Chilblain occurs from exposure to cold temperatures followed by rapid re-warming

Dr Vikas Sharma

A lot of people in the North tend to get shivers down their spine as the cold months of January and February arrive. This is because they have a tendency to develop the cold pain of chilblains in these months which affects their lifestyle. Exposure to cold water some¬times seems to play a triggering role.

What causes chilblain?

Chilblains occur from exposure to cold temperatures followed by rapid re-warming. This results due to blood vessel shut-down. They occur several hours after the exposure. Cold causes constriction of the small arteries and veins in the skin and quick or extreme dilation of blood vessels from rapid re-warming causes leakage of fluid from the blood vessels into the surrounding tissues, resulting in the symptoms of chilblains—painful inflammation, swelling and itching, and red patches, ulcers or blisters.

Contributing factors include:

n A familial tendency.

n Peripheral vascular disease due to diabetes, smoking, hyperlipidaemia, etc.

n Low body weight or poor nutrition.

n Hormonal changes. Chilblains can improve during pregnancy.

n It is very important to rule out connective tissue disease.

Clinically, patients with recurrent painful, tender, erythematous to violaceous plaques on the distal extremities, especially the fingers and the toes. Pernio usually involves the hands, feet, ears and face in children, the legs and toes in women and the hands and fingers in men. Lesions are more common on the back and sides of the fingers and toes. Other exposed areas, such as the nose, face and ears, may also be affected. Heels, lower legs, fatty lumps, wrists in babies and thighs in horse riders are the other affected sites. Lesions may be accompanied by itching and a burning sensation and may be complicated by blister formation or ulceration.

Recurrence prevention

Some people are more likely than others to experience chilblains, including those with poor circulation, high bad cholesterol, low blood pressure or people who are very sensitive to temperature changes. It is of paramount importance for people who are susceptible to chilblains: that when venturing out into the cold weather, dress warmly and cover all exposed skin, especially the hands, feet, earlobes and nose that are especially vulnerable to chilblains. Keeping both the affected extremities and the core body dry and warm are essential in preventing pernio. Patients should wear thick socks and shoes. For perniosis of the hands, gloves are recommended. Clothing should be loose-fitting. Feet should always be kept dry as moisture enhances cold injury. Keep your surroundings comfortably warm. After cold exposure, re-warm skin gradually to avoid causing or worsening chilblains as rapid re-warming can be extremely harmful; do not use hot water bottles.

(Dr Sharma is a Chandigarh-based

dermatologist)