Chilblains

Chilblains, also known as Pernio, are small itchy, red (and sometimes purple) swellings on the skin, which can become increasingly painful, can swell and then dry out leaving cracks in the skin which expose the foot to the risk of infection.

It is caused by inflammation of the blood vessels in the skin, and can become painful and itchy. Untreated they can crack the skin, leading to infections. They are caused when an exposed body part, typically the feet or the hands, moves from an extremely cold environment to a hot one. The most common example of this is when a person with cold hands runs them under the hot tap – frequently leading to swelling and tingling in the hands, but also potentially to the formation of chilblains. The chilblain is caused by the blood vessels restricting blood flow during extreme cold, but being exposed to warmth that causes an unexpected expansion. The result is the leaking of fluid into surrounding tissues. Treatments range from simple antiseptic solutions (such as iodine) to prevent infection through to antibiotics for already infected ulcers.

Chilblains are common on the toes, but can also affect the fingers and the face (especially the nose and ears). Chilblains are also common on areas of the feet exposed to pressure, such as bunions or where the toes are under pressure from tight shoes or where there are corns and callus.

Chilblains can be –

• Acute (short-term), developing within 12-24 hours after exposure to the cold and getting better after one to two weeks if you keep warm
• Chronic, lasting for a minimum of five months a year for the past three years and causing persistent sores that can lead to scarring

Chilblains can be uncomfortable but rarely cause any permanent damage. They normally heal within a few weeks if further exposure to the cold is avoided.

Causes

Chilblains occur several hours after exposure to the cold. Cold causes constriction of the small arteries and veins in the skin. The chilblains are sometimes aggravated by sun exposure, because rewarming results in leakage of blood into the tissues and swelling of the skin.

Chilblains are less common in countries where the cold is more extreme because the air is drier and people have specially designed living conditions and clothing.

Chilblains are more likely to develop in those with poor peripheral circulation, noted by blue-red mottled skin on the limbs (acrocyanosis).

Other factors contributing to chilblains include –

• Familial tendency to chilblains
• Peripheral vascular disease, due to diabetes, smoking, hyperlipidaemia
• Low body weight, or malnutrition, eg anorexia nervosa
• Hormonal changes: chilblains can improve during pregnancy
• Connective tissue disease, particularly lupus erythematosus (chilblain lupus), or, in association with Raynaud phenomenon, systemic sclerosis.
• Bone marrow disorders

Who is at Risk?

Although chilblains are common, the condition mainly affects young adults working outdoors in cold places or people who do not wear socks or tights in winter. Elderly people, whose circulation is less efficient than it used to be, people who don’t take enough exercise and those suffering from anaemia are also susceptible. Following are at risk –

• Clothing that is tight or exposes skin to the cold – Wearing tight-fitting clothing and shoes in cold, damp weather may make you more susceptible to chilblains. And skin that’s exposed to cold, damp conditions is more likely to develop chilblains.
• Sex and Weight – Women are more likely to get chilblains than are children and males. Also, people who weigh about 20 percent less than is expected for their height have an increased risk of chilblains.
• Environment and season – 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 a person lives in an area with high humidity and cold, but not freezing, temperatures. They are more common from November to April.
• Having poor circulation – People with poor circulation tend to be more sensitive to changes in temperature, making them more susceptible to chilblains.
• Having been diagnosed with Raynaud’s disease – People with Raynaud’s disease are more susceptible to chilblains. Either condition can result in sores, but Raynaud’s causes different types of color changes on the skin.
• Medications like beta-blocker, decongestants can increase chances of Chilblains
• Children and Elderly– Chilblains is particularly common in childhood or in elderly.

