Last updated: January 2024
Also known as… pernio or perniosis
What are chilblains?
Chilblains are itchy, red swollen tender areas of skin that develop on the exposed skin of fingers, toes or rims of ears after exposure to cold at temperatures above O° Celsius.
Who gets chilblains?
Chilblains can affect all age groups. Women, children and the elderly are most commonly affected.
Individuals living in Victoria, Tasmania and South Australia are more likely to develop chilblains compared to those in warmer parts of Australia, such as Queensland.
There may also be a genetic influence with developing chilblains as several generations within a family can be affected.
What causes chilblains?
The cause of chilblains remains unknown. The loss of heat from the skin and changes in blood vessels in response to cold, damp, non-freezing windy conditions results in the formation of the lesions.
Other causes may include:
- Haematological malignancy or bone marrow disorders
- Peripheral vascular disease leading to reduced blood flow to the feet and hands secondary to diabetes, smoking or hyperlipidaemia
- Low body weight or poor nutrition, for example in anorexia nervosa
- Connective tissue disease, particularly lupus erythematosus, antiphospholipid antibody syndrome or Raynaud disease
- Chilblain-Like/Pernio-Like lesions (commonly known as ‘Covid toes’) are one of cutaneous manifestations reported with SARS-CoV-2 infection. Lesions are self-limiting, lasting weeks to few months.
What do chilblains look like?
Chilblains present as single or multiple tender and itching red-blue-violet patches, lumps or nodules. They may have a burning sensation or be painful. In severe cases, blistering and ulceration occurs in the affected area.
The tips of fingers, backs of hands and toes are the sites most frequently involved. Lesions are less common on the heels, nose, ears and outer thighs.
How are chilblains diagnosed?
Chilblains are usually diagnosed clinically.
In some cases, a skin biopsy or blood test may be needed to exclude associated disease such as:
- Full blood count and sedimentation rate
- Screening for connective tissue diseases
- Cryoglobulins, cryofibrinogen, and cold agglutinin testing. These tests look for uncommon conditions related to the presence of proteins that may become insoluble at reduced temperature
- Serum protein electrophoresis (SPEP) with immunofixation
How are chilblains treated?
Treatment options will vary depending on the individual and their needs.
Prevention is important, and general prevention measures include:
- Wearing warm clothing and keeping the head, neck, hands and feet warm.
- Avoiding cold, damp windy conditions and medicines which may constrict blood vessels.
- Keeping the affected area dry whenever possible.
- Stopping smoking, as nicotine constricts blood vessels.
It is important that any associated underlying conditions are treated. Other treatment options may include:
- Topical treatments, such as corticosteroids and simple moisturisers may help relieve itch.
- Topical 0.2% nitroglycerin
- Systemic treatments, such as nifedipine, nicotinamide, pentoxifylline or hydroxychloroquine
What is the likely outcome of chilblains?
Chilblains often resolve within 1 to 3 weeks and tend to improve spontaneously in younger individuals, can take longer to resolve in older individuals. However, relapse may occur with subsequent exposures.
| Dr Davin Lim and Dr Heba Jibreal | January 2024 |
| Dr Davin Lim and Dr Heba Jibreal | May 2021 |