Chilblains

Chilblains are small, itchy swellings on the skin that occur as a reaction to cold temperatures.

Introduction

Chilblains are small, itchy swellings on the skin that occur as a reaction to cold temperatures. They affect the body's extremities, such as the toes, fingers, heels, ears and nose.

Chilblains are uncomfortable but can be prevented. They usually develop several hours after exposure to the cold, and it is possible to get several at the same time.

The symptoms of chilblains include burning and itching on the hands and feet and a change of skin colour. In some cases, the skin may become sore and blister.

Some people have chilblains every winter that last for up to five months. These can cause persistent sores that may lead to scarring.

What causes chilblains?

Chilblains are an abnormal reaction to the cold. When the skin is cold, blood vessels near its surface get narrower. If the skin is then exposed to heat, the blood vessels become wider. If this happens too quickly, blood can leak into the surrounding tissue. This is thought to be the reason for the swelling and itchiness associated with chilblains.

Chilblains can occur at any age, but are more common in children and elderly people. The condition also affects women more than men. Certain people, such as people with poor circulation, are more susceptible to chilblains.

Read more information about the causes of chilblains.

Chilblains are common in northern Europe, where damp, cold weather is usual in winter. They are less common in countries with extremely cold winters, because the air is drier and people have homes and clothing that conserve heat better.

Treating chilblains

Chilblains will often get better on their own after one to two weeks if you keep warm. Several creams and lotions are available to treat chilblains. However, there is no clinical evidence that they work and they are not recommended.

If chilblains keep returning, your doctor may recommend a drug called nifedipine. This works by relaxing the blood vessels, allowing better circulation.

Read more information about how chilblains are treated.

As treatment is not always effective, it is better to prevent getting chilblains by limiting your exposure to the cold and looking after your feet. Read more about preventing chilblains.

When to see your doctor or chiropodist

Redness and itching on the skin of your feet, hands or other extremities are obvious signs that you have chilblains. However, if you are unsure, speak to your doctor or chiropodist.

If your chilblains have broken, cracked or become sore, see your doctor or chiropodist. Do not scratch the skin as it can break easily and become infected.

Symptoms

When it is cold, people who are susceptible to chilblains will experience burning and itching on their hands and feet. If they go into a warm room, the itching and burning sensation becomes more intense.

The affected skin may also swell and change colour to red or dark blue. In extreme cases, the surface of the skin may break and sores or blisters can develop.

Chilblains typically occur a few hours after you are exposed to the cold. Although they are uncomfortable, chilblains do not cause permanent damage and will heal on their own if further exposure to cold is avoided.

Chilblains usually take one to two weeks to get better if you keep warm. Some cases can last for months and may flare up whenever the weather gets cold.

Read information about preventing chilblains.

When to see your doctor or chiropodist

Redness and itching on the skin of your feet, hands or other extremities are obvious signs that you have chilblains. However, if you are unsure, speak to your doctor or chiropodist.

If your chilblains have broken, cracked or become sore, see your doctor or chiropodist. Do not scratch the skin as it can break easily and become infected.

Causes

Chilblains are more likely to occur when cold skin is heated up too quickly, for example directly in front of a heater or fire.

During cold weather, blood vessels near the surface of the skin get narrower, causing the blood to flow deeper in the skin. This is your body's normal response to cold and is designed to preserve your core body temperature.

When skin is exposed to warmth again, the blood vessels near the surface of the skin expand and blood flow returns to normal.

If skin is heated up too quickly, the blood vessels near the surface of the extremities, such as the hands and feet, cannot always handle the increased blood flow. A "bottleneck" effect can cause blood to leak into surrounding tissue.

This leads to the swelling and irritation that is characteristic of chilblains.

People at risk

Some people are more at risk of chilblains than others. This includes people with:

  • poor circulation
  • a family history of chilblains
  • regular exposure to damp or draughty conditions
  • a poor diet or low body weight
  • lupus – a long-term condition that causes swelling in the body's tissues
  • Raynaud's phenomenon – a condition where the small blood vessels of the fingers constrict excessively

People who smoke are more at risk of chilblains as nicotine constricts blood vessels. Read information on quitting smoking.

Chilblains can also occur on areas of the feet that are exposed to pressure, such as a bunion or a toe that is squeezed by tight shoes.

Treatment

Chilblains are uncomfortable, but do not cause permanent damage. They will heal on their own after a few weeks if they are not exposed to the cold.

Although several creams and lotions are available to treat chilblains, there is no clinical evidence that they work and they are not recommended. They include over-the-counter preparations with menthol and any type of corticosteroid medications.

Read information about preventing chilblains for advice on how to avoid exposing chilblains to the cold while they heal and to prevent them reoccurring.

Reoccurring (chronic) chilblains

If you keep getting chilblains, your doctor may recommend a drug called nifedipine. This works by relaxing the blood vessels, allowing better circulation.

It is also recommended that anyone with chilblains should stop smoking. Nicotine causes the blood vessels to get narrower, which can make chilblains worse. Get advice on quitting smoking.

Complications of chilblains

The possible complications of chilblains include:

  • infection from blistered or scratched skin
  • ulcers forming on the skin
  • permanent discolouration of the skin
  • scarring of the skin

It is often possible to avoid these complications by not scratching or rubbing the area, and not directly overheating the chilblains (for example by using hot water).

When to see your doctor or chiropodist

Redness and itching on the skin of your feet, hands or other extremities are obvious signs that you have chilblains. However, if you are unsure, speak to your doctor or chiropodist.

If your chilblains have broken, cracked or become sore, see your doctor or chiropodist. Do not scratch the skin as it can break easily and become infected.

If the chilblains have become septic, your doctor or chiropodist may recommend antibiotics.

Prevention

The best way to prevent chilblains is to limit your exposure to the cold. You can also lower your risk of chilblains by avoiding products that can cause your blood vessels to get narrower (constrict).

The following advice may help prevent chilblains:

  • Stop smoking. Nicotine causes the blood vessels to constrict, which can make chilblains worse. Read information on quitting smoking.
  • Avoid medicines that may constrict blood vessels, such as those containing caffeine or decongestants.
  • Keep active. This helps improve your circulation.
  • Wear warm clothes and insulate your hands, feet and legs. Wearing long johns, long boots, tights, leg warmers or long socks will help. If you get cold feet in bed, wear a pair of clean socks.
  • Avoid tight shoes and boots as these can restrict the circulation to toes and feet.
  • Moisturise your feet regularly. This stops them drying out and the skin cracking.
  • Eat at least one hot meal during the day. This will help warm your whole body, particularly in cold weather.
  • Warm your shoes on the radiator before you put them on. Make sure damp shoes are dry before you wear them. If your feet are already cold, make sure that your shoes are not too hot to avoid causing chilblains.
  • Warm your hands before going outdoors by soaking them in warm water for several minutes and drying them thoroughly. Wear cotton-lined waterproof gloves if necessary. If your hands are already cold, make sure not to warm them up too quickly to avoid causing chilblains.
  • Turn up the central heating. Try to keep one room in the house warm and avoid drafts.
  • If you are diabetic, regularly check your feet (or ask someone else to do this). Diabetics may not be able to feel their feet and could have septic chilblains without realising.

If your skin gets cold, warm it gradually. Heating it up too quickly is one of the main causes of chilblains.

Content supplied by NHS Choices