What are the other Names for this Condition? (Also known as/Synonyms)

• Chill Burns
• Erythema Pernio
• Pernio

What is Chilblains? (Definition/Background Information)

• Chilblains is severe form of cold injury; it usually occurs due to longstanding exposure to non-freezing temperature and humidity, followed by a warming of the affected region. The hands (fingers) and feet (toes) are affected causing red, itchy, and painful skin discoloration
• Chilblains does not always occur due to exposure to very low temperatures; they can also occur due to moderately low temperature or sudden change of conditions from hot to cold
• The predisposing factors for Chilblains may include certain occupations (handling frozen meat and fish), individuals with underlying disorders, such as dysproteinemia and blood-related conditions, and use of certain medications
• Chilblains may be diagnosed by studying the clinical symptoms and assessing the history of exposure to cold. If necessary, tests and exams to diagnose an associated condition (if present) may be undertaken
• No severe symptoms or adverse complications have been reported from Chilblains. In many, the condition does not require any treatment and it gets better on its own. The prognosis of Chilblains is typically excellent in many cases

Who gets Chilblains? (Age and Sex Distribution)

• Chilblains may be observed in children and adults. But, most of the cases are reported in young to middle-aged adults; it is generally rare in children
• Both males and females are affected, although more incidents are reported in females
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Chilblains? (Predisposing Factors)

The risk factors for Chilblains may include:

• Children playing outdoors during cold weather
• Exercising in cold and clammy conditions
• Living quarters in damp cold climates with a complete or partial reliance on local source heating (fireplace or non-central heater)
• Prolonged outdoor activity during winters
• Individuals with hyperhidrosis (increased sweating)
• Chilblains can be an occupational hazard, such as for fishermen, those handling frozen meat, and certain construction workers
• Certain underlying systemic disorders can also increase one’s vulnerability to Chilblains, such as the following:
  • A variety of dysproteinemias
  • Antiphospholipid syndrome
  • Chronic myelogenous leukemia
  • Cold agglutinin disorder
  • Cryoglobulinemia
  • Waldenström's macroglobulinemia
• Uncontrolled diabetes
• Smoking
• Having low body weight
• Anorexia nervosa
• Raynaud’s disease
• Celiac disease
• Non-steroidal anti-inflammatory medications (NSAID), such as sulindac, may cause drug-induced Chilblains
• In some, a family history of Chilblains may be noted

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chilblains? (Etiology)

Chilblains is a skin condition occurring due to exposure to (usually) non-freezing cold.

• It normally affects the extremities and develops a few hours after exposure to cold weather/conditions
• Cold temperatures cause the temporary narrowing of blood vessels at the skin surface, which on sudden thawing/warming causes blood to rush back into the blood vessels
• However, since this process happens quickly, it results in a variety of physiological processes leading to blood leakage into areas around the blood vessels
• The decrease in blood supply followed by a sudden increase in blood supply in the affected area results in the characteristic symptoms of Chilblains

What are the Signs and Symptoms of Chilblains?

The signs and symptoms of Chilblains may include:

• Bluish-red skin discoloration on fingers, toes, nose, and ears; numerous small patches may be noticed
• Burning sensation and swelling may be observed
• Rarely, they can form ulcerating blisters
• Moving from a cold environment to a hot environment may increase severity of the condition
• Signs and symptoms of an underlying disorder/condition, if any present, may be noted

How is Chilblains Diagnosed?

Chilblains may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Tests and procedures to diagnose an underlying condition, if present
• Skin biopsy, if necessary: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

In many cases, no skin biopsy is necessary and the condition may be diagnosed via the presenting symptoms by a healthcare provider.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chilblains?

In a majority of individuals, no significant complications due to Chilblains are noted. However, in some cases, the following complications are observed:

• In some cases, there may be permanent discoloration of the affected area
• Cosmetic issues resulting in emotional stress
• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Complications arising from an underlying disorder, if any
• Recurrence of the condition, in many individuals

How is Chilblains Treated?

In many individuals, no treatment is necessary for Chilblains, since the condition gets better spontaneously. If required, the following measures may be considered:

• Gradually warming the affected skin region can help in recovery
• Symptomatic and supportive therapy
• Use of topical steroids and creams
• Vasodilator therapy
• Non-steroidal anti-inflammatory drug (NSAID) therapy

How can Chilblains be Prevented?

Avoiding exposure to cold weather and cold temperatures can help prevent Chilblains. Additionally, the following steps may be taken to prevent the condition:

• Use of protective and warm clothing (including wearing gloves, shoes); especially, taking precautions when there is a sudden change in weather (cold to hot temperatures)
• Applying sunscreen to exposed skin
• Avoiding caffeinated drinks, decongestants, including smoking
• Considering the possibility of relocating to a warmer area
• Undertaking early diagnosis and treatment of any associated condition may be beneficial
• Inform your physician if you are allergic to any medication
• Stop activities that may trigger the condition
• Change your work activities, if possible
• Avoid point-source heating in cold damp housing

What is the Prognosis of Chilblains? (Outcomes/Resolutions)

The prognosis of Chilblains is typically excellent, since it is a self-limiting condition with no severe symptoms or complications being noted. The condition resolves within 2-3 weeks without causing any tissue damage.

Additional and Relevant Useful Information for Chilblains:

The following is a useful resource for additional information on First Aid for Frostbite:

https://www.dovemed.com/healthy-living/first-aid/frostbite-first-aid/