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Chilblains

Table of Contents

Chilblains

Chill Burns; Perniosis; Pernio

Chilblains (perniosis) is thought to be caused by an abnormal response of the blood vessels to cold temperatures. It causes itchy, tender, red or purple bumps and in severe cases, blistering, scabs, or ulceration on the skin as a reaction to cold. Learn about the causes and treatment of chilblains.

Chilblains, also called perniosis

Image by Sapp

Summary

Chilblains

Image by James Heilman, MD

Chilblains

Chilblains from excessively icing the feet

Image by James Heilman, MD

What Is Perniosis?

Perniosis are itchy and/or tender red or purple bumps that occur as a reaction to cold. In severe cases, blistering, pustules, scabs and ulceration may also develop. Occasionally, the lesions may be ring-shaped. They may become thickened and persist for months. Perniosis is a form of vasculitis. Signs and symptoms occur hours after cold exposure. Risk factors for perniosis include having poor blood circulation (such as due to diabetes or smoking), a family history of perniosis, poor nutrition, and low body weight. Perniosis may occur alone or in association with an autoimmune condition (e.g., lupus, scleroderma), bone marrow disorder, or cancer. Treatment aims to relieve symptoms and prevent infection. Lifestyle/adaptive changes may also be recommended to prevent future symptoms.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (7)

What are chilblains?

Video by Patient/YouTube

Sarah Says: How to prevent Chilblains

Video by Patient/YouTube

Chilblains | Symptoms | Causes | Treatment | Diagnosis aptyou.in

Video by Tips To Go/YouTube

C for Chilblains

Video by CF Foot Clinic/YouTube

How To Relieve Chilblains

Video by ToHealth/YouTube

Pernio (Chilblains), SARS-CoV-2, and COVID Toes

Video by Mayo Proceedings/YouTube

CHILBLAINS

Video by Health Apta/YouTube

1:47

What are chilblains?

Patient/YouTube

2:57

Sarah Says: How to prevent Chilblains

Patient/YouTube

1:49

Chilblains | Symptoms | Causes | Treatment | Diagnosis aptyou.in

Tips To Go/YouTube

3:00

C for Chilblains

CF Foot Clinic/YouTube

1:50

How To Relieve Chilblains

ToHealth/YouTube

5:48

Pernio (Chilblains), SARS-CoV-2, and COVID Toes

Mayo Proceedings/YouTube

4:46

CHILBLAINS

Health Apta/YouTube

What Are Chilblains?

Chilblains

Image by Mohammad2018/Wikimedia

Chilblains

Symptômes de chilblains Chilblains apparaissent généralement peu de temps après avoir été au froid. Les symptômes s'aggravent si l'individu entre dans un endroit au chaud. Les signes et les symptômes de Chilblains comprennent: Sensation de brûlure et de démangeaison, généralement dans les extrémités, comme les pieds, les mains, le nez ou les oreilles La peau de la zone affectée peut changer de couleur du rouge au bleu foncé et devenir enflammée (enflée) Des plaies et des cloques peuvent apparaître (rare) Les médecins disent que les signes et les symptômes disparaîtront habituellement dans quelques semaines par eux-mêmes si le patient évite l'exposition au froid. Plus rare

Image by Mohammad2018/Wikimedia

What Are Chilblains?

Chilblains are caused by the repeated exposure of skin to temperatures just above freezing to as high as 60 degrees F. The cold exposure causes damage to the capillary beds (groups of small blood vessels) in the skin. This damage is permanent and the redness and itching will return with additional exposure. The redness and itching typically occurs on cheeks, ears, fingers, and toes.

Source: Centers for Disease Control and Prevention (CDC)

Causes

Thermal image of a person with Raynaud's disease (right hand)

Image by Matthew Clavey, Thermal Vision Research, Wellcome Images

Thermal image of a person with Raynaud's disease (right hand)

A healthy hand (left) and the hand of a person with Raynaud's disease (right). Raynaud's disease usually affects the hands and feet, causing less blood to flow to them when the person is cold, anxious or stressed. This makes the affected area turn pale and can also lead to numbness, pain, and pins and needles.

Image by Matthew Clavey, Thermal Vision Research, Wellcome Images

What Causes Perniosis?

Certain cancers such as chronic myelomonocytic leukemia and Waldenstrom macroglobulinemia
Eating disorders, such as anorexia nervosa
Abnormalities of the protein content in the blood (dysproteinemias)
Cold agglutinin disease
Antiphospholipid antibody syndrome
Raynaud disease
Celiac disease
Viral hepatitis

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (3)

Raynaud syndrome

Raynaud syndrome

Image by MSM98

Raynaud's Syndrome

Discoloured pale fingers associated with abnormally low skin temperature, resulting from Raynaud's.

