Both chilblains and Raynaud’s are associated with symptoms that appear on exposure to cold. These two diseases, however, have distinct presentations, causes, and management.
Both Raynaud’s and chilblains can occur in the same person. Either of these diseases may occur in combination with other underlying conditions, such as blood disorders, lupus, and cancer.
A thorough medical evaluation including lab tests may be necessary to reach a definitive diagnosis. This may particularly be important when there are other signs and symptoms present besides the typical signs of Raynaud’s or chilblains.
- Chilblains: Also called pernio or perniosis, chilblain is a skin condition in which inflammation of the small blood vessels (vasculitis) in the skin occurs on exposure to cold, damp but not freezing conditions.
- Raynaud’s: It is a rare condition that causes narrowing of the arteries (vasospasm), particularly the small arteries supplying the fingers and toes, in response to cold or stress.
Symptoms of Chilblains and Raynaud's
The symptoms generally appear on the hands and feet and typically go away within 7 to 21 days. In some cases, however, it may become chronic or recur annually. Chilblains can affect the legs, ears, and nose, as well as rarely the thighs. They are generally seen in females who wear tight-fitting pants.
The symptoms may include:
- Tingling and numbness in affected parts
- Small itchy bumps
- Vesicles (fluid-filled bumps)
- Pustules (pus-filled bumps)
- Skin swelling and pain
- Redness or dark-bluish skin color
- Burning sensation
- Thick and scaly skin
The symptoms generally appear as attacks that last for a minute or two although rarely they may last for hours. Raynaud’s symptoms generally occur on exposure to cold or emotional stress. The condition generally affects the toes or fingers, but it may rarely affect the ears, nose, lips, or nipples. In a typical attack, the symptoms generally begin on a single finger or toe but later progress to involve more fingers and toes.
Symptoms may include:
- The affected part appears pale and then changes color to white and then blue
- Cold sensation in the affected part
When the blood flow is restored after an attack, there may be a throbbing pain, numbness, or tingling sensation. The affected part may appear red before changing to the normal skin color.
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Causes and risk factors of chilblains and Raynaud's
The exact cause of chilblains is not known. Depending on the underlying cause, chilblains may be:
- Primary (not occurring due to another underlying condition), or
- Secondary (when they occur due to other diseases, such as connective tissue disorders)
Studies suggest that chilblains occur due to the narrowing (constriction) of the small blood vessels under the skin on exposure to cold. On rewarming, these blood vessels may widen, causing leakage of blood that causes swelling and irritation of the skin.
Some people may be more prone to develop chilblains due to allergic reactions to colds, hormonal changes, or genetic predisposition.
They can affect people of any age but are more common in middle-aged adults and uncommon in children. Women are at a higher risk of chilblains than men.
Some of the factors that may increase the risk of chilblains are:
- Poor nutrition
- Wearing tight clothes
- Certain occupations or professions that require exposure to frequent cold, damp conditions, such as farmers, mountaineers, and fishermen
- Family history of chilblains
- Certain underlying conditions, such as Raynaud’s and lupus
Depending on the underlying cause, Raynaud’s may be primary or secondary.
- Primary Raynaud’s is also called Raynaud’s disease and has no known underlying cause. It is more common but tends to be less severe than secondary Raynaud’s. Primary Raynaud’s tends to occur before the age of 30 years and is more common in females than in males. The affected person may have a family history of Raynaud’s.
- Secondary Raynaud’s is also called Raynaud’s phenomenon and may develop due to some underlying conditions or factors. Secondary Raynaud’s tends to occur after the age of 30 years.
Some of the causes of secondary Raynaud’s are:
- Certain diseases, such as rheumatoid arthritis, blood disorders, Buerger’s disease, and Sjogren’s syndrome
- Atherosclerosis (hardening of the arteries)
- Certain occupations or professions, such as those that involve the use of vibrating tools, repeated movements (such as typing or playing piano), or chemical exposure (such as plastic manufacturing)
- A history of surgery on the hands or feet, accidents, or frostbite
- Certain medications, such as oral contraceptive pills, beta-blockers, certain migraine medications (containing ergotamine), over-the-counter cold or allergy medications, and some cancer medications
- Repeated cold exposure
Diagnosis of chilblains and Raynaud's
It is generally diagnosed by a doctor based on the signs and symptoms. Your doctor may ask about your occupation and whether you participate in certain sports (such as skiing) and have a family history of chilblains.
Additional tests, including blood tests or skin biopsy, may be needed in some cases to rule out any underlying health conditions.
The doctor diagnoses Raynaud’s based on medical history, physical examination, and certain tests. Medical tests help ascertain the cause of Raynaud’s (primary or secondary) and rule out any coexisting health conditions.
Some of the tests that may be done include:
- Cold stimulation test (it measures the time taken for the fingers to attain their normal temperature after exposure to cold)
- Nailfold capillaroscopy (to look for abnormal arteries under the nails)
- Blood tests (such as blood counts, antinuclear antibody test, inflammatory markers, etc to rule out other conditions)
Treatment of chilblains and Raynaud's
Chilblains generally go away on their own without the need for medical treatment.
- Keeping yourself warm by wearing protective clothing including gloves and socks and avoiding tight clothes and damp and cold conditions
- If your clothes, socks, or gloves get damp, change them as soon as possible
- Avoid wearing damp shoes
- Keep your house warm and dry
- Avoid smoking
- Do enough exercise to keep yourself warm
- Soak your hands in warm water before an anticipated cold exposure
Light therapy, involving treatment with intense pulsed light, may relieve redness. Antibiotics may be needed if chilblains get infected. This is particularly seen in people with diabetes and may present with pus formation or fever.
Medications (topical or oral) for chilblains may be needed in some cases.
- Topical nitroglycerine
- Topical steroids such as betamethasone
- Oral nifedipine
Raynaud’s cannot be cured, however, it can be managed with lifestyle modifications and proper treatment. Some people may require surgical management as well.
- Lifestyle measures: These include
- Avoiding cold temperatures
- Avoiding or quitting smoking
- Keeping oneself warm
- Maintaining proper skincare
- Medications: These may include medications to improve blood flow to the affected parts, such as calcium channel blockers, alpha-blockers, prescription skin creams, and angiotensin-converting enzyme inhibitors. Antibiotics may be prescribed when an infection is present.
- Surgery: It is generally needed when the affected part develops gangrene. Surgery may be done to remove the nerves causing blood vessel narrowing. Shots containing local anesthetics or onabotulinumtoxin A (Botox) may be administered to block these nerves.
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Genetic and Rare Diseases. Perniosis. https://rarediseases.info.nih.gov/diseases/7373/perniosis/cases/49692
National Institutes of Health. Raynaud's. https://www.nhlbi.nih.gov/health-topics/raynauds
Okafor A, Truong J. Perniosis. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/perniosis/
Hansen-Dispenza H. Raynaud Phenomenon. Medscape. https://emedicine.medscape.com/article/331197-overview
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