|Other names||Pernio, perniones, perniosis, kibes|
|Toes inflamed by chilblains|
|Symptoms||Redness, itching, blistering|
|Usual onset||Within a few hours|
|Duration||1 to 2 weeks|
|Causes||Prolonged cold exposure|
|Risk factors||Lupus, smoking, family history, Raynaud's|
|Diagnostic method||Based on symptoms and examination|
|Differential diagnosis||Frostbite, trench foot, leukemia cutis, cold panniculitis|
|Prevention||Keeping the hands and feet warm|
Chilblains, also known as pernio, is a type of cold injury that results in red, itchy, and tender areas of skin. Less commonly blistering and ulceration may occur. The fingers, toes, ears and cheeks are most commonly affected.
Chilblains typically occurs due to prolonged exposure to cold. The degree of cold; however, is less than freezing, which would result in frostbite. Risk factors include lupus, smoking, family history, and Raynaud's. The underlying mechanism involves the inflammation of small blood vessels. Diagnosis is usually based on symptoms and examination.
Prevention is generally by keeping the hands and feet warm. Other measures may include avoiding caffeine and potentially taking nifedipine. Treatment may involve the use of corticosteroid creams. It may take a week or two for an episode to resolve.
Chilblains is relatively common in regions of the world with cold climates. The young and old are most commonly affected. Women are more commonly affected than men. The condition has been described since at least the 1st century by Pedanius Dioscorides of Anazarbus.
Signs and symptoms
- Blistering of affected area
- Burning and itching sensation in extremities
- Dermatitis in extremities
- Ulceration (severe cases only)
- Erythema (blanchable redness of the skin)
- Pain in affected area
- Skin discoloration, red to dark blue
Chilblains caused by exposure to low temperatures usually heal within 7–14 days.
In infants affected by Aicardi–Goutières syndrome (a rare inherited condition which affects the nervous system) chilblain-like symptoms occur together with severe neurologic disturbances and unexplained fevers.
Chilblain-like symptoms have also been linked to COVID-19. COVID toes, as they are commonly known, have mostly been reported in older children and adolescents, who often have not had other symptoms of COVID-19. The symptoms are usually mild and disappear without treatment. Their cause is debated: it is uncertain whether COVID toes are a delayed consequence of the viral infection itself (or at least partially connected to environmental factors during the COVID-19 pandemic). They may share some of the microscopic features of chilblains caused by lupus. It has been suggested that in the absence of exposure to cold and damp, COVID-19 should be considered as a possible cause of chilblains.
- Keep affected area warm, and avoid any extreme temperature changes (including very hot water).
- Keep affected area dry.
- Wear warm shoes, socks and gloves.
- Wear a hat and a scarf to protect the ears and the nose.
- Avoid tight fitting socks/shoes.
- Exercise at least four times a week to improve circulation.
- Quit smoking, as it damages circulation.
Treatment for the condition depends on its cause. Below are some common treatments for chilblains caused by exposure to low temperatures, though some may also apply to other sources of the condition.
- Soaking in warm water with Epsom salts for 15–20 minutes, 3–4 times a day.
- A topical steroid cream may relieve itching.
- Nifedipine, a vasodilator, may help in some cases, and can be used throughout just the winter months. Vasodilation may reduce pain, facilitate healing, and prevent recurrences. It is typically available in an oral pill but can be compounded into a topical formula.
- Diltiazem, a vasodilator, may help.
- Apply a mixture of friar's balsam and a weak iodine solution.
- Avoid restricting the affected area.
The medieval Bald's Leechbook recommended treating chilblains with a mix of eggs, wine, and fennel root, and a modern home remedy is to put garlic on the chilblains. Neither of these remedies has been supported by scientific research.
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In acral chilblain-like lesions, a diffuse dense lymphoid infiltrate of the superficial and deep dermis, as well as hypodermis, with a prevalent perivascular pattern and signs of endothelial activation, are observed.
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