What are chilblains:
Chilblains are a painful and abnormal reaction of the small blood vessels in the skin when they get exposed to cold temperatures. Chilblains usually occur after exposure to the cold in the temperate humid climates. The cold causes constriction of the smaller blood vessels in the skin and if rewarming of the skin happens too fast, there is some leakage of blood into the tissues as the blood vessels do not respond fast enough to this rewarming. Chilblains are not very common and almost unheard of in countries where the cold is more extreme as the air is drier. The living conditions and clothing used in these climates are so much more protective of the cold. Chilblains are considered more likely to develop in those with poor circulation, but chilblains are still common in those who have good circulation.

What do chilblains look and feel like:
Chilblains initially appear as small itchy, red marks on the skin. Chilblains become increasingly painful over time as they get congested and take on a darker blue appearance. They may also become swollen if more severe. As they dry out, chilblains can leave small cracks in the skin so the risk of getting an infection increases. Chilblains are more common on the toes, but can also affect the fingers and the face (especially the ears and nose). Chilblains are also common on areas of the feet exposed to stress, such as bunions or where the toes are under pressure from tighter fitting shoes or where there are corns and callus.

Chilblains start during the winter months (when the weather gets colder) – the initial symptoms also include a burning and that itching in the area of the developing chilblain. These symptoms are often become intensified when going into a warmer room. There is often some swelling and redness early as well. In many cases, the skin over the chilblain can break down and becomes an open sore (ulcer). An infection may develop in that open area of the chilblain.

Chilblains can often occur in some people every year, for the rest of their lives. In other people, chilblains occur for several years and then just stop occurring one year. The reason for these patterns of the occurrence of chilblains is not known. As they are more common in females, there may be some hormonal influence on the development of chilblains, but males still get them.

What causes chilblains:
Chilblains are more common in those that are just more prone to them and the reasons for this are not entirely clear. The factors that contribute to the increased risk for chilblains include, a familial history, poorer circulation, anaemia, poorer nutrition, sudden hormonal changes, some connective tissue disorders and some of the bone marrow disorders. Damp living conditions have also been suggested to increase the risk for chilblains.

As a chilblain is known to be an abnormal reaction to cold, these factors above increase the risk that of an abnormal reaction occurring. Chilblains occur when there is a too rapid a change from a cold to hot temperatures, so the chilblains occur after the foot is cold. Some people’s circulation is so sensitive to changes that only a small change in the temperature may be enough. A typical history often described for the development of chilblains is after being outside in the cold, the foot is placed next to a direct heat source (eg such as a heater) when coming back inside. The increased demand place on the small blood vessels do not respond quickly enough to the change in temperature

Chilblains self treatment:
Prevention of chilblains:
Keeping your feet warm is the most important way to prevent chilblains. make use of trousers, higher top boots, tights, leg warmers and long, thick woollen socks. If your feet do get exposed to cold, then allow them to warm up slowly. It is important that you do not put them straight in front of a source of heat (this gives time and a chance for the circulation to respond to the warming skin). Do not let the feet become exposed to any source of direct heat (eg such a heater), especially if the foot is very cold.  This is a very common factor that causing chilblains. Smoking is also a factor that interferes with the circulation in the small blood vessels and can increase the risk of getting chilblains.

Once a chilblain develops:
* do not rub or scratch the area
* avoid direct sources of heat (ie do not expose the feet directly to a heater), but keep the feet warm if possible by the use of woollen socks and footwear
* use soothing lotions and creams (eg calamine lotion). There are various chilblain creams on the market
* if the skin is broken or open, use an antiseptic dressing to prevent the chilblains becoming infected
* those with diabetes or poor circulation should see a Podiatrist promptly. There is a high risk of further complications from the chilblains in those with a foot that is ‘at risk’ is too high to delay seeking professional help
* thermal or insulating insoles are something that can help keep the foot warm to prevent chilblains
* lanolin or a similar lotion that is rubbed into the feet regularly  will help stimulate the circulation
* there are a number of natural or homeopathic remedies that are not recommended for the treatment of chilblains. Some of these do appear to help some people, however.

Podiatric management of chilblains:
Podiatrists see a lot of people with chilblains in colder humid climates and can give advice beyond what is described above:
* the use of padding and pressure relief may give some relief for the chilblain symptoms if load can be deflected from the area
* if they are bad, topical steroids may need to be used in case of very swollen severe chilblains
* corns and callus are very common in the pressure areas where chilblains can occur, so reduction by the podiatrist of these will give some pain relief
* sometimes heparin ointment may be used in some people to improve the circulation in the area
* a course of UV light has sometimes been used at the start of winter in those prone to chilblains has been recommended to help stimulate the circulation in the foot
* a very rare occasions the chilblains may be a symptom of rare medical problems (eg connective tissue disease or a bone marrow disorder) and you may need to discuss that with your specialist.