Image by Niklas D

C for Chilblains

Video by CF Foot Clinic/YouTube

Raynaud syndrome

MSM98

Raynaud's Syndrome

Niklas D

3:00

C for Chilblains

CF Foot Clinic/YouTube

Diagnosis

What Is Raynaud's?

Image by National Heart, Lung, and Blood Institute

What Is Raynaud's?

Figure A shows the normal digital arteries with normal blood flow to the fingers. The inset images show cross-sections of a normal artery. Figure B shows white discoloration of the fingertips caused by blocked blood flow. Figure C shows narrowed digital arteries, causing blocked blood flow and purple discoloration of the fingertips. The inset images show cross-sections of a narrowed artery blocking the flow of blood.

Image by National Heart, Lung, and Blood Institute

How Does One Conclude a Diagnosis Between Perniosis and Raynaud Syndrome?

There are no specific laboratory tests used to distinguish perniosis and Raynaud phenomenon. The conditions are diagnosed by their signs and symptoms.

While both perniosis and Raynaud phenomenon are triggered by cold, perniosis causes red or purple bumps on the skin that can be itchy and tender. Severe cases can cause blistering, scabs, pustules, and ulcers. Affected skin may thicken as it heals.

Raynaud phenomenon does not cause bumps or thickened skin. In people with Raynaud phenomenon, the skin often becomes numb and paper white when exposed to the cold. After warming, the skin may turn blueish or red before returning to its normal color. Raynaud phenomenon tends to last for minutes, while perniosis-related skin bumps can last for weeks.

If perniosis is suspected, but the symptoms are unusual, biopsy may be considered. A biopsy can help rule out other causes of the skin findings. It is possible to have both perniosis and Raynaud phenomenon. In addition, both perniosis and Raynaud phenomenon can occur in association with other underlying conditions (such as an autoimmune disorder, blood disorder, or cancer). If another condition is suspected (due to the presence of additional signs and symptoms), testing should be offered to to rule out this possibility.

Source: Genetic and Rare Diseases Information Center (GARD)

Cold Stimulation Test

Cold Stimulation Test

Also called: Cold Challenge Test

A cold stimulation test involves placing your fingers in ice water to diagnose Raynaud's syndrome. Raynaud's is a condition that causes brief episodes where little or no blood flows to fingers or toes. It makes skin turn white and feel numb.

Cold Stimulation Test

Also called: Cold Challenge Test

A cold stimulation test involves placing your fingers in ice water to diagnose Raynaud's syndrome. Raynaud's is a condition that causes brief episodes where little or no blood flows to fingers or toes. It makes skin turn white and feel numb.

