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.

Chilblains are typically red, bluish or purplish. They may feel itchy, tender or painful.

Anyone can get chilblains, but people with a low body mass index (BMI) have a higher risk of developing them. 

Babies can get chilblains as well if they’re not wearing proper clothing in damp or cold weather.

It can be frustrating to get tender, inflamed patches of skin when the temperature drops — especially on visible places like your hands. But know that there are steps you can take to try to prevent them. Your healthcare provider can offer medications, as well.

What are the symptoms of chilblains?

Chilblains are painful, swollen patches of skin. Sometimes, these skin patches look shiny.

You may also have:

• Blisters
• Burning sensation
• Itching
• Skin color changes (red, blue or purple patches)

Although chilblains can appear anywhere, they tend to develop on your fingers or toes. They may also show up on your ears or nose.

What causes chilblains or pernio?

Chilblains form after on-and-off or prolonged exposure to cold or damp air. The cold air causes blood vessels near your skin’s surface to tighten or constrict. This leads to less oxygen and inflammation in the exposed areas.

Researchers don’t know exactly why this reaction happens. Some experts believe pernio develops because of:

• Genetics
• Hormonal changes
• Underlying conditions, like connective tissue diseases

Risk factors for chilblains (pernio)

You’re more likely to get chilblains if you:

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

Your risk of getting chilblains also increases if you have any of the following conditions:

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

How are chilblains diagnosed?

Often, your healthcare provider can diagnose chilblains by looking at your skin. But they may sometimes recommend blood tests or a skin biopsy. These tests help your provider determine if you have a condition that increases your risk for chilblains or 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 chilblains symptoms after two or three weeks, you may need to 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.

Oral medications for chilblains

You take oral medications by mouth. Options include:

• Nifedipine (Adalat^®), which helps dilate your blood vessels
• Pentoxifylline (Trental^®, Pentoxil^®), which helps improve your circulation

Topical medications

You apply topical medications to your skin. Options include:

• Nitroglycerin (Nitrol^®, Nitro-Bid^®)
• A steroid like betamethasone valerate (Beta-Val^®, Valisone^®)

What can I do at home to manage chilblain symptoms?

Some at-home remedies that may ease pain and swelling from chilblains include:

• Keeping your hands and feet warm (in mittens or hand warmers)
• Wearing layered clothing or blankets
• Wearing a hat to help keep your whole body warm
• Moisturizing the affected skin with unscented lotion
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil^®, Motrin^®)
• Soaking the affected skin in warm water for short periods of time only

What is the outlook for chilblains?

Chilblains usually go away within one to three weeks. If you’re at high risk, chilblains may return every year when the weather changes. If chilblains keep coming back, your healthcare provider may give you a medication to prevent chilblains from developing as frequently.

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

When should I see my healthcare provider?

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 chilblains?

Some conditions that affect your blood vessels cause symptoms similar to chilblains. 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 in your legs or feet
• Frostbite
• Raynaud’s phenomenon
• Vasculitis