Chilblains: What you need to know about this pesky winter affliction

As the weather continues to be frosty, our expert explains chilblains, and how to avoid them.

Anyone who knows that hot, itchy feeling in their hands and feet after a trip outdoors in the cold will already be dreading winter – AKA chilblain season.

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But what are chilblains and what can you do to prevent your extremities from suffering? We ask an expert.

What are chilblains?

“They are where your peripheral circulation, the little capillaries – tiny blood vessels - in your toes (and fingers), when the weather’s cold, shut down to conserve heat,” explains Richard Handford, podiatrist at the College of Podiatry.

“That’s what happens in winter, that’s fine, that’s the normal process. That’s why you get cold ear lobes when you’re out in the snow and it doesn’t hurt, it doesn’t bother you.

“When you go back inside and warm up, these blood vessels should open up again. But with people who have chilblains, there’s usually a delay of 15-30 minutes where they stay cold and these blood vessels are still shut down.

During that time the skin hasn’t got a blood supply that’s good enough for the temperature that the skin has now been heated up to, so, during that period of time, the skin in a sense is overheated for the blood supply it’s got, which means it is then damaged.

“After the 15-30 minutes, the blood vessels open up and they come across now damaged skin, so you get an inflammatory response, which is when your skin becomes hot, red and itchy, known as chilblains.”

Who gets chilblains?

“There is not a lot known about why certain people get chilblains, but there are definitely groups of people who are more prone. Most people either get chilblains or don’t,” says Handford.

“The issue is, it’s not a reflection of poor circulation. The tubes, if you like, they’re not blocked, the heart’s working properly, it’s to do with control of those blood vessels, which is the same process as when you blush, it’s subconscious.”

However, people who work outdoors have also been found to be more susceptible, as are the elderly and people who don’t exercise frequently.

Can I reduce the risk?

“It’s not going in the cold that’s the problem, it’s normal for your blood vessels to shut down, it’s heating them up too quickly afterwards that is the issue,” explains Handford. “So, if you do get chilblains, what you don’t want to do is artificially heat up your toes, because you are cooking them.

“What you’ve got to do is slowly increase the temperature, which gives you that time over the 15-30 minutes, where the circulation can open up.

“We recommend that you wear insulated boots and socks. It’s about managing how quickly your extremities warm up. So, if it’s snowing outside, don’t walk straight into your lounge; spend 10 minutes in a room that’s temperature is halfway between the hot lounge and the cold of outside. It gives your toes time to catch up.

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“There are also chilblain creams available over the counter. You’re best to use those as prevention, because once you’ve had the damage occur, it’s like any other form of burn, it’s too late.

“A lot of the creams contain menthol which open up your blood vessels. So you put those on before you get cold feet, so it stops the circulation shutting down as much in the first place.”

How bad can chilblains symptoms get?

“Chilblains can act like a burn or scald,” says Handford. “Certainly people who already have poor circulation, often the elderly, this is enough for them to get a wound that doesn’t heal. It can cause ulcers and things like that. But that’s only if you have other underlying issues as well.”

He adds: “For most people, he or she will find they will have very, very sore feet, and this will last over a period of a couple of weeks if we have a cold snap. Most healthy people don’t get the skin breaking at all; it just gets hot, red, itchy and inflamed.”

What treatments are available?

“Chilblain cream is good because it moisturises and protects the skin. Other than that, there’s not a lot you can do,” says Handford. “If it’s an area of the foot or toe that is being rubbed, it will blister earlier than it would have, so cushion and look after those areas.

Wear good quality wool hiking socks that are soft, cushioning and accommodating. If the skin does break down and you get a sore, you need to cover it with a dry dressing. But you have to let the process take its course and heal up, which is what’s so frustrating about chilblains.”

If you have any concerns about chilblains, seek professional help. Find out more about the College of Podiatry

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