Chilblains (perniosis)
Chilblains are a reaction of the small blood vessels of the skin to cold, damp conditions.
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Medicines commonly prescribed for Chilblains (perniosis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CREAM, 64 mg betamethasone dipropionate / 100 gActive substance: betamethasoneManufacturer: Organon Salud S.L.Prescription requiredDosage form: TABLET, 10 mgActive substance: amlodipineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: amlodipineManufacturer: Laboratorio Stada S.L.Prescription required
Chilblains are a reaction of the small blood vessels of the skin to cold, damp conditions. They appear a few hours after exposure, on the fingers and toes, and they itch and hurt. It is worth being clear at the outset, because the confusion is common: chilblains are not frostbite. Frostbite is an injury caused by tissue actually freezing and is an emergency; chilblains are a benign vascular reaction that settles on its own within weeks. They are unpleasant, but they do not put the digit at risk.
How they present
- they appear 12–24 hours after being out in the cold;
- red or purple swollen patches or nodules;
- intense itching and burning, worse on warming up;
- pain on pressure;
- sometimes blisters or small erosions that heal poorly;
- sites: toes — the most common — fingers, heels, nose and ears;
- they resolve within 1–3 weeks, sometimes leaving a dark mark;
- they recur each cold season.
What makes them more likely
- cold, damp weather rather than intense dry cold;
- warming the fingers too quickly: next to a radiator, under hot water;
- tight footwear and gloves that restrict the circulation;
- moisture: wet or sweaty feet;
- low body weight;
- smoking, which constricts the vessels;
- Raynaud's phenomenon;
- a poorly heated home;
- family history;
- more common in young women.
When to see a doctor
- the lesions have not resolved within three weeks;
- ulcers have appeared that do not heal;
- there is pus, increasing redness, warmth or fever — added infection;
- the pain is severe;
- they appear outside the cold season or without cold exposure — this calls for investigation of other causes;
- they come with joint pain, a facial rash, marked fatigue or weight loss;
- your fingers turn white and then blue in the cold — there may be Raynaud's phenomenon;
- you have diabetes or circulatory problems;
- the lesions are extensive or very painful.
The reason for this list is specific: chilblain-like lesions can occur in lupus and other autoimmune conditions, and also in association with some infections. If the pattern does not fit with cold exposure, you need to look further.
How they are assessed
In a typical case — appearing with cold, resolving spontaneously, recurring each winter — examination is enough. If the picture is atypical or persistent, full blood count, inflammatory markers, antinuclear antibodies and other autoimmune tests are arranged, along with circulatory assessment and sometimes a skin biopsy.
Treatment
The essentials are gradual warming and protection; medication is reserved for cases that need it.
- warm slowly, at room temperature, without hot water or radiators: rapid rewarming is what provokes the reaction;
- keep the area dry and warm;
- a mild topical steroid in a short course for itching and inflammation;
- nifedipine and other vasodilators for severe or recurrent cases, prescribed by a doctor;
- emollients for cracked skin;
- antibiotics only if there is infection;
- do not scratch: broken skin is the route bacteria take.
Prevention
- dress in layers and warm hands and feet before going out, not once they are already cold;
- wool or technical socks and roomy footwear that does not constrict;
- generous mittens, which hold warmth better than tight gloves;
- change immediately if you get wet;
- keep the home at a steady temperature;
- keep moving: activity improves peripheral circulation;
- stop smoking: it has a direct effect;
- avoid sudden temperature changes to the hands;
- if you are prone, start these measures in early autumn rather than once lesions have appeared.
Common questions
Is this frostbite? No. Frostbite is serious tissue injury from freezing, with hard, pale or numb skin, and it requires emergency care. Chilblains are a vascular reaction that resolves on its own.
Could I lose a toe? No. Chilblains do not destroy tissue.
Does rubbing with snow or soaking in hot water help? Neither: both make things worse.
Will they come back next winter? Probably, if nothing changes. Prevention is what reduces the episodes.
Why me and not others? Individual vascular reactivity, body weight, smoking and family predisposition all play a part.
Online consultation
In an online consultation the doctor reviews photographs, helps distinguish chilblains from frostbite and from similar autoimmune conditions, advises whether further investigation is needed, prescribes treatment for the itch and works out a prevention plan for the cold season with you.
This material is for information only and does not replace a medical consultation.
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Reviewed on Aug 7, 2026
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