Chilblains

Chilblains are small, itchy swellings on the skin that can appear after you've been out in the cold. They can be uncomfortable, but they usually get better on their own within a few weeks.

Chilblains most often affect the body's extremities, such as the toes, fingers, heels, ears and nose. They usually develop several hours after you've been in the cold.

The symptoms of chilblains include:

• a burning or itching feeling in the affected areas, which can get worse if you go into a warm room
• swelling
• the affected skin turning red or dark blue
• in severe cases, the surface of the skin breaks, and sores or blisters develop

If you have chilblains, don't scratch your skin. It can break easily, and then it may become infected.

You don't usually need to see a doctor about chilblains, because they normally get better on their own within a few weeks.

• You have chilblains and your skin has not got any better after 2 to 3 weeks
• There is pus coming out of your skin
• Your temperature is very high, or you feel hot or shivery
• You keep getting chilblains
• Your chilblains are severe
• You have diabetes and have chilblains (foot problems can be more serious if you have diabetes)

Chilblains often clear up on their own, without any treatment.

If chilblains itch, a soothing lotion such as calamine or witch hazel can help relieve it. A pharmacist can advise you on the right product for you.

If your chilblains are severe and keep coming back, your doctor may prescribe a medicine called nifedipine. You take it every day, as a tablet or a capsule. It relaxes the blood vessels, which improves your circulation.

Nifedipine can help chilblains that you already have to heal, or you can take it to stop them developing in the first place.

Chilblains are caused by an abnormal reaction to the cold. They're common in places where the winter weather is damp and cold.

Some people get chilblains that last for several months every winter.

When your skin is cold, the blood vessels near its surface get narrower. If the skin is then exposed to heat, those vessels become wider. When this happens too quickly, the vessels near the surface can't always handle the increased blood flow. Blood can leak into the surrounding tissue, and this may cause the swelling and itchiness of chilblains.

Some people are more likely to get chilblains than others. This includes people with:

• poor circulation
• a family history of chilblains
• regular exposure to cold, damp or draughty conditions
• a poor diet or low body weight
• lupus, a long-term condition that causes swelling in the body's tissues
• Raynaud's phenomenon, a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes

If you smoke, you are more at risk of chilblains because nicotine constricts blood vessels.

Chilblains can also appear on areas of the feet that are under pressure. A bunion is one example, and a toe that's squeezed by tight shoes is another.

If you're more at risk of chilblains, you can help prevent them by:

• staying out of the cold where possible
• looking after your feet
• improving your circulation

If your skin gets cold, warm it up gradually. Heating the skin too quickly is one of the main causes of chilblains, for example if you put your feet in hot water or hold them near a heater.

• stop smoking, because nicotine makes the blood vessels constrict, which can make chilblains worse
• keep active, as this helps improve your circulation
• wear warm clothes and insulate your hands, feet and legs. Long johns, long boots, tights, leg warmers or long socks will help
• wear a clean pair of socks if you get cold feet in bed
• avoid tight shoes and boots, because these can restrict the circulation to your toes and feet
• moisturise your feet regularly, which stops them drying out and the skin cracking
• eat at least 1 hot meal during the day, as this will help warm your whole body, particularly in cold weather
• warm your shoes near a heater before you put them on, and make sure damp shoes are dry before you wear them. If your feet are already cold, make sure your shoes aren't too hot, or you could cause chilblains
• warm your hands before going outdoors by soaking them in warm water for several minutes and drying them thoroughly, and wear cotton-lined waterproof gloves if necessary. If your hands are already cold, don't warm them up too quickly, or you could cause chilblains
• keep your house well heated. Try to keep at least 1 room in the house warm and avoid draughts
• if you have diabetes, check your feet regularly (or ask someone else to do this), because people with diabetes may not be able to feel their feet and could have infected chilblains without realising it

If your chilblains are severe or keep coming back, there's a small risk of complications. These include:

• infection from blistered or scratched skin
• ulcers forming on the skin
• permanent discolouration of the skin
• scarring of the skin

You can often avoid the complications that chilblains can cause.

• do not scratch or rub the affected areas of skin
• do not directly overheat the chilblains (by using hot water, for example)

You can lower your risk of infection by:

• cleaning any breaks in your skin with antiseptic
• covering the area with an antiseptic dressing
• changing the dressing every other day until your skin heals

If the skin does become infected, you may be prescribed antibiotics.