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Skin, circulatory system
Chilblains are small, red and itchy patches on the skin caused by an abnormal reaction to cold temperatures. These patches usually occur on the toes and fingers but they can also develop on the face, particularly the nose and lobes of the ears, and on areas of the foot where there is pressure, for example bunions.
Chilblains are caused by an abnormal reaction of the small blood vessels in the skin when exposed to cold temperatures and sudden rewarming. The cold causes the blood vessels to constrict or narrow, limiting the blood supply to the skin. If the area is then warmed too quickly, for example putting cold hands and feet on a radiator or washing them in hot water, the blood vessels do not have enough time to widen properly and there is leakage of fluid out of the blood vessels into the surrounding tissues. This fluid causes the area to become swollen and painful. Anybody can get chilblains if they warm cold areas of their body too quickly, but those most at risk include those with poor circulation, anaemia, poor nutritional state and those who have a family tendency to chilblains. Those particularly at risk are the elderly and people who work outdoors or in cold environments.
Symptoms of chilblains include burning, itching and pain when the skin becomes chilled. When the affected area warms up, these symptoms become more intense and there may be some swelling or redness. In extreme cases, the surface of the skin may break to form painful sores or the chilblain can dry out leaving cracked areas that can often become infected. In severe cases a sore or ulcer may form.
Keep the area clean and dry and apply a soothing lotion such as witch hazel or calamine to take away a lot of the heat and ease discomfort.

If the skin is intact, paint with a mixture of Friar's balsam and a weak solution of iodine. If the skin is broken, apply an antiseptic dressing. At night, rub some lanolin ointment well into the hands and feet to help retain heat.

In severe cases, a doctor may prescribe a medicine that helps to improve the circulation to your hands and feet.
When to consult your pharmacist
Soothing creams and lotions are available from pharmacies that will help alleviate the pain and discomfort of chilblains. The pharmacist may also recommend products to moisturise the skin to keep it supple and prevent the skin from breaking. Antiseptic creams and protective dressings may be used to prevent infection.

Let the pharmacist know if you are taking any medicines. Some medicines used for the treatment of high blood pressure, for example beta-blockers, may constrict the circulation to hands and feet and make you more likely to develop chilblains.

If you have diabetes and you are suffering from chilblains in your toes and feet, your pharmacist will recommend that you see a chiropodist or your doctor.

A chiropodist will give advice about managing pressure on the toes from bunions or toe deformities and advise about correct shoe fitting.
When to consult your doctor
You should see your doctor if the chilblains are persistent or severe, if a skin infection develops or if you are elderly, have diabetes or suffer from arthritis of the hands or feet. Tell your doctor if you have developed chilblains for the first time after taking a medicine as it may be the cause of the problem. In some cases, your doctor may decide to prescribe a product such as nifedipine to help improve the circulation in the hands and feet. Surgical correction may be required for painful bunions or for severe circulatory problems.
Living with chilblains
It is better to try to prevent chilblains from occurring by taking a few simple precautions. If going out in cold conditions try to keep the extreme parts of your body such as toes, fingers and ears warm by wearing warm socks, good fitting shoes, gloves and a hat. When returning indoors, do not warm these areas too quickly but remove your outdoor clothing and allow your hands, feet and other cold parts to adapt to the room temperature. Do not wash hands and feet in hot water and do not stand too close to a fire or radiators. Regular exercise, a healthy diet low in fat and high in fruit and vegetables and not smoking will also all help to maintain a healthy circulation.

If you do develop chilblains it is important that you do not scratch the area. Scratching chilblains increases the inflammation and may break the skin and introduce infection.

Use a soothing lotion and keep the skin clean and dry. Also try to avoid injuries that break the skin.
Useful Tips
  • Avoid sudden changes in skin temperature, especially during the winter
  • Keep yourself warm, especially if you have poor circulation
  • Wear leg warmers, thick socks and gloves in winter. Thermal products are recommended
  • Rub lanolin ointment well into the hands and feet at night to help retain heat
  • Do not warn hands and feet quickly after being out in the cold
Further information
Further information may be obtained from The Society of Chiropodists and Podiatrists:
1 Fellmonger's Path
Tower Bridge Road
Tel: 020 7234 8620

Reviewed on 20 October 2010