Chilblains (Pernio): Symptoms, Causes, Treatment, and Prevention

Chilblains are itchy, tender or painful patches that can appear on fingers, toes, ears or other exposed areas after a period in cold, damp air. The medical name is pernio or perniosis. Unlike frostbite, chilblains usually follow cold that is not freezing. The skin may turn red or purple, swell, sting, burn or blister, then gradually settle as the weather and skin temperature improve.

Most episodes are temporary and improve with gentle warming and protection from further cold. The key is to warm the skin gradually: direct heat and vigorous rubbing can injure tissue that is already irritated. Recurrent, persistent or ulcerating lesions deserve medical assessment, especially in people with diabetes or poor circulation. This guide explains how chilblains develop, how to distinguish them from similar problems, and what care may help.

What are chilblains?

Chilblains are a localized inflammatory skin reaction to cold, damp, nonfreezing conditions. Small blood vessels in the skin respond to cold by narrowing. In susceptible areas, the return to warmth and the local blood-flow response can be abnormal, leading to inflammation. The result is a small, swollen, itchy or painful patch, most often on the toes or fingers. DermNet describes chilblains as a cold-related localized inflammation, while the NHS explains how blood vessels respond as the skin warms.

An episode can begin several hours after exposure rather than while a person is still outdoors. It may affect one or more digits, sometimes symmetrically, but the pattern varies. The hands, feet, ears, nose and other exposed areas can be involved. A patch can feel intensely itchy or stinging when warming begins, then remain sore or sensitive for days.

Clinicians distinguish primary or idiopathic pernio, where no associated cause is identified, from secondary pernio, where another condition or factor may contribute. Most people with chilblains do not have a serious underlying illness. Repeated episodes, sores that do not heal, or symptoms that continue during warm weather may prompt a clinician to look for another explanation.

Symptoms and what to look for

Chilblains often appear as small red, pink, blue or purple swellings on the skin. They can feel itchy, tender, burning or painful, and the surrounding skin may look shiny or swollen. Some lesions blister or become shallow sores. When they settle, dry skin or small cracks may remain. Scratching can break the skin and increase the chance of infection.

The toes are commonly affected, especially the smaller toes, but fingers are also frequent sites. A person may notice several toes becoming itchy or painful after cold exposure, or a few distinct patches on the knuckles or sides of the feet. Tight shoes, damp socks and gloves that allow cold air or moisture to reach the skin can add pressure or irritation. The changes may be more noticeable in winter or after a change in season, but indoor cold exposure can also matter.

Symptoms generally improve over a few weeks if the skin is protected and further cold exposure is reduced. Mayo Clinic notes that many episodes settle in about two or three weeks. Some people have a flare during each cold season. A longer course, repeated ulceration, severe pain or lesions that do not fit the cold-related pattern should not automatically be assumed to be routine chilblains.

Why do some people get chilblains?

Cold exposure is the main trigger, but not everyone exposed to the same weather develops pernio. Susceptibility may relate to how the small vessels respond, skin temperature, moisture, clothing, circulation and individual biology. Chilblains are more likely in cold, humid environments that are not cold enough to cause freezing injury. Tight footwear or gloves may trap moisture, restrict movement or increase pressure on vulnerable areas.

Some people who develop chilblains have Raynaud phenomenon, a connective-tissue disease such as lupus, or another circulation-related condition. These associations do not mean that a person with chilblains has lupus. In a Mayo Clinic series of 104 people, most did not have an associated systemic disease, while a small number did. The report is available through PubMed. A clinician considers the pattern and other symptoms rather than using chilblains alone to diagnose a systemic illness.

Risk factors may include a history of chilblains, being in cold conditions without adequate protection, low body weight, smoking, or a medical condition that affects blood flow. Some of these associations come from observational evidence and do not predict what will happen to an individual. Do not blame yourself for getting chilblains or assume that one specific behavior is the sole cause.

