Back

Chilblains

What Is It, Causes, Signs, Symptoms, and More

Author:Georgina Tiarks

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy M. Johnson, LMSW


What are chilblains?

Chilblains, also known as pernio or perniosis, are a form of vasculitis and vessel inflammation caused by an atypical reaction to cold conditions. Chilblains result in sensitive, pruritic (i.e., itchy) nodules (i.e., bumps) with an erythematous (i.e., reddish) discoloration that may appear on the skin after prolonged exposure to cold, damp conditions. They may occur 12 to 24 hours after the exposure and can last up to three weeks.

Dorsal surface of hand with multiple erythematous papules.

What causes chilblains?

Chilblains are caused by cold weather on small blood vessels. Tiny blood vessels constrict when skin is exposed to cold temperatures to prevent heat loss. However, a physiologic reflex opposes this signal and dilates these blood vessels to improve circulation. Further rewarming may result in blood escaping into tissue.

Several risk factors increase an individual’s risk of developing chilblains, which include tobacco use, inadequate nutrition, low body mass index (BMI), prolonged cold exposure, and autoimmune disorders (e.g., lupus erythematosus), and bone marrow disorders (e.g., chronic myelomonocytic leukemia). Chilblains may also be familial and run in families, meaning there may be a genetic component.

Excited Mo character in scrubs
Join millions of students and clinicians who learn by Osmosis!
Start Your Free Trial

What are the signs and symptoms of chilblains?

The signs and symptoms of chilblains include sensitive, itchy, and burning nodules with surrounding red patches on skin areas exposed to cold, damp conditions, such as hands and feet. These blistering bumps can ulcerate and scab, over time. This condition occurs most often in the fall or early spring due to the likelihood of inefficient use of cold protective gear. 

How are chilblains diagnosed?

A health care provider diagnoses chilblains after obtaining a thorough physical examination and medical history. Subsequently, a provider may use major and minor criteria to diagnose chilblains. Major criteria include visual inspection of dermatological lesions with erythematous or violaceous coloration during the examination. The minor criteria include the onset of lesions after exposure to cold, histology confirmation via skin biopsy, and alleviation of symptoms after warming. A skin biopsy demonstrating lymphocytes surrounding blood vessels with eccrine glands (i.e., sweat glands) may also be used to diagnose chilblains.

How are chilblains treated?

Treatment for chilblains may be achieved through various methods. Prevention strategies are the primary method used to treat chilblains. Health care providers may recommend avoiding cold, damp weather for those affected. Individuals who may be predisposed to developing chilblains are often encouraged to use cold weather clothing protection, such as gloves and jackets, when necessary. Additionally, it is advised to rewarm the body slowly rather than with sudden exposure to heat. Smoking cessation can also help to prevent the onset of chilblains. 

Topical treatments with nitroglycerin or a steroid (e.g., hydrocortisone) may be used to relieve some of the uncomfortable itching or burning symptoms. A provider may also prescribe systemic calcium channel blockers, such as nifedipine, to dilate blood vessels and improve circulation. Nonetheless, there is limited evidence that these pharmacologic therapies are effective.

What are the most important facts to know about chilblains?

Chilblains are painful, itchy, red blisters that arise on hands and feet after exposure to cold temperatures and damp conditions. This most often occurs during the fall and spring seasons. When an individual is cold, the blood vessels constrict to prevent further heat loss. During rewarming, these vessels dilate atypically, thereby causing leakage of blood into neighboring tissue and the resulting red blisters. This condition may be diagnosed during a physical examination from a healthcare provider. Moreover, a lesion biopsy can show histopathological changes showing lymphocytes surrounding blood vessels. Treatment includes avoiding cold climates, smoking cessation, using cold protective clothing, and rewarming the body slowly after exposure to the cold. Studies have shown limited efficacy with topical treatments and systemic medications.  

Quiz yourself on Chilblains

10 Questions available

Quiz now!

80 Flashcards available

Quiz now!

Watch related videos:

Mo with coat and stethoscope

Want to Join Osmosis?

Join millions of students and clinicians who learn by Osmosis!

Start Your Free Trial

Related links

Vasculitis
Vasculitis: Pathology review

Resources for research and reference

Chilblains (Pernio): Symptoms and Management—DermNet. (n.d.). Retrieved June 3, 2022, from https://dermnetnz.org/topics/chilblains

Nyssen, A., Benhadou, F., Magnée, M., André, J., Koopmansch, C., & Wautrecht, J.-C. (2020). Chilblains. Vasa, 49(2), 133–140. https://doi.org/10.1024/0301-1526/a000838

Singh, H., Kaur, H., Singh, K., & Sen, C. K. (2021). Cutaneous Manifestations of COVID-19: A Systematic Review. Advances in Wound Care, 10(2), 51–80. https://doi.org/10.1089/wound.2020.1309

Sohier, P., Matar, S., Meritet, J.-F., Laurent-Roussel, S., Dupin, N., & Aractingi, S. (2021). Histopathologic Features of Chilblainlike Lesions Developing in the Setting of the Coronavirus Disease 2019 (COVID-19) Pandemic. Archives of Pathology & Laboratory Medicine, 145(2), 137–144. https://doi.org/10.5858/arpa.2020-0613-SA

Viguier, M., Pinquier, L., Cavelier-Balloy, B., De La Salmonière, P., Cordoliani, F., Flageul, B., Morel, P., Dubertret, L., & Bachelez, H. (2001). Clinical and Histopathologic Features and Immunologic Variables in Patients with Severe Chilblains: A Study of the Relationship to Lupus Erythematosus. Medicine, 80(3), 180–188.