Chilblains

Subject: Chilblains Thu Jan 20, 2011 1:09 pm

Chilblains
Filed under: Heart & Vascular
Chilblains are the painful inflammation of small blood vessels in your
skin that occur in response to sudden warming from cold temperatures.
Also known as pernio, chilblains can cause itching, red patches,
swelling and blistering on extremities, such as on your toes, fingers,
ears and nose.

Chilblains usually respond well to treatment and clear up within one to
three weeks, though they may recur seasonally for years. Treatments
typically consist of lotions and medication. While Chilblains don't
usually result in permanent injury, they can lead to infection, which
may cause severe damage if left untreated.

The best approach to chilblains is to avoid developing them by limiting
your exposure to cold, dressing warmly and covering exposed skin.

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Symptoms

Signs and symptoms of chilblains may include:

* Small, itchy red areas on your skin, often on your feet or hands
* Possible blistering
* Swelling of your skin
* Burning sensation on your skin
* Changes in skin color from red to dark blue, accompanied by pain
* Possible ulceration

When to see a doctor
Some people with chilblains never need to see a doctor — they simply use
lotions to alleviate the pain and itching. However, if the pain becomes
too severe or the affected skin begins to look as if it might be
infected, a doctor can help you treat it more effectively. Also, make
sure to seek medical attention if your skin doesn't improve after a week
or two.

If you have poor circulation or diabetes, see a doctor immediately after
discovering chilblains to prevent possible complications.

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Causes

Chilblains are usually the result of an abnormal reaction of your body
to cold. They tend to develop on skin that's exposed to cold and then
warmed too quickly, such as by warming cold hands directly in front of a
heater or fire. This rapid heating of cold skin can cause small blood
vessels under the skin to expand more quickly than nearby larger blood
vessels can handle, resulting in a "bottleneck" effect and the blood
leaking into nearby tissues. Exactly why this occurs in certain people
is unknown.

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Risk factors

Factors that may increase your risk of chilblains include:

* Exposure of skin to cold. Skin that's exposed to cold conditions and then warmed can develop chilblains.
* Being female. Women are more likely to get chilblains, though why is not known.
* Being underweight. People who weigh about 20 percent less than is
expected for their height have an increased risk of chilblains.
* Where you live. Ironically, chilblains are less likely in colder
and drier areas because the living conditions and clothing used in these
areas are more protective against cold. But, if you live in an area
with high humidity and low, but not freezing, temperatures, your risk of
chilblains is higher.
* The time of year. Chilblains are more common from November to April.
* Wearing ill-fitting shoes. Chilblains may result from or be
aggravated by unusual pressure on your skin, such as tight shoes.
* Having poor circulation. People with poor circulation tend to be
more sensitive to changes in temperature, making them more susceptible
to chilblains.
* Having been diagnosed with Raynaud's phenomenon. People with
Raynaud's phenomenon, another cold-related condition that affects the
extremities, are more susceptible to chilblains. Either condition can
result in sores, but Raynaud's causes different types of color changes
on the skin.

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Complications

Chilblains may cause complications if your skin blisters. If that
happens, you may develop ulcers and infections. Besides being painful,
infections are potentially life-threatening if left untreated. See a
doctor if you suspect infection.

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Preparing for your appointment

Most people with chilblains don't need to see a doctor, but if you're in
pain or suspect you might have an infection, see your primary doctor.
He or she may suggest treatment, or may refer you to a doctor who
specializes in skin disorders (dermatologist) or circulatory disorders
(cardiologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

* Write down any symptoms you've noticed, including any that may
seem unrelated to the reason for which you scheduled the appointment.
* Write down key personal information, including any major stresses, recent life changes or vacations to different climates.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Write down questions to ask your doctor.

Preparing a list of questions can help you ensure that you cover all of
the points that are important to you. For chilblains, some basic
questions to ask your doctor include:

* What's the most likely cause of my symptoms?
* Are there other possible causes for my symptoms?
* Do I need any tests?
* Is this condition temporary or long lasting?
* What treatments are available, and which do you recommend?
* What types of side effects can I expect from treatment?
* Are there any alternatives to the primary approach that you're suggesting?
* Are there any activity restrictions that I need to follow?
* Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over points you want to spend more
time on. Your doctor may ask:

* When did you begin experiencing symptoms?
* Do your symptoms get worse in response to quick changes in temperature?
* Does anything seem to improve your symptoms?
* Have you ever had these symptoms before?
* Have you been diagnosed with Raynaud's syndrome?

What you can do in the meantime
While you're waiting to see your doctor, be sure to keep the affected area warm and clean.

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Treatments and drugs

Treatment options for chilblains include:

* Corticosteroid creams. Topical corticosteroids can help relieve itching and swelling.
* Blood pressure medication. A blood pressure lowering drug called
nifedipine (Adalat, Procardia) is sometimes used to treat the cause of
chilblains, since it can help open up blood vessels.
* Infection prevention. If your skin has broken, treatment also
includes cleaning and protecting your wounds to prevent infection.

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Lifestyle and home remedies

Chilblains usually clear up after one to three weeks. In the meantime, you can take steps to ease your symptoms, including:

* Keeping your affected skin warm, but away from sources of heat
* Using lotions to alleviate itching and swelling
* Making sure the affected skin is cleaned with an antiseptic to prevent infection
* Avoiding scratching

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Alternative medicine

Vitamin D has sometimes been used to treat chilblains, but recent research suggests that this therapy doesn't work.

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Prevention

To prevent chilblains, avoid or limit your exposure to cold. Follow this advice:

* Dress in warm layers of clothing.
* Cover all exposed skin when going outside in cold weather.
* Make sure you keep your hands, feet and face warm.
* Keep your home and workplace comfortably warm.

If your skin is exposed to cold, it's helpful to rewarm it gradually, since sudden rewarming of cold skin may worsen chilblains.