When episodes are new, unusually persistent, severe, or appear outside cold seasons, a clinician may ask about other symptoms such as joint pain, unusual fatigue, changes in finger color, skin ulcers, or medicines. These questions help decide whether to look for secondary causes. Most people do not need extensive testing after one typical, short-lived winter episode.

Chilblains, Raynaud phenomenon and frostbite

Chilblains can be confused with other conditions that affect fingers and toes. Raynaud phenomenon causes brief episodes of color change, often white or blue then red, during cold or stress as blood flow changes. Chilblains are more likely to leave persistent itchy, swollen or tender patches after cold exposure. Some people can have both conditions, so the history may include both transient color changes and longer-lasting skin lesions.

Frostbite is a cold injury caused by freezing temperatures. Numbness, pale or gray skin, waxy or hard tissue, and blisters after freezing exposure are more concerning for frostbite than ordinary chilblains. If you may have been exposed to freezing conditions and your skin is numb, unusually firm, pale, or blistered, seek urgent medical care. Do not rub the area or place it against a radiator or in very hot water.

Other possibilities include acrocyanosis, cold urticaria, dermatitis, infection, chilblain lupus and other vascular or inflammatory disorders. Chilblain lupus can have a similar appearance but is a distinct condition. A lesion that is one-sided, ulcerated, unusually painful, associated with fever or pus, or not linked to cold exposure may need assessment for another cause.

How are chilblains diagnosed?

A clinician usually asks about recent cold or damp exposure, when the lesions appeared, how long they last, whether they return, and whether they improve when kept warm and dry. They examine the affected skin for swelling, color, blisters, cracks or ulcers. A typical seasonal pattern may be enough to make a clinical diagnosis without tests.

Blood tests or a skin biopsy may be considered if the diagnosis is uncertain or the lesions are persistent, recurrent, unusually severe or not seasonal. Testing can help rule out other causes or assess for a condition linked to secondary chilblains. The choice of tests depends on symptoms and medical history. Not every person with a winter rash needs laboratory testing.

Tell the clinician about any numbness, color changes, ulcers, joint symptoms, medication changes, smoking, circulation problems, diabetes or immune-suppressing treatment. Bring a list of medicines and supplements. If the lesions are intermittent, dated photos can show how they change over time, but a photo is not a substitute for examination, especially if there are open sores or signs of infection.

Safe care at home

For mild chilblains, the goal is to protect the skin from more cold and let it rewarm slowly. Move to a comfortably warm environment and use dry socks, gloves or layers. Keep damp clothing away from the skin and dry the area gently. A plain moisturizer may ease dryness or itch if the skin is intact. Try not to scratch, rub or massage a lesion, even when it feels itchy or stinging.

Avoid placing hands or feet directly on a radiator, using a heating pad, holding them over a heater, or soaking them in hot water. Do not use a hair dryer or hot water bottle directly on affected skin. Rewarming too quickly can increase discomfort, and reduced sensation can make it hard to notice a burn. Mayo Clinic advises gentle rewarming and avoiding direct heat and rubbing.

If a blister or small sore develops, keep it clean and protect it from friction with a nonstick dressing if available. Do not pop blisters or peel attached skin. Check the area daily for increasing redness, warmth, swelling, pus or worsening pain. A person with diabetes, poor circulation or reduced sensation should get advice early because a small break in the skin can be more consequential and may heal slowly.

Over-the-counter anti-itch products may not be right for everyone. Ask a pharmacist or clinician what is safe for the body area and your health history, particularly if skin is broken, you are pregnant, or you take other medicines. Avoid starting a prescription steroid or circulation medicine on your own.

When to see a healthcare professional

Contact a clinician if symptoms are not improving after two to three weeks, keep recurring, persist into warm weather, or are severe enough to interfere with walking, using your hands or sleeping. Get care for blisters that break, open sores, pus, increasing swelling, spreading redness, fever, or pain that is getting worse rather than settling. NHS advice also recommends review when chilblains keep returning or when a person with diabetes develops them.

