Chilblains/Pernio
Chilblains are itchy and/or tender red or purple bumps occurring as a reaction to the cold. This is also known as pernio or perniosis.
Chilblains occur several hours after exposure to the cold in temperate humid climates. They are sometimes aggravated by sun exposure. Cold causes constriction of the small arteries and veins in the skin and by rewarming these results in leakage of blood into the tissues and swelling of the skin.
Children and the elderly and most often affected.
Chilblains are more likely to develop in those with poor peripheral circulation i.e. blue-red mottled skin on the limbs.
Contributing factors include:
- A familial tendency towards vessel sensitivity
- Peripheral vascular disease due to diabetes, smoking, high blood fats and cholesterol.
- Poor nutrition, e.g. anorexia nervosa
- Hormonal changes
- Connective tissue disease (lupus erythematous)
- Bone marrow disorders
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Common site for chilblains are:
- Backs and sides of the fingers and toes
- Heels
- Lower legs
- Thighs (especially in horse riders)
- Wrists of babies
- Over fatty lumps (lipomas)
- Nose
- Ears
Each chilblain comes up over a few hours as an itchy, red swelling and subsides over the next 7-14 days. In severe cases blistering, pustules, scabs and ulceration can occur. Occasionally the lesions may be ring-shaped. They may become thickened and persist for months.
In children recurrences each winter for a few years are common but complete recovery is usual. Chilblains in elderly people have a tendency to get worse every year unless precipitating factors are avoided.
Treatment
Unfortunately, chilblains respond poorly to treatment. The following may be useful:
- A potent topical steroid applied accurately for a few days may relieve itch and swelling.
- Antibiotic ointment or oral antibiotics may be necessary for secondary infection.
Prevention
The hands and feet must NOT be allowed to get cold. DO NOT SMOKE!
The following measures may help to keep you warm:
- Insulated and heated home and workplace
- Stop all drafts
- Warm clothing, especially gloves, thick, woolen socks, and comfortable, protective footwear. Keep the head and neck warm with hat and scarf.
- Wear cotton-lined waterproof gloves for wet work, and change if wet and chilly.
- Apply sunscreen to exposed skin every day.
- Take vasodilator medication such as nifedipine prescribed before the onset of cold weather and taken throughout winter. Side effects include flushing and headaches. [Discuss with your physician if this is safe and appropriate].
- NEWER portable heat sources (hand warmers) and battery operated heated socks are also possible solutions.
