Brief overview
- Description: Reddish-bluish, itchy and painful skin lesions caused by cold and damp climates. Occur mostly on toes and feet as well as hands and ears.
- Causes: Frostbite occurs when cold causes blood vessels to contract, resulting in insufficient blood flow to the tissues.
- Treatment: Frostbite usually heals on its own, but the use of vasodilator medications and nourishing ointments is advisable depending on the severity. Warmth (e.g. warm clothing) supports the healing process.
- Course: In most cases, chilblains are harmless and heal on their own within a few weeks. However, complications such as pain, scarring and infection are possible and may last much longer.
- Symptoms: The skin is swollen, reddish to bluish in color (spots). The skin itches, burns and hurts. In some cases, blisters appear on the skin, rarely ulcers.
- Diagnosis: Talking to the doctor, examining the skin for changes such as swelling, discoloration, deformities and injuries.
- Prevention: wearing warm clothing, adequate exercise, abstaining from alcohol and smoking.
What are chilblains?
Frostbite already occurs at temperatures around freezing point, for example during winter sports.
Frostbite is the result of circulatory disorders. Particularly susceptible to frostbite are therefore areas of the body with weaker blood circulation, such as the hands and feet, especially the fingers and toes. Colloquially, chilblains are also called “winter toes.” However, frostbite also frequently affects the face, ears and nose, as well as the heels, thighs and lower legs.
There is also a distinction between frostbite that occurs acutely, a short time or a few hours after exposure to cold, and frostbite that occurs chronically, when the body is repeatedly exposed to the cold.
Frostbite is not frostbite, in which ice crystals form in the tissues, and is usually harmless.
How do frostbites develop?
Often, there is no identifiable cause as to why some people are prone to chilblains. However, it is possible for chilblains to occur due to other conditions. For example, chilblains are known to occur as a result of the autoimmune disease lupus erythematosus. In addition, chilblains occur in association with neurological disorders such as Aicardi-Goutières syndrome (ABS), a rare inherited brain disease.
Studies also indicate that frostbite-like skin changes occur in some people during or after infection with SARS-CoV-2 (so-called “COVID toes” or “corona toes”). However, further investigations have yet to show what the correlations are here.
What are the risk factors?
In addition to cold, high humidity and wind favor the development of frostbite. People who spend more time outdoors (e.g., riding horses, bicycles or motorcycles) are therefore more likely to be affected by chilblains. Those who then do not protect themselves sufficiently from damp, cold weather (e.g. by wearing gloves or a hat) or wear clothing that is too tight (e.g. shoes that are too tight) additionally promote the development of frostbite.
What can be done against frostbite?
In most cases, chilblains heal on their own. However, the use of vasodilator medications and caring ointments prescribed by the doctor is advisable, depending on the severity. In addition, heat supports the healing process. Those affected, on the other hand, are better off avoiding cold.
Warmth
Generally, chilblains disappear again on their own within a few weeks. Heat is a reliable means of relieving symptoms and preventing further chilblains. At the first sign of frostbite, it is best to warm the affected area immediately.
For example, place your warm, dry hands on the chilblain, or run lukewarm water over it. You should avoid hot water or direct contact with a hot heater. This will cause additional damage to the already affected skin areas.
Warm clothing such as gloves, thick socks, earmuffs or a blanket also help against frostbite. Warming teas and soups are also recommended for frostbite. They warm the body from the inside. Until the chilblains have healed, it is also best to avoid the cold as much as possible.
Exercise
Exercise also helps to stimulate blood flow in the vessels. Endurance sports are particularly suitable: hiking, long walks, swimming or cycling not only improve blood circulation, but also strengthen the immune system.
Home remedies
The effectiveness of home remedies for chilblains has not yet been sufficiently proven. In general, it is advisable to integrate alternating showers, Kneipp watering and more exercise into your daily routine in order to promote blood circulation. Ointments containing extracts of calendula or lanolin care for the skin.
To ease the discomfort of chilblains, some people swear by home remedies such as oak bark and horsetail baths, healing clay dressings or rubbing with tea tree oil.
Home remedies have their limitations. If the symptoms persist for a long period of time, do not get better or even get worse, you should always consult a doctor.
