response to the cold.
The direct cause of chilblains is exposure to the cold and sometimes moisture. The arteries and veins contribute to chilblains. That means that both the blood vessels to the area and away from the area are vasoconstrictored (narrowed).
In most patients, the exact cause of chilblains is unknown but a recent review suggests that up to 20%-40% of chilblains may be associated with an underlying condition(1) such as:
- Viral hepatitis
- HIV infection
- Rheumatoid arthritis
- Lupus erythematosus (the diagnosis then becomes chilblain lupus erythematosus)
- Weight loss medications
- Raynaud’s disease
- A type of leukaemia
- Antiphospholipid syndrome, an autoimmune disease
Chilblains are not to be confused with similar lesions that can occur on the thigh due to exposure to the cold. The lesions are due to inflammation of subcutaneous (below skin) tissue. Because this occurs mostly in female horse riders, the condition are been termed equestrian cold panniculitis.
How are Chilblains diagnosed?
The diagnosis of chilblains is usually made clinically in that the symptoms are discussed and the affected areas are inspected to meet the criteria for chilblains.
Rarely laboratory studies such as blood sampling and biopsy of the area are required. If someone is not responding to treatment or an underlying condition contributing the chilblains is suspected a doctor is more likely to refer for further investigations. Some people may be referred to a vascular specialist to assess their chilblains.
How to Prevent Chilblains
Some ways to prevent chilblains are very obvious and some are not proven with scientific evidence but have worked for my clients. The main concept in preventing chilblains is to keep the vulnerable areas at a consistent temperature.
1. Avoid rapid changes in temperatures.
This includes jumping straight into a hot shower or going from a warm bed to cold bathroom tiles. Get into a warm shower after heating the shower floor tiles and slowly increase the temperature. Avoid going outside in the cold after being in a hot car or after standing in front of a heater or fire. Wear slippers after getting out of a warm bed but avoid wearing slip-ons while walking during the day as this makes the toes claw. This will place excessive pressure on the tips of the toes which are vulnerable to chilblains.
2. Rug up the affected area.
Wear a beanie or scarf to cover the ears and the nose. Wear warm socks and shoes and gloves for the feet and hands. Avoid holey socks!
3. Avoid synthetic materials.
Avoid materials such as nylon when covering the affected areas. Natural fibres such as cotton, wool and bamboo are better at insulating temperature. Leather shoes and wooly ugg boots as opposed to plastic based shoes are also better at keeping feet warm. Avoid walking around too much in ugg boots are they are slip-ons that will make you vulnerable to clawing your toes.
4. Placing cotton wool between the toes
Placing cotton wool between the toes may assist with insulting temperature.
5. Avoid putting the affected area in direct contact with heat.
This includes such as putting your feet right in front of a heater. Placing a hot source on the feet and hands may ‘shock’ your blood vessels, there is a safer way to get warm blood to the feet and hands. If you are cold, place a hot water bottle or heat pack at your core (back, stomach). In winter our body’s priority is to keep the vital organs in our core warm. Heat is transferred around the body through the blood stream. Therefore, in winter, there is no additional heat or blood to transfer to the feet and hands.
Naturally in summer our body wants to get rid of this heat in our core to keep our vital organs from overheating so our feet and hands get much more blood and heat. So by heating our core, our body will want to transfer this heat away from the core to our extremities and by doing so warm them up.
6. Consider an electric foot blanket
Use an electric foot blanket and place it on a low temperature overnight. When we are sleeping our blood ‘pools’ as the blood isn’t getting pumped down to the feet and hands by our muscles and gravity isn’t assisting blood flow as it does when we are standing and sitting. A low temperature heat setting is safe as to not ‘shock’ the blood vessels.
7. Wax bath therapy
Using wax therapy once weekly may assist in keeping the feet and hands warm and more resistant to the cold. Warm (not hot) paraffin wax is placed around the feet and hands and left for 15-30 minutes. The warming results can last for several days. Wax baths can be purchased online or are available through some spas and beauty therapists.
Exercise several times a week to improve circulation and remember to rug up after exercise, even if you feel hot. Slowly lowering the body’s temperature is important.
9. Healthy Diet
Eat a healthy diet and avoid alcohol and caffeine. Alcohol and caffeine affect the closing and opening of the blood vessels, reducing or increasing blood flow to certain body parts. Chilblains are associated with blood vessel inflammation. Certain foods are somewhat known to increase and decrease inflammation within our bodies. Although this area needs more research, you can read what foods Harvard University considers to contribute to and alleviate inflammation.
10. Avoid smoking
Avoid smoking as the chemicals in cigarettes such as nicotine constrict the blood vessels around the body which makes them smaller and harder for the heart to pump blood through them to the extremities. The picture below shows a narrowed and hardened artery secondary to smoking.
If your skin is sweaty in the area of the chilblains the excessive moisture which decreases the local temperature needs to be addressed. Wearing natural fibres, applying sprays and powders to decrease perspiration are some ways to decrease excessive moisture.
Treatment of chilblains
Some treatments can be done at home and some require General Practitioner guidance.
- Application of Hirudoid Ointment to the affected area. This cream helps to open up the blood vessels. People may be familiar with this cream for bruising. This cream should only be applied to intact skin.
- If the chilblains are itchy, a low dose topical steroid cream can be used. This has some risk in that steroid creams can thin the skin and by placing the cream on a fragile lesion skin breakage may occur but is unlikely. This cream should only be applied with General Practitioner prescription and should never be applied to a blistered or ulcerated chilblain.
- As mentioned in preventing chilblains, cotton wool can be used in combination with Friar’s basalm to treat chilblains. Apply Friar’s basalm to the skin, then a layer of cotton wool which will stick to the basalm, then another layer of the basalm and cotton wool. This will create a cocoon to keep the toes or hands warm. Do not get wet. Cotton wool can be purchased in balls or rolls.
- Lanolin cream can be used at night to keep your skin soft and supple.
- Oral medications prescribed by a General Practitioner may be warranted if the above steps and preventative methods don’t work. These medications are vasodilators which means they open the blood vessels to help with circulation.
I think Elsa should read this article
If you think you have chilblains try the preventative strategies first, if they don’t work see a health professional such as a general practitioner or podiatrist who can help you with the next step. Please remember if the skin is broken a different treatment plan is required and it is best to see a health care professional as there is a risk of infection.
(1) Yang, X., Perez, O.A., & English, J.C. (2010). Adult perniosis and cryoglobulinemia: a retrospective study and review of the literature. J Am Acad Dermatol. 62 (21–2).
Jordaan, H.F. (2007).The diagnosis and management of perniosis (chilblains), South African Family Practice, 49 (6), 28-29. Retrieved from http://dx.doi.org/10.1080/20786204.2007.10873574
Weisman, M.H.& Prakash, S. (2009). Idiopathic chilblains. The American journal of medicine. 122 (12) 1152-1155. Retrieved from http://www.amjmed.com/article/S0002-9343(09)00681-0/abstract