Introduction To Chilblains (Pernio)

Chilblains (sometimes referred to as pernio) describes a number of symptoms which occur in the peripheries (e.g. toes, fingers, earlobes) in response to the cold. It is thought to be caused by an abnormal vascular response to cold exposure.

Clinical Signs And Symptoms: 

• The areas most affected are the toes, fingers, earlobes, nose.
• Blistering of affected area
• Burning and itching sensation in extremities
• Dermatitis in extremities
• Digital ulceration (severe cases only)
• Erythema (blanchable redness of the skin)
• Pain in affected area
• Skin discoloration, red to dark blue
• Chilblains usually heal within 7–14 days.

Risk factors: Factors that may increase risk of  developing chilblains include:

• Clothing that is tight or exposes skin to the cold. 
• Women are more likely to get chilblains than are children and males. 
• People who weigh about 20 percent less than is expected for their height have an increased risk of chilblains.
• Chilblains are less likely in colder and drier areas because the living conditions and clothing used in these areas are more protective against cold. The risk of chilblains is higher if you live in an area with high humidity and cold, but not freezing, temperatures. They are more common from November to April.
• Having poor circulation. 
• Having been diagnosed with Raynaud's disease. 

Complications: Chilblains may cause complications if the  skin blisters. If that happens, it may develop ulcers and infections. Besides being painful, infections are potentially life-threatening if left untreated.

Management:  Although chilblains are uncomfortable, they do not usually cause any permanent damage. They will usually heal on their own if further exposure to the cold is avoided.

• Keep the affected areas warm. This means staying out of the cold, or wearing warm gloves, socks, etc, when outdoors.
• No other treatment is normally needed, as they usually go away by themselves.
• A range of creams and lotions can be bought from a pharmacy. However, there is no evidence that any of these are of benefit so they are therefore not recommended.
• Steroid creams are no longer recommended for the treatment (or prevention) of chilblains.
• If you smoke then you should try to stop, as smoking can make chilblains worse.
• Medicines are not usually needed. A medicine called nifedipine can open wide (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.