What Are Chilblains (Pernio)? What Causes Chilblains?

Chilblains also known as chilblain, pernio and perniosis are small, itchy swellings on the skin, which are not painful at first, but can become painful - they are acral ulcers; ulcers affecting the extremities. They are a localized form of vasculitis that occur when a predisposed individual is exposed to cold. Exposure to the cold can damage tiny blood vessels (capillaries) in the skin, resulting in redness, blisters, itching and inflammation. The itching, swelling and blistering red patches may occur on the toes, fingers, ears and nose.

Treatment for chilblains, which consist mainly of topical remedies and medications, is usually effective and the patient makes a full recovery within a couple of weeks. If left untreated though, there is a risk of complications, such as skin ulcers, cracked or broken skin, and infections.

Vulnerable individuals who wrap up warmly, or stay away from the cold as much as possible are much less likely to develop chilblains.

According to Medilexicon's medical dictionary:

Chilblains are Erythema, itching, and burning, especially of the dorsa of the fingers and toes, and of the heels, nose, and ears caused by vascular constriction on exposure to extreme cold (usually associated with high humidity); lesions can be single or multiple, and can become blistered and ulcerated. (synonym: periniosis)

What are the signs and symptoms of chilblains?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Chilblains signs and symptoms generally appear a short while after being in the cold. There will be a burning and itching sensation, usually in the extremities, such as the feet, hands, nose or ears. Symptoms get worse if the individual walks into somewhere warm.

The skin of the affected area may go red and become inflamed (swollen). Sores and blisters may appear (rare).

Doctors say that signs and symptoms will usually go away within a couple of weeks on their own if the patient avoids exposure to cold. More rarely, recovery may take months.

What causes chilblains?

Our blood vessels narrow when exposed to cold. When returning to warmth , the blood vessels expand again. For some people, this change results in blood leaking out of the blood vessels, causing inflammation and chilblain symptoms, especially if the change from cold to warmth is abrupt.

The following groups of people are more susceptible to getting chilblains when exposed to cold:

• Individuals with close family members who have/had chilblains
• Patients with circulation problems
• Patients with lupus
• People whose homes are draughty and cold (not well insulated)
• Tobacco smokers
• Very thin individuals

What are the complications of chilblains?

Chilblains may sometimes lead to infections, skin ulcers, and scarring. Complications are generally linked to an underlying condition/illness.

How are chilblains diagnosed?

Diagnosing chilblains is straightforward. If symptoms are present and the patient has been exposed to the cold, a doctor will diagnose chilblains.

What is the treatment for chilblains?

The patient can treat chilblains that have not developed into and infection or skin ulcer with OTC medications purchased at a pharmacy.

According to the National Health Service, UK patients have had good results by applying a mixture of friar's balsam and a weak iodine solution (ask your pharmacist).

A corticosteroid cream may also help with symptoms of inflammation and itching. If the skin is cracked you should see your doctor.

How are chilblains prevented?

To prevent chilblains:

• When it is cold, dress appropriately, this includes warm footwear (shoes and socks), gloves, a hat and scarf. In other words, wear clothing that protects your feet, hands and ears from the cold. You can protect your nose by wrapping something like a scarf around part of your face.
  
• Some people find that placing cotton wool between their toes helps circulation
  
• If you are particularly susceptible, try to avoid exposure to cold as much as possible


• When coming back from the cold, do not expose susceptible areas to sudden warmth (a gradual process is better).


• Exercise - do plenty of exercise at least four times a week; this helps maintain good circulation