Chilblains (Perniosis)

Definition

• Red or purple itchy, tender bumps caused by cold-induced vasoconstriction and ischaemia

• Localised form of vasculitis; in severe cases, can lead to microgeodic changes in bone

• Typically resolve within 1–2 weeks if re-warming and avoidance of cold are maintained

Common Sites

• Fingers, toes, heels, lower legs, thighs, wrists, nose, ears

Risk Factors

• Familial predisposition

• Female sex

• Impaired peripheral circulation (e.g. diabetes, smoking, hyperlipidaemia)

• Low body weight or malnutrition

• Hormonal changes (e.g. pregnancy)

• Connective tissue diseases (e.g. lupus, Raynaud’s phenomenon)

• Bone marrow disorders (rare)

Symptoms

• Red/purple itchy bumps that may blanch on pressure

• Lesions typically appear hours after cold exposure

• Can blister or ulcerate in severe cases

• Usually resolve spontaneously in 7–14 days

Management

• Preventive Measures (First Line)

  • Avoid cold exposure, stress, and vasoconstrictive medications (e.g. beta-blockers)

  • Smoking cessation to improve peripheral circulation

  • Keep warm with thick socks, gloves, and adequate heating

  • Avoid caffeine and decongestants (both can induce vasoconstriction)

• Topical Treatment

  • Topical corticosteroids (e.g. betamethasone dipropionate 0.05%) for extensive or painful lesions

  • GTN ointment (limited evidence, sometimes used prophylactically)

• Oral Treatment (Second Line)

  • Nifedipine (a calcium channel blocker) daily for recurrent or severe cases

• Other Options (Severe/Recurrent)

  • Other vasodilators (e.g. low-dose aspirin, fish oil supplements)

  • Investigate and treat any underlying connective tissue or haematological disorders

Chilblains vs. Raynaud’s Phenomenon

Notes

• Chilblains represent an inflammatory, cold-induced vasculitis. They generally resolve without intervention when the trigger is avoided.

• Raynaud’s phenomenon is a vasospastic disorder, often linked to autoimmune diseases, and may need more aggressive treatment to prevent tissue damage.

• First-line for both conditions includes preventive strategies (warmth, trigger avoidance).

• Second-line pharmacotherapy commonly involves calcium channel blockers (e.g. nifedipine) for recurrent or severe cases.