Swelling And Redness On Fingers And Toes In Winter - Chilblains Or Perniosis
What causes Chilblains?
Chilblains are localized, reddened, itchy swellings that develop on fingers and toes, are painful to touch, tend to ulcerate, or may develop blisters.
They occur as an abnormal reaction to the cold ambient temperature above the freezing point, followed by rapid rewarming. Dampness and the wind that increase cold conductivity and convection play a part.
The reasons why cold causes chilblains in some individuals and not in others, include the following:
- Genetic factors - This condition runs through generations when it is superimposed on a background of bluing or redness of hands and feet (Acrocyanosis and/or Erythrocyanosis).
- Focal sepsis.
- Hormonal changes.
- Diseases - Dysproteinemias, myelodysplastic disorders.
Pregnancy may have a beneficial effect on chilblains.
In normal people, moderate cold exposure causes blood vessels to constrict initially, and then to dilate in an attempt to maintain reperfusion, while, in those afflicted by chilblains, there is a persistent cold-induced constriction of large arteries in the skin, and persistent dilatation or widening of the smaller, more superficial blood vessels. This causes a leakage of blood into the nearby structures.
There are two different variants of chilblains, which include the following:
- Superficial perniosis or Acral chilblains - These include swellings on fingers and toes, with inflammation and fluid accumulation in the upper dermis of the skin.
- Deep perniosis or Equestrian chilblains - These are multiple swellings that develop in the thigh region, with inflammatory changes that occur in the dermis of skin, and the subcutaneous fat layer present beneath the skin.
Thigh perniosis is due to a combination of external cooling and insulation from internal warming, whereas acral perniosis involves only cooling from outside, as there is very little or no fat layer in fingers and toes.
Factors That Increase The Risk Of Developing Chilblains
- Exposure of skin to cold, damp conditions.
- Being female.
- Being underweight.
- Place of Residence - They are less likely to develop if you live in cold and dry areas, as living conditions and clothing are more warm and protective in such places.
- Time of the year - This condition commonly occurs from early winter to spring.
- Having poor blood circulation.
- Having been diagnosed with Raynaud's phenomenon.
Signs and Symptoms of Chilblains
The onset of perniosis is in autumn or early winter when the atmospheric relative humidity is high.
Tender single or multiple, burning, itchy, red or purple colored swellings, which may blister or ulcerate, tend to develop on fingers, toes, heels, lower legs, nose, and ears. When mild, this condition runs a self-limiting course over about 3 weeks.
In those people who are severely affected, particularly elderly with venous stasis, this condition may persist throughout winter, and may be unremitting even in summer months.
Tight garments such as gloves, stockings and shoes are to be avoided in people suffering from peripheral vascular diseases.
This problem is common in children, women, and people with a low body mass.
A particular type of chilblains called equestrian perniosis, tend to occur in young women who are horse-riding enthusiasts (practice this sport for several hours daily during winters), and wear tight fitting breeches. In such individuals, infiltrated reddish-blue plaques develop symmetrically on lateral calves and outer aspects of thighs, with associated ulceration.
To prevent these lesions, experienced horse riders usually wear baggy breeches that give insulation, and are not tight enough to compromise the circulation.
People who indulge in sustained vigorous exercise program to lose weight drastically may also develop acral chilblains (on fingers and toes) along with bluish discoloration of extremities.
Acral chilblains are more common in people with low body mass
Other Variants of Chilblains
- Senile chilblains - These lesions develop in the elderly due to hardening of arteries, systemic diseases, prolonged exposure to cold or friction, and may persist for many weeks or months.
- Papular perniosis - The lesions develop in crops, as red colored raised areas and favor the sides of fingers, often superimposed on a background of bluish discoloration of extremities. This variant can occur at all times of the year.
- Pustular chilblains (Acrodermatitis pustulosa hie malis)
- Annular chilblains
- Perniosis associated with leukemia and other myeloproliferative disorders.
- Chilblain lupus - A distinct disease similar to discoid lupus erythematosus.
- Lupus pernio - A variant of sarcoidosis.
Spontaneous healing of chilblain lesions occurs when spring arrives, to occur again in the following winter.
Treatment of Chilblains
- Prophylactic wearing of warm, loose, insulating clothing, and living in warm housing conditions and workplace. A susceptible person should avoid rapid changes in temperature from cold to warm. In order to maintain a healthy blood circulation, the affected person should avoid immobility. A short course of ultraviolet light in the beginning of winter was a tradition that has been refuted in recent studies. Once chilblains have occurred, rest, warmth, and topical antipruritics are essential. Keep the area dry to prevent superinfections.
- Blood vessel dilator medicines of the calcium channel blocker group (Nifedipine, Diltiazem) are beneficial to cure the existing lesions and to prevent new lesions from developing, especially for severe recurrent perniosis. A headache and flushing are troublesome side effects of these medicines in some individuals.
- Pentoxifylline (Trental) is another medication that helps to improve the blood flow and heal chilblains.
- Nicotinic acid derivatives.
- Topical application of minoxidil.
- Infection prevention - If your skin has broken, cleaning and protecting the wounds prevents infections.
- Vitamin-D and Calcium supplements.
How To Prevent Chilblains
- Avoid rapid changes in temperature from cold to warm.
- Wear loose warm, socks, shoes, and gloves. Avoid tight fitting footwear.
- Wear a hat and a scarf to protect the ears and nose.
- Place cotton wool between the toes to improve circulation.
- Soak hands and feet in warm water with Epsom salt for 15-20 minutes, 3-4 times a day.
- Healthy diet.
- Exercise at least 3-4 times a week to improve circulation.
- Avoid alcohol before going out in the snow.
- Avoid scratching on itchy areas.