What’s Wrong With My Toes? Chill Blains

Julia Schneemann | | BrainsBrains
Chill blains
Chill blains on a toe. | Picture: SnowBrains

Are one or several of your toes swollen or itchy, or simply feel like there is something in-between them or rubbing? You might be suffering from chill blains.

SnowBrains spoke with Dr. Elizabeth Dawes-Higgs, who is a dermatologist and skin cancer specialist. Dr. Dawes-Higgs holds a degree in Medicine and Engineering as well as a Ph.D. from The University of Sydney. As a medical professional, she has volunteered in The Cook Islands and Nepal. In her spare time, she is also an avid skier.

What Are Chill Blains?

Chill blains — also known as perniosis —are itchy, red or purplish, swollen, and tender areas of skin that develop on your toes or even your fingers or rims of your ears. They can present as single or multiple patches, lumps, or nodules. In severe cases, blistering and ulceration occur in the affected area.

Chill blains
Chill blains on a patient’s hand. | Picture: Dr. Elizabeth Dawes-Higgs

How Do Chill Blains Happen?

Chill blains typically occur after exposure to cold at temperatures above 0° Celsius (32° Fahrenheit). The blood vessels in those areas become inflamed with prolonged exposure to cold, wet, non-freezing conditions, but the precise cause is unknown. It appears that the loss of heat from the skin in those areas and the resulting change in blood vessels cause these lesions. There may be genetic factors that contribute to chill blains since several generations within a family can be affected. Women, children, and elderly people are more susceptible to chill blains. They are also more common in those with:

  • Hematological malignancy
  • Bone marrow disorders
  • Peripheral vascular disease
  • Diabetes
  • Low body weight / poor nutrition
  • Connective tissue disease

Why Do Chill Blains Happen During Skiing/Boarding?

Chill blains are common in humid cold climates and are therefore more common in humid ski areas like Australia. Also, the relative cold combined with moisture in ski boots from sweating contributes to the likelihood of chilblains occurring while participating in snowsports. They are also known to happen to hikers who get wet feet.

Wet feet in cool environments can also cause chill blains in those predisposed to the condition. | Picture: SnowBrains

How to Treat Chill Blains?

Unfortunately, there is no quick fix as once chill blains appear, the damage has been done as the blood has leaked into the skin tissue, forming the lesions. But don’t worry, chill blains will often resolve within two to three weeks without any treatment. It can take longer to resolve in older people. Avoid re-exposure to cold, damp windy conditions and medicines which may constrict blood vessels. Keep the affected area dry and warm, and protected, and treat any associated underlying conditions you may have. Any normal moisturizer may be applied to the area to relieve any itching or discomfort. Topical corticosteroids may be used to reduce inflammation. However, there are no controlled trials demonstrating their effectiveness versus conventional moisturizers. The most important part is not to scratch the lesions, as the tender skin can break, and this will leave you exposed to a potential bacterial infection.

Should You Seek Medical Advice?

There is no evidence that topical creams, like corticosteroids, improve the condition. “However, if you have repeat attacks, seek medical intervention as there are oral options that are able to open up the blood vessels in your hands or feet,” Dr Liz Dawes-Higgs recommends “Nifedipine causes dilatation of the blood vessels and may be helpful in individuals who have recurring cases of perniosis.”

How to Prevent Chill Blains?

“Prevention is key,” says Dr. Liz Dawes-Higgs. “Make sure to keep your extremities warm and dry. Wear appropriate footwear when venturing into colder areas and avoid sudden temperature changes.” After prolonged cold exposure, it is important not to expose toes or fingers to instant heat. It is tempting when you come in from the cold to warm up quickly, but this tends to make chill blains more likely if you are predisposed. Make sure to keep your toes and hands dry and warm, and carry spare socks or gloves with you. Make sure your ski boots dry out properly overnight and consider using boot warmers if you have cold feet while skiing or boarding.

Chill blains. | Picture: SnowBrains

Related Articles

Got an opinion? Let us know...