Chilblains and chilblains: a painful discomfort

The icy cold can cause quite a few discomforts in winter. Many people suffer from winter toes or chilblains, especially during this period: red, painful, glowing, intensely itchy swellings of toes or fingers. The cause is an incorrect response of the small blood vessels in the skin to a low temperature. The painful areas usually disappear on their own within a few weeks. Chilblains and chilblains are more common in women than in men. The condition is medically called perniones or pernio. Although the symptoms are most commonly seen on the feet (toes, heels) and hands, in principle any part of the body exposed to cold can be affected. In addition to the feet and hands, the ear edges, nose tip and lower legs are especially vulnerable.

Wrong reaction of blood vessels

When you are in a cold environment, the small, superficial blood vessels normally allow less blood to pass through. This means that the skin receives less blood, causing the temperature to drop. However, the core temperature of your body remains at the correct level in this way; no unnecessary heat is lost. Only when the temperature of your skin becomes too low will your body respond again. The small vessels are now opened wide, causing the skin to heat up very quickly. Your skin will then turn red and glow. This is a normal reaction.
If you suffer from chilblains or chilblains, your blood vessels do not respond normally. The slightly larger vessels in the skin are properly closed when you are in a cold environment. However, when the temperature of your skin becomes too low, these vessels remain closed. So they are not going to be wide open, as they should be. The smallest blood vessels try to absorb the persistent closure of the larger vessels by opening maximally. As a result, complaints arise in your feet or hands.

Painful and itchy red spots

The spots on the skin that have been exposed to the cold turn red to even dark blue, glow, tingle, itch and hurt. The spots are usually sharply defined. The complaints arise acutely and become worse when you enter a warm environment or try to warm your feet and hands. Sometimes blisters, sores or wounds develop on the toes or fingers, which can sometimes even become seriously infected as a result of a bacterial infection.

Chilblains / Source: Sapp, Wikimedia Commons (Public domain)

Without further treatment , the painful areas usually disappear on their own within a few weeks. You will then have to prevent your skin from being exposed to even more cold. There may be ointments available that improve skin circulation. Examples are capsicum cream 0.075% FNA (available with a prescription) or Midalgan Forte (available without a prescription from a drugstore or pharmacy). If the complaints are severe, the GP can prescribe vasodilator medications (for example Nifedipine, felodipine or amlodipine). Occasionally an operation is performed. The nerves that cause the blood vessels to contract are then cut. However, the usefulness of this operation is not supported by all physicians.

Cause of chilblains and chilblains

Why the blood vessels in the skin do not respond normally to cold is largely unknown. Long-term exposure to severe cold, in combination with high humidity and wind, certainly play a role in this. As well as wearing insufficiently protective or too tight clothing or (gloves) shoes.
Heredity is a possible factor; the condition often occurs in multiple members of the same family. Smoking and the use of medicines that cause blood vessels to constrict can also play a role in the occurrence of perniones. Chilblains and chilblains are also more commonly seen in people with excessively sweaty feet or hands and in people with poor nutritional status, such as anorexia nervosa. Occasionally the condition is caused by an underlying vascular disorder. A well-known example of this is Raynaud’s phenomenon or disease.

Different phases of Raynaud’s syndrome / Source: Tcal, Wikimedia Commons (CC BY-SA-3.0)

Raynaud’s phenomenon or disease , the small arteries sometimes suddenly contract due to cold or emotions. This reduces the blood flow, especially to the feet and hands. The toes and fingers first turn white and cold. Due to the lack of oxygen, they then turn blue. When blood flow is restored, the feet and hands become red and tingling. Often no clear cause can be found for Raynaud’s disease. Sometimes the condition is caused by the use of certain medicines (for example beta blockers), persistent vibrations (for example due to drills or chainsaws) or heavy strain on the fingers (for example in typists and pianists). In a small minority of cases, there is a more serious underlying disease (such as arteriosclerosis, Buerger’s disease, small blood clots or an autoimmune disease that affects the connective tissue). Raynaud’s disease usually starts at a fairly young age and is more common in women than men. Fairly mild attacks, without an underlying cause, are most common. In that case, treatment is not necessary. To prevent an attack as much as possible, the same advice applies as for chilblains or chilblains.

Prevent chilblains and chilblains

If you regularly suffer from chilblains or chilblains, it is important to avoid prolonged exposure of your feet and hands to low temperatures. So wear well-insulating, warm and thick socks and gloves when you go outside and don’t let your clothes get wet. Also make sure that your shoes and gloves are not too tight. Otherwise the insulation is insufficient and blood circulation is hampered. You can possibly improve the local blood supply in your feet and hands by massaging them regularly and by taking alternating baths some time before the winter (alternating cold and warm water for 2 to 3 minutes).
Furthermore, try to avoid rapid and large temperature changes; Expose your feet and hands to (severe) cold or heat in doses. Smoking is not recommended; Nicotine has a vasoconstrictive effect, which only makes the complaints worse. Medicines that cause the blood vessels to constrict also worsen the symptoms. Discuss with your doctor whether you can (temporarily) reduce or stop the use of these medications. Finally, do not drink alcohol just before going out into the cold and exercise your feet and hands regularly and sufficiently.

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