What are chilblains?
With chilblains (perniones), there is sometimes severe pain in the toes on exposure to cold. The pain is caused by an abnormal reaction of the small blood vessels in the skin of the toes when the feet are exposed to cold.
What causes chilblains?
Normally the small blood vessels in the skin automatically narrow on exposure to cold. Through this mechanism the blood cannot lose its heat to the surroundings, so the most important organs deep in the body stay at temperature and energy is saved. If the skin cools so strongly that damage threatens, the vessels open again so the skin warms up, even giving a glowing feeling. In chilblains this automatic system does not work properly: on exposure to cold, it is not the smallest skin vessels that narrow but the larger vessels lying deeper in the skin, and to compensate the small vessels now open maximally. This disturbance of the skin’s blood supply leads to pain and burning in the affected skin. The cause of this wrong reaction to cold is not known.
Not only toes
The condition is called chilblains (“winter toes”), but other parts of the skin exposed to cold can react in the same way — besides the toes, especially the hands, heels, ears and tip of the nose.
What are the complaints?
The skin is blotchy red-purple in colour. In more severe cases there are also blisters and superficial wounds.
How can I prevent chilblains?
If you are prone to chilblains, try to protect the skin as well as possible against the cold. In winter, wear roomy, insulating shoes with thick socks, and make sure you have good gloves.
How are chilblains treated?
Various “treatments” have been devised. Contrast baths (alternating cold and warm water) are sometimes used to try to improve the blood supply to the toes, but in many cases these unfortunately have the opposite effect. Warming rubs (usually containing glycol salicylate, capsicum or methyl nicotinate) can be tried, but the effect is usually very limited, as it is for nifedipine tablets. Preventing the complaints by keeping the body well warmed is therefore by far the best approach.
When to see a doctor
See a doctor if chilblains are severe, blister or form open wounds, or keep recurring, so other cold-related conditions (such as Raynaud’s) can be considered.