Symptoms

Each chilblain comes up over a few hours as an itchy red swelling and subsides over the next 7–14 days or longer. In severe cases, blistering, pustules, scabs and ulceration can occur. Occasionally the lesions may be ring-shaped. Chilblains may become thickened and persist for months. Common sites for chilblains are –

• Backs and sides of the fingers and toes
• Heels
• Lower legs
• Thighs
• Wrists of babies
• Over a fatty lump (lipoma)
• Nose
• Ears

The following are some signs and symptoms related to chilblains:

• Chilblains appear as small itchy, red areas on the skin
• In some cases the skin over a chilblain may blister which may delay healing
• Sometimes the skin breaks down to leave a small ulcer which is prone to infection
• Possible secondary infection
• Finger skin inflammation
• The chilblain may become ulcerated
• Chilblains become increasingly painful as they get congested and take on a dark blue appearance
• A burning sensation on the skin
• Toe skin inflammation – the affected area is swollen

Complications

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

Treatment

Chilblains will go away naturally within a few weeks, but the process of healing can be accelerated by applying friar’s balsam or an over the counter lotion to the affected area.

Medications – For adults whose chilblains don’t clear up with home remedies, treatment may include prescription drugs:

• Topical corticosteroid – A corticosteroid such as triamcinolone 0.1 percent cream is applied to the affected area.
• Blood pressure medicine – A blood pressure lowering drug called nifedipine (Procardia). It can help open up blood vessels.

Lifestyle Changes –

• Nicotine constricts the blood vessels, so smokers must stop smoking.
• Home and workplace should be well insulated without draughts, and heated in winter.
• Warm clothing should include gloves, thick woollen socks and comfortable protective footwear.
• Cotton-lined waterproof gloves are protective for wet work.
• Soaking hands in warm water for several minutes warms them for up to several hours.
• Vigorous indoor exercise keeps the body warm for a period afterwards.
• Medicines that constrict blood vessels should be minimised, including caffeine, decongestants and diet aids.
• Vasodilator medications such as nifedipine are taken throughout the winter months. Side effects may include flushing and headache.

Alternative Treatment

Gingko Biloba is a very useful herb for treating chilblains. This is because this herb improves the circulation of the body. This herbal remedy ensures that the small blood vessels are dilated. This improves the flow of blood to different parts of the body including the area affected by chilblains.

Grape seed extract can be an ideal way to boost your intake of these essential antioxidants. Grape seeds also contain other substances supporting good health, such as Vitamin E, flavonoids and linoleic acid which are beneficial in chilblains.

Vitamins – Several tests have shown that the best protection to exposure to cold weather is afforded by the vitamin C. The speed at which tissues heal and an anti-inflammatory action are other things that the vitamin C contributes to the recovery process. A warm flush and the bolstering of the circulatory system are effectively promoted by the vitamin niacin in people recovering from the effects of cold weather.

Herbs – In the treatment and healing of skin that has been damaged through frostbite, effective use has been made of aloe vera . The recovery and rebuilding of damaged connective tissue can be achieved through the consumption of tea made form the horsetail herb. Dose should be about a tsp. of the herb, mixed with a cup of boiling water, taken thrice a day. The speed and recovery of the tissues is also aided actively by drinking rose hip tea, which has a lot of vitamin C in it. Infusions made from the horsetail herb, the bark of the oak tree, horse chestnut or if unavailable tormentil can be added to the bath water to promote the rate of healing and as a topical measure. Other beneficial herbs

• Black Mustard
• Black Snakeroot
• Calendula
• Cayenne
• Echinacea
• Elder
• Ginger
• Heather
• Horseradish
• White Mustard

Reference –

http://www.ncbi.nlm.nih.gov/pubmed/2212122

http://www.dermatocare.com/blog/Treating-Chilblains–Itchy-and-swollen-toes

http://www.merriam-webster.com/dictionary/chilblain

http://www.theguardian.com/lifeandstyle/2012/jan/15/should-i-selftreat-chilblain

http://www.raynauds.org.uk/images/stories/75-Chilblains08.pdf

http://patient.info/health/chilblains

http://www.scpod.org/foot-health/common-foot-problems/chilblains/

http://www.channel4embarrassingillnesses.com/conditions/chilblains/

http://www.webmd.com/first-aid/tc/chilblains-perniosis-topic-overview