Chilblains: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Medically Reviewed by Zilpah Sheikh, MD on September 06, 2024
Written by Janie McQueen
9 min read

Chilblains, also known as perniosis, or pernio, can happen when parts of your body are exposed to damp and cold, but not freezing weather. They appear as small, swollen spots on your skin. They might itch, feel tender, or have a burning sensation. Often reddish but sometimes blue, chilblains may form blisters or shiny patches.

Chilblains most often occur on your hands and feet, mainly your fingers and toes. They also can appear on other extremities, such as your ears, heels, and nose. In rarer cases, they can happen on the thighs or buttocks.

Anyone can get chilblains, but it’s more likely if you:

  • Have poor blood circulation
  • Smoke. Nicotine constricts your blood vessels.
  • Have poor eating habits or a low body mass index (BMI)
  • Live in a climate that’s damp or humid and cold. They happen more if your home doesn’t have central heating, which circulates warmth through all parts of your home. For example, chilblains are more common in parts of northern Europe and the U.K., where people often use heat sources that warm targeted areas only.
  • Wear tight clothing. Perniosis in the form of red or blue plaques (patches) can form on your thighs and hips if you often wear pants that fit too snugly.
  • Wear ill-fitting shoes. Tight footwear can put pressure on your toes or a part of your foot that sticks out like a bunion. This can cause chilblains.
  • Are a young or middle-aged woman. Studies have shown this may be at least partly due to clothing choices. However, more research needs to be done to figure out other reasons women are more prone to chilblains than men. 
  • Are an or inactive person who lives in a climate prone to dampness and cold.

Babies who aren’t properly clothed or covered, including on their faces, can get chilblains, too.

Certain medical conditions also can play a role.

The word "chilblains" is a blend of the two Old English words "chill" (meaning cold) and "blegen" (sore). Scientists consider them an abnormal response to the cold. This doesn’t make them uncommon, though, especially in parts of the world where the climate is often cold and damp.

In the U.S., more cases seem to crop up in areas to the North and West. Scientists aren’t sure how many chilblains cases really occur throughout the country, though, because the condition often is undiagnosed or misdiagnosed. 

Chilblains can form when parts of your body are exposed for too long in damp, cold weather. Chilly air narrows the blood vessels near the surface of your uncovered skin. This cuts oxygen flow and leads to swelling. If your skin is then exposed to heat, the blood vessels will widen again. But if this happens too fast, those vessels can’t manage the sudden increase in blood flow. The extra blood can seep into nearby tissue. This can trigger itchiness and inflammation.

These symptoms usually start about 12 to 24 hours after the cold weather exposure.

Researchers don’t know why some people are more likely to get chilblains than others. They think genetics or hormonal changes might play a part.

Certain medical conditions might have a link to chilblains, though such connections are rare. They include:

  • Connective tissue diseases like systemic lupus erythematosus (SLE). SLE is the most common condition that seems to relate to chilblains.
  • Raynaud’s phenomenon, in which spasms or too much narrowing of the small blood vessels in your toes or fingers can make them change color. If you have Raynaud’s, these changes can happen before or after you have chilblains symptoms.
  • Peripheral arterial disease (PAD). PAD happens when the vessels that carry blood from your heart to your legs get narrow or blocked, usually by fatty plaque buildup.
  • Bone marrow disorders such as chronic myelomonocytic leukemia (CMML), a chronic blood cancer.
  • Anorexia nervosa, which contributes to low BMI.
  • Celiac disease, in which an intolerance to gluten can lead to poor nutrition. 
  • Plasma disorders such as macroglobulinemia.

The main symptoms of chilblains include:

  • Small, itchy patches on your skin. If the skin breaks, it can form a blister, sore, or ulcer, which can let in bacteria and lead to infection or scarring.
  • The affected areas can turn red or dark blue.
  • A burning or itching feeling on your skin, which can worsen if you enter a warm room.
  • Swelling in your fingers or toes.

Chilblains usually go away within 2 or 3 weeks or when the weather warms up. You might find they come back at the same time each year. If symptoms don’t get better after home treatment, see a doctor. While most cases don’t become serious, follow up if it keeps returning. Chronic, meaning ongoing, recurrent pernio has sometimes led to a connective tissue disease diagnosis.

Chilblains appear on parts of your body that get exposed to the cold. This usually means your extremities: cheeks, toes, nose, ears, heels, and fingers. If chafing from tight clothing is the cause, this can include your thighs and hips. In rare cases, chilblains have appeared on your butt.

If you have chilblains on your toes, they might swell and turn red or purple. If your skin is black or brown, the color changes can be harder to see.

While it might seem to make sense that layering socks or tights will help keep your feet and toes warm, doing this can restrict your blood circulation and make your feet colder. Do this instead:

  • Wear leather shoes or boots lined with fleece – sheepskin or synthetic – in cold, wet weather. Make sure they fit well and aren’t too tight.
  • Wear house slippers that cover your heels and ankles.

Swollen fingers are considered a main sign of chilblains. As with your toes, they can look purple or reddish and be harder to notice on darker skin.

The best ways to guard your fingers against chilblains are:

  • Wear warm mittens or gloves in cold, wet weather.
  • Keep your hands warm and dry.
  • Maintain a comfortable, warm temperature in your home and place of work.

