Wilderness First Aid Q&A

Taking the chill out of chilblains




In the heart of winter we dare not test the weather. Getting ready to go outside is as much of a process in itself as the outdoor activities we are planning to do! Layers of warm clothing and waterproof boots not only keep the cold away but also serve as protection against some of the most peculiar skin disorders, like chilblains.

chlblan-300x222Chilblains (CHILL-blayns), known more commonly as pernio, is a rare and painful response of our blood vessels to cold, specifically, in above freezing temperatures. Actually, the temperature itself doesn’t play much of a difference; instead, it is the exposure of skin to dampness and wind that is most crucial. For this reason chilblains has been seen most often in mild-temperature regions where cold and damp winters are rare leaving people surprised by and least prepared for the occasion. England, known for its wet and chilly climate, has about 10 percent new cases of chilblains per year. Most surprisingly, the usually hot and humid Hong Kong has some chilblains cases reported annually during its coldest months of January and February.

How or why chilblains develops is not entirely understood. Our skin acts like a thermometer and helps sense the temperature outside and inside our body; it makes sure we are always perfectly warm at 37° Celsius (98.6° Fahrenheit) . When the temperature outside lowers, our skin tries to preserve our internal heat by sending signals to our farthest blood vessels in our hands, feet, and tip of our nose telling those vessels to squeeze tight; this slows the flow of hot blood to our most distant tissues and retains heat toward the center of our body. In chilblains, those distant “shut-off” areas begin to react abnormally to the lack of blood flow. The blood vessels closest to the skin surface, and with the least blood, wage a full inflammatory response asking the body to pay attention to them. Instead of helping the situation, the inflammation actually leads to the destruction of blood vessels and real damage to the skin above them.

Chilblains can look like single or multiple, red or purple swellings or blisters. Many affected people complain of severe itching, burning, and pain in the areas. Fingers and toes are the most commonly affected areas.

Some people are at higher risk of developing chilblains than others. Those with chronic diseases of poor blood circulation, like diabetes, are more sensitive to temperature changes since their blood vessels are not as reactive to skin’s signals. Young, horse-riding women are also somewhat more susceptible! This group of women ride their horses for hours during winter months. Their tight and improperly-insulated riding outfits squeeze skin and blood vessels and, thus, interfere with the intricate cold temperature response mechanism leading to large, tender chilblains-like spots on the lateral calves and thighs.

Smoking cigarettes also increases your risk of chilblains because the ingredients in tobacco – including nicotine – directly damage your blood vessels. Thus, overtime the vessels are much more likely to have an abnormal reaction in response to cold temperatures leading to a painful chilblains reaction.

To decrease your risks and prevent this condition, wear properly-insulated, waterproof, and loose-fitting clothing in layers. Crucially, strive to keep the most distant parts of your body – toes and fingers, for example – warm and dry. Avoiding sitting in one place, and try to maintain motion in order to promote better blood circulation.

Some healthcare providers may be unfamiliar with this rare disorder, which sometimes leads to unnecessary hospital admissions and extensive laboratory and imaging evaluations. The good news is that chilblains usually goes away on its own in a couple of weeks without much treatment! Thus, it is vital for you to become familiar with this rare, painful but non-life threatening condition which can pop up in a cold, wet, and windy situation.

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  • Dr. Andrew C. Krakowski is the host of the boonDOCS Wilderness & Travel Medicine show on Outdoor Channel. He is the founder of the Johns Hopkins School of Medicine's wilderness medicine program and currently works in the field of pediatric dermatology at the Rady Children's Hospital in San Diego.

    Dr. K loves the outdoors and believes that knowledge, adaptability, and experience are essential for being prepared in the wilderness.

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