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Use the slider below to see how your results affect your health.
Your result is Normal.
Normally your finger temperature will return to normal within 15 minutes after the cold water exposure.
Related conditions
A cold stimulation test involves placing your fingers in an ice water bath to find out if you have Raynaud's syndrome. Raynaud's syndrome, also known as Raynaud's disease or Raynaud's phenomenon, is a condition that causes brief episodes where little or no blood flows to certain parts of your body after exposure to cold or sometimes stress. It mostly affects fingers and/or toes.
A Raynaud's episode can be triggered by very mild and limited exposure to cold, such as taking food out of the freezer or holding a cold drink. When an episode happens, your skin may feel cold and numb. It may also make your skin turn white or blue. As blood flow returns, your skin may tingle, throb, or turn red. It usually takes about 15 minutes for normal blood flow to return.
There are two forms of Raynaud's syndrome:
- Primary Raynaud's, a fairly common and mild condition. It is not associated with any other health problem. Symptoms usually start between the ages of 15 and 25. Most people with primary Raynaud's syndrome can manage their symptoms without medical treatment.
- Secondary Raynaud's, often referred to as Raynaud's phenomenon, is less common than primary Raynaud's but more serious. Symptoms may include skin ulcers (open sores caused by poor blood flow) or skin infections. Symptoms usually start between the ages of 35 and 40. Secondary Raynaud's is most often caused by another medical condition. These include immune system disorders and connective tissue diseases. Connective tissue diseases affect blood flow to tissues and organs.
You may need this test if you have symptoms of Raynaud's syndrome. Symptoms usually show up after exposure to cold. They mostly affect fingers and toes and include:
- Skin that turns white or blue
- Skin that is numb and painful
- Skin that takes a long time to warm up after exposure
- A small device that measures temperature will be taped to your fingers.
- Your provider will record the temperature.
- You will then place your hands into an ice water bath for 20 seconds.
- You will remove your hands from the ice water.
- Your provider will record your finger temperature every five minutes for up to 20 minutes, or until your temperature returns to the same as it was before the ice water bath.
If it takes 20 minutes or more for your finger temperature to return to normal after the ice water bath, it probably means you have Raynaud's syndrome. If your symptoms are severe and/or you are age 35 or older, you may have secondary Raynaud's syndrome. Secondary Raynaud's can be caused by several disorders, including:
- Scleroderma, a disease that causes hardening of the skin and other body tissues
- Sjögren's syndrome, a disorder that causes dryness of the eyes and mouth
- Lupus, an autoimmune disorder that affects multiple parts of the body, including the joints, blood vessels, kidneys, and brain
- Rheumatoid arthritis, an autoimmune disorder that causes pain, swelling, and stiffness of the joints
- A blood disorder, such as polycythemia vera, a disease that causes your body to make too many red blood cells
- Pulmonary hypertension, a type of high blood pressure that affects arteries in your lungs and heart
If your provider thinks you have secondary Raynaud's syndrome, he or she may order more tests to help diagnose the disorder that is causing it. These tests include:
- Nailfold capillaroscopy. For this test, your provider will place a drop of oil on the base of one of your fingernails. The nail area is then examined under a microscope. If abnormal arteries are seen, it can be a sign of scleroderma or other connective tissue disease.
- Blood tests to check for immune system disorders. These include an antinuclear antibody (ANA) test, erythrocyte sedimentation rate (ESR), and C-reactive protein.
If you have questions about your results, talk to your health care provider.
There are steps you can take that may help you avoid or reduce the symptoms of Raynaud's syndrome, including:
- Dressing extra warmly for cold weather. This includes wearing a hat, mittens, scarf, and heavy socks.
- Using battery- or chemical-operated hand and/or foot warmers
- Turning down air conditioning and wearing a sweater or jacket when in an air-conditioned space
- Getting regular exercise, which increases blood flow
- Limiting caffeine and alcohol
- Avoiding stress
These changes should be enough to manage the symptoms of primary Raynaud's syndrome. If your symptoms are causing too much discomfort, or if you have secondary Raynaud's syndrome, your provider may also prescribe medicines that can help open your blood vessels.

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

First Aid

Corticosteroid cream

Image by Kristoferb/Wikimedia

Corticosteroid cream

Halometasone cream.

Image by Kristoferb/Wikimedia

First Aid for Chilblains

Workers suffering from chilblains should:

Avoid scratching
Slowly warm the skin
Use corticosteroid creams to relieve itching and swelling
Keep blisters and ulcers clean and covered

Source: Centers for Disease Control and Prevention (CDC)

Symptoms

Frostbite

Image by BruceBlaus

Frostbite

Frostbite

Image by BruceBlaus

What Are the Symptoms of Chilblains?

Symptoms of chilblains include:

Redness
Itching
Possible blistering
Inflammation
Possible ulceration in severe cases

Source: Centers for Disease Control and Prevention (CDC)

Additional Materials (2)

Chilblains

Chilblains from excessively icing the feet

Image by James Heilman, MD

Chilblains, also called perniosis

Chilblains, also called perniosis

Image by Sapp

Chilblains

James Heilman, MD

Chilblains, also called perniosis

Sapp

Treatment

Insulated clothes in Snow

Image by blickpixel/Pixabay

Insulated clothes in Snow

Image by blickpixel/Pixabay

How Might Perniosis Be Treated?

The main method of treatment for perniosis focuses on avoiding exposure to cold. Individuals with this condition may be advised to keep the affected areas of their body warm by wearing insulated clothing, gloves, and footwear. The use of ultraviolet light at the beginning of cold, damp season may help prevent outbreaks. It is also suggested that people with this condition do not use cigarettes or nicotine. The use of certain medications, such as topical steroids and nifedipine, a calcium channel blocker, have been effective in treating some individuals.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (2)

Mittens

Image by MariaGodfrida/Pixabay

Chilblains | Symptoms | Causes | Treatment | Diagnosis aptyou.in

Video by Tips To Go/YouTube

Mittens

MariaGodfrida/Pixabay

1:49

Chilblains | Symptoms | Causes | Treatment | Diagnosis aptyou.in

Tips To Go/YouTube

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Chilblains

Chilblains (perniosis) is thought to be caused by an abnormal response of the blood vessels to cold temperatures. It causes itchy, tender, red or purple bumps and in severe cases, blistering, scabs, or ulceration on the skin as a reaction to cold. Learn about the causes and treatment of chilblains.

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