Overview

Chilblains, also known as pernio, are small, itchy, and painful red or purple swellings that occur on the skin after exposure to cold and damp conditions. They are a localized form of cold injury affecting the blood vessels in the skin, typically appearing on the fingers, toes, ears, or nose. Chilblains are not caused by freezing temperatures but by rapid warming after cold exposure, leading to inflammation and damage to the small blood vessels. Although chilblains are usually harmless and resolve on their own within a few weeks, they can cause significant discomfort and, in some cases, lead to skin breakdown or infection.

Causes

Chilblains develop due to abnormal vascular responses to cold temperatures. The main causes and contributing factors include:

• Cold and Damp Weather: Prolonged exposure to cold, especially in humid conditions, causes the small blood vessels to constrict and then rapidly dilate when warmed, leading to leakage of blood into nearby tissues.
• Sudden Temperature Changes: Rapid warming of cold skin can trigger chilblains due to impaired circulation adjustment.
• Poor Circulation: Individuals with poor peripheral blood flow are more prone to developing chilblains.
• Low Body Mass: People with lower body fat, such as the elderly or underweight individuals, have less insulation and are more susceptible.
• Occupational Exposure: Outdoor workers or those who work in unheated environments are at greater risk.
• Underlying Health Conditions: Disorders like Raynaud's phenomenon or connective tissue diseases (e.g., lupus) increase susceptibility.
• Tight Clothing and Footwear: Restrictive clothing can impair circulation and worsen the risk of chilblains.

Symptoms

The symptoms of chilblains typically appear within a few hours after exposure to cold and are characterized by:

• Red or Purple Patches: Discolored areas on the fingers, toes, ears, or nose.
• Swelling: Mild to moderate localized swelling around the affected area.
• Itching: Intense itching, especially as the area warms up.
• Pain or Burning Sensation: Painful or burning feelings in the affected skin, especially when touched or exposed to warmth.
• Blistering: In severe cases, small blisters or ulcerations may form.
• Cracked or Broken Skin: Persistent chilblains can lead to skin cracking, increasing the risk of secondary infections.
• Delayed Healing: Lesions typically take one to three weeks to heal and may leave residual discoloration.

Diagnosis

Chilblains are usually diagnosed clinically based on a physical examination and history of cold exposure. Diagnostic steps include:

• Clinical Evaluation: A doctor examines the skin for characteristic signs, including red or purple patches with associated swelling and itching.
• Medical History: Assessment of recent exposure to cold, occupational risks, and underlying health conditions.
• Exclusion of Other Conditions: Chilblains must be differentiated from frostbite, Raynaud's disease, vasculitis, and diabetic neuropathy.
• Blood Tests: Rarely, tests may be done to rule out systemic conditions such as lupus or other autoimmune diseases, especially in recurrent or atypical cases.
• Skin Biopsy: In unusual cases, a biopsy may be performed to confirm the diagnosis and exclude other dermatological conditions.

Treatment

The primary goal of treatment is to relieve symptoms, promote healing, and prevent recurrence. Treatment options include:

• Warming Measures: Gradual rewarming of affected areas using warm (not hot) water or warm environments.
• Topical Corticosteroids: Creams may be prescribed to reduce inflammation, itching, and swelling.
• Oral Medications: In severe or recurrent cases, medications like nifedipine (a vasodilator) may be prescribed to improve circulation and prevent recurrence.
• Moisturizers: Regular application of emollients to keep skin soft and prevent cracking.
• Avoid Scratching: Preventing scratching minimizes the risk of skin damage and infection.
• Antibiotics: If secondary bacterial infection occurs, topical or oral antibiotics may be necessary.
• Lifestyle Adjustments: Wearing warm clothing, using insulated gloves and socks, and avoiding rapid temperature changes are important preventive measures.

Prognosis

The prognosis for chilblains is generally good with appropriate care:

• Self-Limiting: Most cases resolve on their own within one to three weeks without lasting damage.
• Full Recovery: With protective measures and treatment, the skin usually returns to normal without scarring.
• Risk of Recurrence: Chilblains can recur seasonally in cold climates or with repeated cold exposure.
• Complications: Potential complications include skin ulceration, infection, and in rare cases, chronic skin changes.
• Management of Underlying Conditions: Treating associated diseases like Raynaud's or lupus reduces the risk of recurrent chilblains.

Preventive strategies, such as avoiding cold exposure and maintaining proper circulation, play a crucial role in reducing both the frequency and severity of chilblain episodes.