Chilblains

Chilblains, also known as pernio or perniosis, is a medical condition characterised by damage to capillary beds in the skin due to cold exposure. This condition predominantly affects women and typically involves the hands and feet, resulting in redness, itching, inflammation, and sometimes blisters.

Signs and Symptoms

The primary areas affected by chilblains include the toes, fingers, earlobes, and nose. The symptoms are:

• Blistering of the affected area
• Burning and itching sensation in extremities
• Dermatitis in extremities
• Ulceration (in severe cases)
• Erythema (blanchable redness of the skin)
• Pain in the affected area
• Skin discolouration ranging from red to dark blue

Chilblains caused by exposure to low temperatures usually heal within 7–14 days.

Prevention

Exposure

Preventing chilblains primarily involves managing exposure to cold and damp conditions. Key preventive strategies include:

• Keeping the affected area warm and avoiding extreme temperature changes.
• Keeping the affected area dry.
• Wearing warm shoes, socks, and gloves.
• Protecting ears and nose with a hat and a scarf.
• Avoiding tight-fitting socks and shoes.

Other Preventive Measures

• Regular exercise, at least four times a week, to improve circulation.
• Quitting smoking, as it damages circulation.

Treatment

Once diagnosed, the first-line treatment for chilblains includes avoiding cold, damp environments and wearing appropriate protective clothing. Additional treatments include:

• Nifedipine and amlodipine, which are vasodilators in the calcium channel blocker class. These may reduce pain, facilitate healing, and prevent recurrences. They are typically available as oral pills but can also be compounded into a topical formula.
• Diltiazem, another vasodilator.
• Topical application of a mixture of friar's balsam and a weak iodine solution.

Related Conditions

Chilblains can be idiopathic but may also be indicative of other serious medical conditions such as Raynaud syndrome, erythromelalgia, frostbite, trench foot, and connective tissue diseases like lupus or vasculitis. In infants with Aicardi–Goutières syndrome, chilblain-like symptoms may occur along with severe neurological disturbances and unexplained fevers.

Etymology and History

The term "chilblains" is derived from the Modern English word "chill," meaning cold, and the archaic word "blain," meaning swelling or blister. Historically, treatments included remedies like a mixture of eggs, wine, and fennel root as recommended in the mediaeval Bald's Leechbook. Modern home remedies suggest using garlic, although these have not been scientifically validated.

COVID-19 and Chilblains

Chilblain-like symptoms, also known as "COVID toes," have been observed in older children and adolescents during the COVID-19 pandemic. These mild symptoms often disappear without treatment and may be a delayed consequence of the viral infection or related to environmental factors during the pandemic. They share some microscopic features with chilblains caused by lupus. Research at the dermatology department of Saint-Louis Hospital in Paris found that affected individuals had high levels of autoantibodies and type 1 interferons, proteins that activate pathogen-fighting genes in immune cells.

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Self-assessment MCQs (single best answer)

Which of the following is NOT typically a symptom of chilblains?

What is the primary cause of chilblains?

Which demographic is predominantly affected by chilblains?

Which of the following is a preventive measure for chilblains?

Which medication is used as a vasodilator to treat chilblains?

Chilblains may be indicative of which serious medical condition?

What is a common historical remedy for chilblains mentioned in the text?

"COVID toes" observed during the COVID-19 pandemic share some microscopic features with chilblains caused by which condition?

What is the etymology of the term "chilblains"?

Which of the following is NOT a recommended preventive measure for chilblains?