Chilblains are small, painful red or purple bumps on the skin, which develop after exposure to cold, damp conditions. They are usually found on the fingers, toes, ears, nose and heels but may also affect other areas of the body. Also known as perniosis (or just pernio), chilblains are one of the mildest but most common forms of cold injury.

Chilblains usually get better on their own with self-care measures. But prevention is better than cure, so if you are prone to chilblains, rug up to stop them developing in the first place.

Symptoms

Chilblains are small areas of inflamed, reddish-blue or purple swollen skin. They usually cause a burning sensation but may be itchy to start with. These painful lumps – there may be one or several in one area – are usually found on the toes and fingers.

Chilblains usually heal on their own in one to 3 weeks. In some cases, they may form blisters containing clear fluid, or in severe cases can develop into ulcers.

Causes

Chilblains are inflammatory lesions in the skin that develop after ongoing or repeated exposure to cold air, especially if the air is also damp or if it’s windy.

The exact cause is not known, but a sudden change in temperature from cold to warm seems to be important. Warming up cold skin very quickly is thought to cause an abnormal reaction in the small blood vessels in the skin in susceptible people. This causes swelling and inflammation, resulting in chilblains.

Chilblains are more common in cold, rather than freezing temperatures. That’s because people living in areas that get particularly cold in the winter time tend to be better set up for the conditions.

Chilblains should not be confused with frostbite.

Risk factors

Women tend to get chilblains more frequently than men. Children, older people and those with a family history of the condition may also be at increased risk. People who are underweight and those who are sensitive to the cold and have poor circulation are also more likely to get chilblains.

Conditions that can increase your risk of chilblains include:

Smoking also increases the risk of chilblains because it constricts your blood vessels and increases the risk of problems with circulation.

Complications

Complications from chilblains can include:

  • infection – often arising from scratching or from blistered skin;
  • skin ulcers; and
  • scarring or discoloration of the skin.

When to see your doctor about chilblains

In many cases, chilblains will clear up on their own. See your doctor if:

  • the chilblains are very painful;
  • the skin looks infected;
  • the chilblains become cracked or sore; or
  • there is no improvement after a week.

If you have diabetes or a circulation disorder, see a doctor as soon as possible after developing chilblains.

Your GP (general practitioner) will ask about your symptoms and examine the affected area of skin. They will also check your circulation.

The diagnosis of chilblains can usually be made based on your symptoms and the appearance of the lesions. Tests are rarely needed, but blood tests may be recommended to rule out possible causes or related conditions.

Your doctor may refer you to a dermatologist if the diagnosis is in doubt or if you have ongoing problems with chilblains. In some cases, a skin biopsy (sample of skin from the affected area) may be recommended.

Treatment for chilblains

Chilblains will usually heal themselves within a few weeks with self-care measures but in some cases treatment may be needed.

Self-care for chilblains

It’s important to keep yourself warm and dry – cover up when outdoors and keep your home warm. Don’t apply direct heat or heat packs to the affected area, as sudden changes in temperature can aggravate chilblains.

Chilblains are often itchy, but should not be scratched as this can slow down healing and if the skin breaks it can lead to infection. Lanolin-based creams that you can get from your pharmacy or simple moisturisers can be applied to ease irritation and itch.

Medicines

If your chilblains are painful or not healing after a week or 2, your doctor may prescribe corticosteroid ointment to be applied to the affected area. They may also recommend you apply a dressing over the ointment.

If chilblains become infected, antibiotics may be needed.

Prevention

If you are temperature-sensitive you should always try to keep warm and avoid extreme changes in temperature. Wear a scarf, hat, gloves and warm socks when it’s cold outside. Keep your home warm in winter and wear layers of warm clothing to keep your whole body warm to help prevent chilblains.

If you’ve been out in the cold, avoid warming up your hands and feet too quickly. Don’t put your hands or feet directly in front of a heater or use a heat pack to warm them up. It’s better to heat the room and warm up gradually.

For those with severe or recurrent chilblains, medicine to dilate your blood vessels and prevent chilblains may be recommended for when the weather is cold.

If you are a smoker, quit to improve your circulation and help prevent further episodes of chilblains.

Last Reviewed: 20/08/2019

myDr



References

1. Cutaneous vasculitis - Chilblains (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Jun. https://www.tg.org.au/ (accessed Aug 2019).

2. Arthritis Australia. Chilblains (perniosis) (reviewed Dec 2017). https://arthritisaustralia.com.au/types-of-arthritis/chilblains/ (accessed Aug 2019).

3. Australasian College of Dermatologists. Chilblains (updated 22 Jul 2015). https://www.dermcoll.edu.au/atoz/chilblains/ (accessed Aug 2019).