Chilblains

Symptoms

Chilblains are small and irritated, red patches of skin. As chilblains swell up and look dark blue, they grow more and more painful. Additionally, they could swell. Chilblains cause skin splits when they dry up, raising the possibility of contracting an infection. Although they are frequently found on the toes, chilblains can also occur on the fingers, cheeks, and, particularly, the nose and ears. Chilblains are also frequently seen on pressure-sensitive parts of the foot, such as bunions, the toes pressed against a tight shoe, and places with corns and calluses.

Chilblains begin in the winter (when the temperature drops), and the earliest signs include burning and itching in the area where the chilblain is growing. Going into a warm room frequently makes these feelings worse. Redness and swelling are frequently seen. The skin around the chilblain may frequently degenerate and become an ulcer (sore). The chilblain may get infected.
Some people experience chilblains yearly for the remainder of their life. Others get chilblains for a number of years until they suddenly stop. There is no known cause for these patterns of chilblain incidence. There could be a hormonal effect on the development of chilblains given that they are more frequent in females.
It's not fully apparent why chilblains occur more frequently in those who are just more vulnerable to them. A genetic predisposition, poor circulation, anaemia, poor nutrition, hormonal changes, various connective tissue disorders, and some bone marrow illnesses are among the factors that might cause chilblains. Chilblain risk may also be increased by damp living circumstances.
The likelihood of developing chilblains is increased by the aforementioned circumstances since they are an unusual response to cold. Chilblains develop after the foot has warmed up because they happen when the transition from cold to hot happens too quickly. Because of their sensitivity, some people's circulation may only need minor temperature fluctuations. After spending time in the cold outdoors, the foot is frequently put adjacent to a heat source (such as a heater) while returning indoors, which leads to the formation of chilblains. The tiny blood vessels cannot adapt to the temperature drop soon enough.

Causes

The exact cause of Chilblains is not known.
 

Treatment

Self-Treatment:
Use leg warmers, tights, high top boots, wool socks that are long and thick, and pants to keep your feet warm and prevent chilblains. If your feet do become chilly, give them time to warm up gradually rather than placing them immediately in front of a heat source (this allows the circulation a chance to adjust to the warming skin). Avoid exposing the feet to any direct heat source (such as a heater), especially if the foot is extremely cold, as this is a typical cause of chilblains. 

Utilise a cream for chilblains like Akileine Akilwinter. Smoking also affects the tiny blood vessels' ability to circulate, which raises the chance of developing chilblains.

Tests Required for Diagnosis

Making the diagnosis is more challenging when episodic or seasonal patterns are not mentioned, or when lesions are ulcerated or scarred. Lab testing and diagnostic investigations like skin biopsies are useful. Dermal edoema and a lymphocytic perivascular and perieccrine inflammatory infiltrate are seen in skin biopsies of pernio patients. The epidermis may occasionally have discrete regions of basal vacuolization and necrotic keratinocytes.
 

Useful info

Patients should be informed of the environmental pernio triggers (cold, wet circumstances) and that medicinal therapy is typically unnecessary if precautionary steps are taken to preserve normal skin/body temperature. Furthermore, it's critical to reassure patients that pernio is a self-resolving illness with few, if any, major cutaneous or systemic side effects.
Patients who may have secondary pernio linked to an autoimmune connective tissue illness or vascular disease should be identified by a comprehensive history and skin examination; these patients should receive laboratory assessment based on the narrative and/or physical results. If pharmacotherapy is necessary, it is frequently possible to stop taking the drug in the summer and start it again right before the autumn and winter.

When Chilblain’s develop: 
• Avoid rubbing or scratching chilblains.
• Keep the feet warm by wearing woollen socks and shoes rather than exposing the feet to direct heat (i.e., do not place them near a heater).
• Apply calming products, such as calamine lotion.
• To prevent the chilblains from becoming infected, use an antiseptic treatment if the skin is damaged.
• Diabetics and those with impaired circulation should visit a podiatrist. For people who have a foot that is "at risk," the risk of subsequent chilblain problems is too great to put off obtaining medical attention.
• Insulating or thermal insoles can keep the foot warm to ward against chilblains.
• Applying lanolin or a comparable lotion to the feet will assist to increase circulation.
• Several homoeopathic or natural treatments are suggested for the treatment of chilblains. certain of these things seem to be beneficial to certain people.

Podiatric management of chilblains:
In cold, humid areas, podiatrists frequently treat patients with chilblains and can offer further advice in addition to that mentioned above:

•    Padding and pressure reduction might provide some alleviation for the symptoms of chilblains.
•    In the event of extremely swollen, severe chilblains, topical medications may be required.
•    Corns and calluses are frequent in the pressure points where chilblains might develop; therefore, reducing them will provide some pain relief.
•    Some are advised to use heparin ointment to increase the blood flow in the region.
•    To encourage circulation in the foot, it has been suggested that people who are prone to chilblains undergo a course of ultraviolet light treatment at the beginning of winter.
•    In extremely rare circumstances, chilblains may be a sign of uncommon medical conditions. (For instance, a bone marrow condition or a connective tissue illness)