From the Research
Chilblains are a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather, typically affecting the extremities such as toes, fingers, ears, and nose, and can be managed by keeping affected areas warm and using gentle warming methods. The etiology of chilblains is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold 1. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases, showing dermal edema and an inflammatory infiltrate, particularly around the eccrine gland 1.
Key Points in Management
- Keeping extremities warm is the first recommendation for management, as well as smoking cessation 1
- Calcium channel blockers, such as nifedipine, may be used in severe or recurrent cases, although their effectiveness is not confirmed by all studies 1, 2
- Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials 1
- Other treatments, such as pentoxifylline, hydrochloroquine, and topical nitroglycerin, have shown positive effects only in a reduced number of patients 1
- Acupuncture seems to bring a benefit, although more research is needed to confirm its effectiveness 1
Recent Evidence
A systematic review of pharmacologic treatments for idiopathic chilblains found moderate evidence to support the use of nifedipine and pentoxifylline in severe or refractory cases, while other therapies had inadequate evidence or nonsignificant results compared to placebo 2. However, a randomized controlled trial found that nifedipine was not superior to placebo for treating chronic chilblains 3.
Prevention
Prevention is key, and individuals can reduce their risk by wearing warm, layered clothing, insulated footwear, and avoiding rapid temperature changes 1. People with poor circulation, Raynaud's phenomenon, or who are underweight face higher risk 1. Unlike frostbite, chilblains rarely cause permanent damage but can recur seasonally if preventive measures aren't taken 1.