Other measures
When to see a doctor?
In most cases, chilblains are harmless and do not need to be treated by a doctor. If there are no additional complaints or severe pain, the chilblains heal by themselves.
In severe cases, however, inflammatory wounds develop on the affected skin areas. To avoid further complications such as infections or ulcers, consult a doctor immediately in these cases. If you repeatedly experience swelling due to cold, a visit to the doctor is also recommended. This is because it is possible that the tissues may become damaged over time or that you have a disease that promotes chilblains (e.g., an autoimmune disease such as lupus erythematosus). If the chilblains spread or take longer than two weeks to heal, it is equally advisable to see a doctor.
In severe cases, the physician treats chilblains with vasodilator drugs (e.g. calcium antagonists such as nifedipine or diltiazem). However, the efficacy of this has not yet been adequately studied.
If an underlying disease such as arteriosclerosis (“hardening of the arteries”) is responsible for the circulatory disorders, the physician treats it and recommends measures to promote circulation (e.g., more exercise, alternating showers). Sometimes he prescribes anticoagulant drugs such as acetylsalicylic acid in low doses (e.g. 100 mg per day), which the patient takes permanently.
It is important to go to your follow-up appointments until the chilblains are completely healed to reduce the risk of complications.
How long do you have frostbite?
Generally, chilblains are not dangerous. The itchy, painful swellings usually resolve on their own within one to two weeks (six weeks maximum). However, if the vulnerable areas of the body are repeatedly exposed to the cold without protection, chronic swellings may develop, causing recurring symptoms even years later.
Be sure to have frostbite checked out by a doctor, especially if it has already occurred several times!
What do chilblains look like?
Frostbites usually look reddish or bluish in color at the beginning. Later, the affected areas of skin are often swollen and painful. The skin feels cold and moist (doughy). When heated, the chilblain usually itches and burns. Sometimes it tingles and feels furry. Affected individuals often report discomfort in the affected area, such as feeling like “ants walking” on the skin.
The skin is also usually bulged out in a bump shape, bulges slightly upward and reacts painfully to pressure. Sometimes blisters form on the skin. In severe cases, it is also possible for ulcers to develop, extending into the subcutaneous fatty tissue. If the chilblains do not heal properly, scars remain.
Where do chilblains often occur?
How does the doctor diagnose chilblains?
If the affected person notices painful or unusual skin changes, the general practitioner is the first point of contact. If necessary and for further examinations, he or she will refer the patient to a dermatologist.
Discussion with the doctor
Before examining the skin, the physician conducts a detailed discussion with the affected person (anamnesis). In the anamnesis interview, he asks questions about, for example, when the skin changes occurred, whether they arose suddenly or developed over a longer period of time, and whether they have already occurred several times.
In addition, he will ask about possible triggers, such as whether you have been outside in the cold for a long time or whether you have other diseases (e.g., lupus erythematosus, arteriosclerosis).
Physical examination
The physician then examines the skin for visual abnormalities (e.g., deformities, injuries, swelling, discoloration). In doing so, he closely examines the skin (e.g., with a special skin magnifier or a microscope) and palpates it if necessary.
Most of the time, the doctor recognizes quite quickly whether it is frostbite on the basis of the symptoms described and the physical examination.
If the symptoms indicate another disease, it is necessary to perform further examinations to trace the basic problem (e.g. blood tests).
How to prevent frostbite?
The best protection against frostbite is to avoid cold. Protect your body with warm clothing (e.g., gloves, hat, socks) that does not constrict. In cold and damp weather, use waterproof and breathable clothing.
When it comes to clothing, make sure that you cover your head well. This is where the body radiates the most heat. Avoid shoes or gloves that are too tight. They cut off the blood supply in the vessels and are more likely to cause frostbite. Constricting bracelets, stockings or belts also inhibit blood flow.
Also, refrain from alcohol and smoking. Both substances damage your blood vessels and have a negative effect on your immune system.
After the treatment of chilblains, it is advisable that you continue to care for the pre-damaged skin areas with creams so that the skin damage is kept within limits. In wet and cold weather, it is best to protect your facial skin with a thick fat or cold cream. Ask your doctor or pharmacist which creams are suitable for you, as some may irritate your skin.