Your health care provider likely can diagnose chilblains just by looking at the affected area. They might want to run a blood test or a biopsy to see if the chilblains are related to another condition or to discern if it’s another condition with symptoms similar to chilblains.

An example of some confusion and disagreement in the medical world was the COVID-19 phenomenon dubbed “COVID toes.” Early in the pandemic, when people were hyper-focused on their health, some people sought medical help for spots of painful, red swelling on their toes. They looked a lot like chilblains.

Many medical practitioners now think “COVID toes” actually were chilblains. During the pandemic, people were at home much more, perhaps not covering their feet when walking on cold surfaces or being in cold air. They also were paying more attention to what was going on with their bodies, which may have led more people to see a doctor.

A study on whether the abrupt uptick of chilblains cases in 2020 was connected to COVID-19 found a weak link. Researchers also noted that few people in the case studies tested positive for COVID-19. The cases might have been caused by behavior changes during the pandemic and could thus have led to more chilblains diagnoses. 

Chilblains will usually get better and go away without other treatment if you protect the areas from further cold or damp weather. If they still linger after several weeks, see your health care provider.

Certain medications can improve your symptoms, make you more comfortable, and lessen the chances the chilblains will come back. Drugs your doctor might prescribe include:

  • Oral medications, meaning you take them by mouth. Drugs such as nifedipine (Adalat) help widen your blood vessels. Pentoxifylline (Pentoxil, Trental) boosts your blood circulation.
  • Commonly prescribed topical medications – meaning you put them directly on your skin – are nitroglycerin (Nitrol, Nitro-Bid) or a steroid such as betamethasone valerate (Beta-Val, Valisone).

You can often treat chilblains on your own. Some ways include:

  • Ease swelling and pain with over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
  • Soak the areas with chilblains in warm water for brief periods of time.
  • Use unscented lotion to keep your skin moist.
  • Wear layered clothing and cover up with blankets to stay warm.
  • Keep your hands and feet cozy with mittens or other hand warmers, socks, and slippers.
  • Wear a hat. Even if the chilblains aren’t on your ears, hats help retain your body warmth.
  • Avoid going out in wet, cold weather.
  • Avoid smoking and drinking caffeinated beverages. Caffeine and nicotine hamper healthy blood flow.
  • Don’t try to heat up your hands or feet with hot water, a gas fire, water bottle, or a radiator. Too much heat applied too quickly can cause more pain and damage.
  • Don’t pick at or scratch your skin.

The best way to manage chilblains is to prevent them from happening. Try to stick with these guidelines:

  • If you’ve been out in cold weather, warm up gradually, not all at once.
  • Keep your indoor air dry and warm.
  • Bundle up and try to leave as little skin exposed as possible when you go outside. Layer loose-fitting clothing, wear a scarf and hat, cover your hands, and wear water-resistant shoes or boots.
  • Soak your hands in warm water before going out.
  • Only go out in the cold when you have to.
  • Exercise every day to keep your body warm and improve your blood flow.
  • Quit smoking.

Chilblains, also known as pernio, are swollen, red or bluish areas on your skin that can happen if you stay out in cold, wet weather for too long. Sometimes they can become blisters or sores. 

Chilblains are most likely to happen in the winter months and ease up in spring, when the weather warms up. Your fingers and toes are the areas most likely to get chilblains. 

The best way to avoid getting them is to wear warm clothing and footwear that’s waterproof and not too tight. Chilblains are usually simple to treat with topical creams and meds that lessen pain and help blood flow.

What is the main cause of chilblains? 

You’re most likely to get chilblains if you stay out in damp or cold weather for an extended period, with extremities – i.e., fingers, toes, ears, nose etc. – exposed. 

What is the fastest way to cure chilblains?

Warm up the affected areas slowly. A good way is to alternate dipping your feet and hands in warm – but not hot – water, then cold water, until they start to feel normal again. Dry them completely. A warm bath and a hot drink can help, too.

What vitamin deficiency causes chilblains?

A small Turkish study found a possible link between chilblains and how low levels of vitamin B12 can affect the widening or narrowing of blood vessels.

How can you avoid getting chilblains? 

The best way to not get chilblains is to avoid going out in cold, damp weather for extended periods. When you must go out, cover all skin that might get exposed with a scarf and hat, mittens, and footwear that keeps your feet warm and fits well.

Which cream is best for chilblains?

A corticosteroid cream can help ease itching, swelling, and pain and might help heal them faster, especially if the areas have broken open and become sores. Topical meds like triamcinolone 0.1% must be prescribed by your health care provider.

Is walking good for chilblains?

Walking is an ideal, low-impact exercise to improve your blood circulation throughout your body, which can help guard against chilblains. Don’t walk on cold surfaces with bare feet, though.

Can hot water cure chilblains?

Hot water can make existing chilblains worse. Reheat your skin gently and gradually by bathing the affected areas alternating with warm, then cold, water.

What foods are good for chilblains?

A good nutrition plan featuring lots of veggies and fruits supports your circulation, which helps protect against or heal chilblains.

When do you need to see a doctor?

See your health care provider right away if:

  • Your symptoms don’t go away after 2 weeks of home treatment or return in flare-ups.
  • You still have chilblains after the weather warms up.
  • There’s a possibility the weather you were exposed to might have been cold enough to cause frostbite.
  • You think the area might have gotten infected.
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