Seek urgent advice if you are unsure whether the exposure was below freezing, especially with numbness, hard or waxy skin, marked color change or blistering. These signs may suggest frostbite, which is different from pernio. A person who feels generally unwell, has rapidly worsening pain, or sees signs of a serious infection should use their local urgent-care or emergency pathway.

People with diabetes, peripheral arterial disease, connective-tissue disease, immune suppression or prior foot ulcers should have a lower threshold for assessment. Do not wait for a lesion to become an open sore before asking for help. If you are uncertain, a primary care clinician, dermatologist, podiatrist or local advice line can help identify the right service.

Medical treatment for persistent or severe chilblains

Most chilblains settle without prescription treatment. A clinician may suggest medication if symptoms are severe, recurrent, slow to improve or associated with sores. Depending on the situation, this may include a topical medicine for inflammation or itch, or a prescription medicine that affects blood vessel tone. Evidence and practice vary, and medicines may not be suitable for everyone.

Nifedipine, a calcium-channel blocker, is sometimes prescribed for more persistent chilblains because it can widen blood vessels. It can lower blood pressure and cause headache, flushing, dizziness or ankle swelling, and it may interact with other medicines. It should be considered only by a clinician who can review blood pressure, other conditions and medications. Do not borrow someone else’s prescription or change a dose without medical advice.

If there are recurrent lesions, ulcers or signs of a secondary cause, treatment may also involve addressing the underlying condition. For example, a clinician may recommend tests for a connective-tissue or blood disorder based on the whole picture. Finding an associated condition is not the usual outcome, but it matters when the symptoms are persistent or atypical. If an ulcer is present, wound care and protection from pressure may be needed.

Ask what improvement to expect and when to return if treatment is not helping. If a medication is prescribed, ask about side effects and what symptoms mean you should stop and call. Care should be individualized, since the same red-purple patches can have different causes.

Preventing future episodes

Prevention focuses on reducing cold and damp exposure and avoiding sudden temperature changes. Wear several loose layers rather than one tight layer. Choose warm, dry socks and shoes with enough room for the toes, and use insulated gloves or mittens when outdoors. Cover ears, nose and other exposed skin in cold weather. Change damp clothing when you come inside and keep the home or workplace at a comfortable temperature when possible.

Rewarm gradually after being outside. If your hands or feet are cold, use dry layers and a warm room rather than direct high heat. Avoid tight shoes, gloves or socks that compress the skin. If you sit still for long periods, gentle movement can help maintain comfort, but exercise is not a substitute for staying warm and dry. Avoid tobacco; smoking narrows blood vessels and can slow wound healing.

If chilblains recur every winter, plan before cold weather begins. Keep spare dry socks or gloves available, check that footwear does not rub, and ask a clinician whether an underlying circulation or connective-tissue condition should be considered. If you have diabetes or neuropathy, ask for personalized advice about foot checks, since reduced sensation can make a cold injury or blister harder to notice.

Possible complications and outlook

Most episodes resolve without lasting damage. In more severe cases, blisters or sores can form, and repeated inflammation may leave cracks, pigment change, scarring or thin skin. Open skin can become infected. Infection signs include increasing warmth, swelling, spreading redness, pus, worsening pain or fever. Prompt care can help protect the skin and check whether another condition is present.

People with circulation problems, diabetes or reduced sensation can have a different risk profile because small wounds may heal more slowly or be noticed later. They should protect the skin and seek care early for blisters or sores. If symptoms are extensive, recur frequently, or persist as the weather warms, a clinician may review the diagnosis and consider secondary causes.

For most otherwise healthy people, chilblains are uncomfortable but temporary. Symptoms often fade over a few weeks, though they can return in later cold seasons. Knowing how to keep skin warm and dry, how to avoid direct heat, and when to get medical help makes it easier to manage an episode safely.

Frequently asked questions

Medical information disclaimer

This article is for general education and is not a substitute for personalized medical advice, diagnosis or treatment. A clinician can assess symptoms, review medicines and determine whether testing is needed. Seek urgent medical care for suspected frostbite or severe infection, and follow local emergency guidance if you are seriously unwell.