Chilblains (Pernio)

What are chilblains (pernio)?

Chilblains, also known as pernio, are small patches of inflamed skin. They develop after exposure to air that’s cold or damp but not freezing. Usually, chilblains form on your fingers or toes, but they can develop on the legs or ears.

Chilblains are typically red or bluish. They may feel itchy, tender or painful. Other names for chilblains include pernio and perniosis.

Who might get chilblains?

Anyone can get chilblains, but females and people with a low body mass index (BMI) have a higher risk of developing them. You are also more likely to get chilblains if you:

• Live in a damp or nonfreezing climate.
• Smoke.
• Wear tight-fitting shoes, gloves or mittens or clothing in cold, damp weather.

Babies can get chilblains if they are not dressed in appropriate clothing (including face covering) in damp or cold weather.

Your risk of getting chilblains also increases if you have:

• Bone marrow disorders, such as chronic myelomonocytic leukemia (CMML).
• Lupus erythematosus.
• Raynaud’s phenomenon.
• Peripheral arterial disease (PAD).

How long do chilblains last?

Chilblains usually heal within one to three weeks providing you avoid cold or damp weather and dress appropriately. If you’re at high risk, chilblains may return every year when the weather changes. Your provider may prescribe treatment to prevent frequent chilblains.

What causes chilblains or pernio?

Chilblains form after intermittent or prolonged exposure to cold or damp air. The cold air causes blood vessels near your skin’s surface to tighten or constrict, leading to decreased oxygenation and inflammation in these exposed areas.

The exact reason why this reaction occurs is unknown. Some experts believe pernio develops because of:

• Genetics.
• Hormonal changes.
• Underlying diseases, such as connective tissue disorders or peripheral arterial disease.

What are the symptoms of chilblains?

Chilblains are painful, swollen patches of skin. Although they can appear anywhere, they usually develop on your fingers or toes. They may also show up on your ears or nose. Sometimes, these skin patches look shiny.

You may also have:

• Blisters.
• Burning sensation.
• Itching.
• Skin color changes, with red or blue patches.

How are chilblains diagnosed?

Often, your healthcare provider can diagnose chilblains by looking at your skin. You may also have blood tests or a skin biopsy. These tests help your provider determine if you have a condition that increases your risk for chilblains or have another condition that mimics chilblains.

How are chilblains treated?

Often, chilblains go away on their own as long as you avoid the cold and/or damp weather conditions. If you still have chilblain symptoms after two or three weeks, you may see a healthcare provider for treatment.

Your provider may prescribe medications. These medicines can soothe pain or itching. Some medicines also lower your chances that chilblains will come back. You may take:

• Oral medications (taken by mouth): Includes medications such as nifedipine (Adalat®) that will help dilate your blood vessels or pentoxifylline (Trental®, Pentoxil®) that will improve your circulation.
• Topical medications (applied to your skin): Includes medications such as nitroglycerin (Nitrol®, Nitro-Bid®) or a topical steroid such as betamethasone valerate (Beta-Val®, Valisone®).

What can I do to manage chilblain symptoms?

When you get chilblains, you may use over-the-counter remedies to ease pain and swelling. You should:

• Keep your hands and feet warm (in mittens or hand warmers) and wear layered clothing or blankets. Wearing a hat is also important. Hats cover your ears to keep your whole body warm and help prevent loss of heat from unprotected areas of your body.
• Moisturize the affected skin area with unscented lotion.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®).
• Soak the affected skin area in warm water for short periods of time only.

How can I reduce my risk of developing chilblains?

There is no guaranteed way to prevent chilblains. You may reduce your risk by:

• Avoiding cold, damp environments as much as possible.
• Exercising regularly to improve your blood circulation.
• Quitting smoking.
• Wearing warm clothing in layers in cold weather, especially over your feet, hands and ears.

What is the outlook for chilblains?

Chilblains usually go away within one to three weeks. If chilblains keep coming back, your healthcare provider may give you a medication to prevent chilblains from developing as frequently.

Usually, chilblains do not lead to long-term health problems or complications. It’s important to keep any affected skin areas clean so that you don’t get a skin infection.

When should I see my healthcare provider?

For many people, chilblains heal without treatment. See your healthcare provider right away if you have:

• Chilblains that don’t go away after three weeks.
• Diabetes and develop chilblains on your feet.
• Fever or chills.
• Pus coming out of your skin.

What conditions are similar to perniosis?

Some conditions that affect your blood vessels cause symptoms similar to perniosis. Some of these conditions can be severe. A healthcare provider can provide a diagnosis and treatment.

These conditions include:

• Cellulitis.
• Chilblain lupus.
• Contact dermatitis.
• Blood clots (embolisms) in your legs or feet.
• Frostbite.
• Raynaud’s phenomenon.
• Vasculitis.

A note from Cleveland Clinic

Chilblains are painful, inflamed patches of skin. They develop after exposure to cold temperatures. Anyone can get chilblains, but they are most common in women. You are also more likely to develop chilblains if you have a low BMI or live in a cold, damp climate. For many people, chilblains go away without treatment. If chilblains keep coming back, your provider may prescribe medicines to keep them from returning as frequently. For most people, chilblains don’t lead to long-term health complications.