Chilblains: What you need to know and how to manage them

Published by: Dr Dona Samarasekara, DPM

What is chilblains?

Chilblains are known as swollen, blister-like patches that develop on the skin in response to either cold conditions, poor circulation or a combination of both. They usually present as either red, blue, purple or white patches.

The areas that are commonly affected by this phenomenon are the distal extremities such as fingers and toes. It can also affect areas such as the tip of your nose and earlobes. Other areas prone to chilblains are pressure areas, such as areas in the feet affected by tight footwear friction- e.g. bunions.

Out of all the extremities, the feet and toes are areas most likely to develop chilblains- this is because our feet are furthest away from our heart, so it takes a little while for our blood circulation to reach them.

Although chilblains may cause a stinging or burning discomfort, in most cases they don’t result in permanent damage to the skin. However if not managed properly, they can progress to skin breakdown and ulcerations.

How do chilblains work?

Let’s consider our body’s circulation system-

This is composed of arteries (sending oxygenated blood away from the heart), veins (bringing de-oxygenated blood back to the heart) and the small blood vessels closest to our skin called capillaries.

• When the temperature is warmer- the blood vessels closest to our skin expand or dilate to allow excess heat to be expelled from our body.

• When the temperature gets colder- the blood vessels will constrict to prevent heat from escaping our body.

In the case of chilblains, long term constriction of the blood vessels in our toes can hinder our peripheral circulation especially if it is not adequate. Without proper blood flow to these areas, this can trigger pain and discomfort from our nerves- i.e. an “itching” or numb sensation, which is a signal that they are not getting enough blood and oxygen.

What can cause or trigger chilblains?

Chilblains are generally caused by frequent exposure to cold climates, which can trigger an abnormal response in the skin upon re-warming. The phenomenon tends to be seasonal, with many people developing chilblains during the winter. In some cases, people can develop chilblains for many months during this season.

Going back to our blood vessels- if exposed to heat too quickly, they will be unable to tolerate the sudden increase in blood flow. Keep in mind, our capillaries are very tiny and only so much blood can pass through them. In the case with chilblains, the capillaries will be overwhelmed and blood can leak into the nearby skin tissue. This in turn triggers the itching and swelling feeling that is commonly associated with chilblains.

Am I at risk?

Chilblains can happen to anyone. However there are certain factors that can increase the likelihood of developing chilblains:

• People who live a sedentary lifestyle

• Poor circulation

• Elderly people

• Young women aged between 15-30

• People who work in cold and/or damp conditions (e.g. farmers, construction workers)

• History of smoking (nicotine constricts blood vessels)

• Family history of chilblains

• Low BMI

• Poor dietary lifestyle

• Medical conditions such as Raynaud’s phenomenon, COVID-19, lupus and diabetes

If I have chilblains, what can I do to manage/prevent it?

In minor cases, chilblains generally subside without treatment in about 1-2 weeks. In order to ease and manage symptoms, the following interventions are known to be effective:

• Using specialised ointments, warming creams and/or soothing lotions

• Avoid using anti-inflammatory creams/gels such as Voltaren or Deep Heat- these are too strong and can make symptoms worse

• Keeping yourself protected from long-term cold exposure (i.e. warm clothing)

• Light exercises to improve blood circulation e.g. walking

• Avoid causing further pressure to areas that are at risk of chilblains (e.g tight footwear)

• Do not scratch areas that have chilblains- this will increase the risk of skin damage

• Gradual warming of affected areas only, DO NOT apply direct heat. Also avoid soaking your feet in hot water (the boiling point of water is 100 degrees, your feet when cold can be below the 30 degree mark: the temperature difference is quite significant and your toes will not like that!)

Professional Treatment:

Chilblains, particularly in the severe stages (i.e. ulcerating or recurrent) will require professional intervention from either your GP or a qualified podiatrist:

• A preventative drug (e.g. Nifedipine) can be prescribed by your GP in the case of recurrent chilblains.

• A podiatrist can assess and treat recurrent and/or ulcerated chilblains, as well as provide detailed information on how to manage and prevent chilblains.

• Seek medical advice from your GP if you have pre-existing conditions like diabetes or lupus, as there may be issues with circulation that will warrant further investigation.

• In cases of chilblains that develop without cold weather exposure, also consult with your GP. This can potentially occur from other conditions such as COVID-19; also referred to as “Covid toes”.