The underestimated skin problem in cold weather

What are chilblains (perniosis)?

Chilblains, medically also called perniosis, appear as painful, doughy areas of skin with inflammatory signs. They may be swollen and can show blisters or reddish‑blue‑violet spots. 

Raised areas suggest a possible inflammation, often accompanied by abnormal sensations such as „pins and needles". The affected skin may also feel colder and damper, be more tender to pressure and burn when warmed.

There are acute chilblains, which develop shortly after cold exposure or within a few hours, and chronic chilblains that arise from repeated cold exposure. There are also secondary chilblains associated with autoimmune diseases such as lupus erythematosus or neurological disorders like Aicardi‑Goutières syndrome.

How do chilblains differ from other skin reactions to cold?

Reddened skin after a change from cold to warm conditions is usually not chilblains. These normal reactions are characterised by temporary redness, burning, tingling or transient dryness of the skin. Similar symptoms can also occur with frostbite, allergic reactions, circulatory disorders such as acrocyanosis or vascular diseases like vasculitis. 

Unlike frostbite, chilblains are not tissue damage caused by extreme cold, but a cold‑induced narrowing of blood vessels. This leads to reduced oxygen supply to the tissue and eventually to an inflammatory reaction. Chilblains develop through prolonged mild cold exposure, particularly at temperatures around freezing, high humidity and large temperature fluctuations.

It is important to emphasise that in case of doubt or persistent symptoms a professional medical assessment is recommended to obtain an accurate diagnosis.

Where do chilblains most frequently occur and who is particularly affected?

Chilblains occur mainly on the dorsal surfaces (tops) of the fingers and toes, the shins, the outer thighs and in women sometimes on the breasts. The face and earlobes can also be affected. In general chilblains are unpleasant but mostly harmless. 

Some people are more susceptible to chilblains than others. Women are more likely to be affected than men. Risk factors for developing chilblains include low body weight, an unbalanced diet, smoking and excessive alcohol consumption. Genetic predisposition and family tendency to chilblains also play a role, especially with prolonged time outdoors in cold conditions, whether for work or winter sports.

What are the risk factors for developing chilblains?

Bone marrow diseases, connective tissue disorders and disease‑related circulatory disorders such as acrocyanosis or Raynaud's syndrome increase the risk of chilblains. 

Other conditions such as diabetes mellitus, angina pectoris, stroke and depression are also influencing factors.

How are chilblains treated?

Chilblains usually heal spontaneously within one to six weeks if the affected area is kept warm and cold is avoided. In more severe cases, the treating physician may use corticosteroid creams and vasodilator medications to support healing. In general, however, these inflammations do not pose a threat to health and are also not contagious.

For secondary chilblains the underlying condition is treated. Pain relief can be achieved with short‑term use of analgesics; medical advice is recommended regarding dose and choice.

How to care for your skin to relieve symptoms

• Soothe the affected limbs with lukewarm water or a gentle massage using warm, dry hands.
• Avoid very hot water or direct contact with heaters or ovens to prevent additional stress to the skin.
• Apply lanolin (wool wax) preventively to feet or hands before exposure to cold to create a protective layer that helps retain body heat.
• Promote circulation by light physical activity, especially during sedentary tasks.
• Enjoy comforting internal warmth with hot teas and soups.
• Protect affected skin from the cold with breathable wool or cotton socks, gloves, hats or scarves.
• Wear water‑repellent clothing outdoors and keep the whole body warm, preferably in layers of breathable materials.
• Ensure shoes have enough space so as not to restrict blood circulation. It is important that shoes fit well and do not rub, so sensitive skin areas are not additionally irritated.
• Wear sufficiently warm and weather‑proof clothing that protects against moisture while remaining loose enough.
• Warm up slowly after being exposed to the cold to avoid overloading the body.
• Avoid long stays outdoors in cold or damp weather.
• Reduce consumption of caffeine and nicotine to avoid further impairing circulation.
• Thoroughly dry your feet after showering or bathing to avoid moisture that can promote the development of chilblains.
• Give up smoking to protect vascular health and wound healing.
• When itchy, avoid scratching and use over‑the‑counter skin care products from the pharmacy to relieve itching.
• If necessary, use painkillers containing acetylsalicylic acid or ibuprofen. Anti‑inflammatory creams with glucocorticoids such as cortisone provide relief.
• See a doctor for poorly healing or open wounds, especially with diabetes or circulatory disorders.
• Train your vessels with regular contrast showers to help prevent chilblains in the long term.

A mindful approach to cold and targeted protective measures are crucial to prevent or treat chilblains. The tips presented here emphasise the importance of appropriate clothing, movement and suitable skin care in cold weather.