With winter gracing us with his chilly presence, Anette Thompson speaks about chilblains – what they are and what causes them?

What are chilblains and what causes them?

Chilblains (also called pernio) are small, itchy, painful, red swellings on the skin caused by an abnormal reaction to cold weather. They most frequently occur on exposed toes, fingers, ears and nose; and are usually red in colour but may change to purple. Other areas of skin can also develop painful and tender chilblains if exposed to cold, e.g. heels, lower legs and thighs.

Chilblains are quite common. Small blood vessels, called capillaries, become narrow (constrict) when the skin becomes cold. In addition, the cooled blood will flow slower. When the skin is re-warmed, there is leakage of fluid from the blood vessels into the tissues. This is thought to cause the inflammation, swelling and itching associated with chilblains.

The speed (rate) of temperature change may play a part. Some people develop chilblains if they warm up cold skin too quickly. For example, with a hot water bottle or by sitting very close to a fire, stove or heater. Natural ways of warming the skin better are with warm water (not hot!), real wool or mohair socks and gloves.

People are more at risk of developing chilblains, if they:

• have poor circulation and other problems associated with their blood vessels.
• have a condition called systemic lupus erythematosus (SLE).
• smoke because nicotine constricts blood vessels.
• have a family history of chilblains.
• have frequent exposure to cold, draughty or damp weather.
• have a poor diet or low body weight.
• wear shoes that create pressure points, e.g. over a bunion or squeezing the toes so that blood flow is constricted.
• suffer from Raynaud’s phenomenon – a condition that affects blood circulation to the extremities.
• take medications that have the side effect of constricting their blood vessels, e.g. beta blockers.
• suffer from microangiopathy (damage to small blood vessels) e.g. due to diabetic complications.
• suffer from peripheral neuropathy (unable to feel their feet) e.g. due to diabetic complications.

How do you prevent chilblains?

• Keep your hands and feet warm when out in cold weather by using warm gloves and socks. Consider special polar gloves and socks, if chilblains are a recurring problem. Look for real wool, angora or mohair socks as their fibres trap more heat than acrylic wool.
• Keep your head and ears warm by wearing a hat and scarf or a beanie. Remember that 40% of the heat of your body can be lost through the top of your head if it is exposed to cold.
• You should keep as warm as possible in the cold. Wearing several loose layers is ideal to trap body heat. You should also keep as dry as possible.
• Insulate your feet and legs by wearing long johns, long boots, tights, leg warmers or long socks. It’s a good idea to wear a clean pair of warm socks if you get cold feet in bed. 
• If your skin gets cold, it’s important to warm it up gradually. Heating the skin too quickly, for example, by placing your feet in hot water or near a heater, is one of the main causes of chilblains.
• Side effects from some medicines may narrow (constrict) tiny blood vessels. This may be enough to make you prone to recurring chilblains. For example, beta-blockers can have this effect. Tell your doctor if you become prone to chilblains following starting any medication.
• Look after your feet, examine them carefully every day, especially if you have diabetes as people with diabetes may not be able to feel their feet and could have infected chilblains without realising it. Moisturise them regularly – this stops them drying out and the skin from cracking.
• Take steps to improve your circulation; keep active – this helps improve your circulation.
• Stop smoking – nicotine causes the blood vessels to constrict, which can make chilblains worse.
• Avoid tight shoes and boots – these can restrict the circulation to your toes and feet.
• Eat at least one hot meal during the day – this will help warm your whole body, particularly in cold weather.
• Warm your shoes in front of a heater before you put them on. Make sure damp shoes are completely dry before you wear them; if your feet are already cold, make sure your shoes aren’t too hot. 
• Warm your hands before going outdoors; place them in warm water (not hot water) for a few minutes and dry thoroughly, and wear cotton-lined waterproof gloves, if necessary. If your hands are already cold, make sure not to warm them up too quickly.
• Keep your house well heated – try to keep one room in the house warm and avoid drafts.
• A range of creams and lotions, claiming to be beneficial for chilblains,can be bought from a pharmacy. However, there is no evidence that any of these OTC creams ease chilblains, so therefore not recommended.
• It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching.
• Steroid creams are no longer recommended for the treatment (or prevention) of chilblains as they thin the skin and can be implicated in the breakdown of the skin.
• Medicines are not usually needed. However, nifedipine can open (dilate) the small blood vessels and may help to treat chilblains, which are not settling within the normal time. Occasionally, it may also be used to prevent chilblains in the winter months in people who have recurring symptoms. A doctor will have to prescribe it.

Complication of chilblains for people living with diabetes

• Occasionally, the skin breaks down to leave a small ulcer, which is prone to infection.
• Permanent discolouration of the skin.
• Scarring of the skin.
• In some cases, the skin over a chilblain may blister, which may delay healing.
• It’s important not to scratch the skin as it can break easily and become infected. You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing.  The dressing should be changed every day until the skin heals.

 Signs of infection may include:

• Redness and heat.
• Swelling and pus forming in the affected area.
• Feeling generally unwell.
• Blood glucose levels rise.
• A high temperature (fever) of 38C (100.4F) or above.
• Swollen glands.

If the skin does break down and become infected, see your podiatrist or doctor immediately. Diabetic ulcer wound treatment will need to be initiated and antibiotics are likely to be prescribed to treat the infection.