Home remedies and treatment options for chilblains
The first line of treatment for chilblains generally includes home remedies to keep the hands and feet warm and dry, such as:
- Avoiding cold, wet environments if possible
- Wearing warm and dry clothing during cold weather
- Performing exercise to stay warm and improve circulation
- Keeping indoor areas warm and dry
- Applying soothing lotion
- Cessation of smoking
If the lesions still don't clear up with these home remedies, medications can be added to make them go away, which include:
- Nifedipine: Calcium channel blockers that treat chilblains by opening the blood vessels and improving circulation
- Topical corticosteroid: May help the lesions fade away
What are chilblains?
Chilblains, also called pernio or perniosis, are painful, itchy lesions on the skin that occur due to repeated exposure to cold, nonfreezing conditions. They are a form of small vessel vasculitis (inflammation of the blood vessels) that typically form on the fingers or toes, but they can develop on the legs or ears too.
- The lesions are usually red or bluish and cause itching, swelling, and blistering on the hands and feet.
- They often clear up within a few weeks with faster healing that occurs in warmer conditions.
- People may experience recurrences seasonally for years.
What causes chilblains or pernio?
Intermittent or prolonged exposure to cold causes small arteries near the skin’s surface to tighten or constrict.
- On rewarming, a protective physiologic reflex gets activated and expands the blood vessels quickly to prevent skin ischemia.
- This reaction may cause blood to move out into nearby tissue, resulting in swelling.
- This swelling irritates the nerves in the affected area, causing pain.
The precise reason why this reaction occurs is still unclear; however, some believe this condition develops due to:
- Hormonal changes.
- Underlying connective tissue disorders or peripheral arterial disease.
Who might get chilblains?
Chilblains can affect all age groups but are most common in young to middle-aged adults with female predominance.
Moreover, the following people have a higher risk of chilblains:
- People who live in a damp, cold but nonfreezing climate
- People who smoke
- People with low body mass index and poor nutrition
- People who wear tight-fitting shoes, gloves, or clothing in cold, damp weather
- Babies who are not dressed in appropriate clothing in damp or cold weather
- People who take part in ice-skating sports
- People who have an underlying bone marrow disorder such as chronic myelomonocytic leukemia
- People who have connective tissue disorders, particularly systemic lupus erythematosus
- People who have acrocyanosis and primary or secondary Raynaud’s disease
- People who have a family history of chilblains
What are the symptoms of chilblains?
Chilblains are painful, swollen patches of skin that commonly occur on the fingers, toes, and ears (acral sites). However, they may develop in any area following exposure to chronic cold, such as the thighs/hips of horse riders. Sometimes, these skin patches may look shiny.
These lesions develop several hours after exposure to cold temperature and last for more than 24 hours.
Chilblains typically present as follows:
How are chilblains diagnosed?
Chilblains are usually diagnosed clinically. Sometimes, investigations may be required to look for causes of secondary chilblains (caused by underlying health conditions such as lupus or hormonal issues).
The diagnosis of chilblains is made based on the following criteria:
- Major criteria:
- Localized swelling and redness of acral sites that last at least 24 hours
- Minor criteria (any one of the following):
- Onset and/or worsening in cooler months
- Histopathology consistent with chilblains
- Improvement with warming and drying
Investigations to rule out secondary causes may include:
- Full blood count
- Antinuclear antibody, rheumatoid factor, and antiphospholipid antibodies
- Complement levels
- Protein electrophoresis
- Cold agglutinins and, in children, cryoglobulins
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