Medicines for Chilblains

What it is

Chilblains are small, itchy, sometimes painful swellings on the skin that develop as a reaction to cold. They most often affect the extremities — particularly the toes, but also the fingers, and sometimes the ears, nose, or other exposed areas. Chilblains occur when the skin is exposed to cold and then warmed up too quickly; the small blood vessels near the skin surface react abnormally to the change in temperature, causing inflammation. They appear as red, or sometimes blue or purple, patches or swellings on the skin, which can be itchy (often the first symptom), and may become painful, burning, or sore; the skin may be swollen, and, in more severe cases, can blister or, occasionally, break down. Chilblains usually develop a few hours after exposure to the cold. They are more common in cold, damp weather, and some people are more prone to them (for example people with poor circulation, those who are underweight, or those with certain conditions). Chilblains are usually not serious and often heal by themselves within a week or two, particularly if the skin is kept warm and not exposed to further cold. The most important thing is prevention — keeping warm and protecting the skin from cold, and warming up gradually rather than quickly. It is also important not to warm cold skin too quickly (for example on a hot radiator), as this can trigger chilblains. In most cases chilblains are managed with simple measures, but if they are severe, keep recurring, or the skin breaks down or becomes infected, or if there is concern about circulation, it is worth seeking advice.

How it is treated

Chilblains usually heal on their own within a week or two and are managed with simple self-care and, most importantly, prevention. To help chilblains heal and ease symptoms: keep the affected area warm (but warm up gradually, not quickly), avoid further exposure to the cold, and resist scratching (which can damage the skin and risk infection); soothing lotions or creams may help with itching, and a pharmacist can advise. It is important not to warm cold skin too quickly — for example not putting cold feet straight onto a hot water bottle or radiator — as rapid rewarming can trigger chilblains. Preventing chilblains is the key, especially for those prone to them: keeping warm in cold weather by wearing warm clothing, gloves, warm socks, and comfortable, warm footwear; keeping the whole body warm (which helps the circulation to the extremities); warming up gradually when coming in from the cold; keeping active to help circulation; and keeping the home adequately warm. Stopping smoking and managing conditions that affect circulation also help. Most chilblains settle with these measures. It is worth seeking advice from a pharmacist or GP if chilblains are severe, very painful, keep coming back, do not heal, or if the skin breaks down, blisters, or shows signs of infection (increasing pain, redness, swelling, pus, or feeling unwell) — and particularly if there is any concern about circulation, or in people with diabetes or circulation problems, where foot care and assessment are important. The reassuring messages are that chilblains are usually not serious and heal on their own, that keeping warm and warming up gradually prevent them, and that simple measures manage them — while severe, recurring, or non-healing chilblains, or broken or infected skin, should be checked.