Scenario

Counter assistant Mandy is talking to technician Vicky. “I hate this time of year. The cold and rain seem to conspire against me and I always get chilblains, no matter how many pairs of socks I wear, the type of boots I put on in the morning, or how quickly I get my feet on the radiator or a hot water bottle when I get home in the evening. My husband just laughs at me when I complain about them. He says they are an old person’s problem, but he doesn’t realise how sore my feet are for months every winter. I haven’t got any yet this year, but I l know it’s only a matter of time.”

Answer

Mandy may actually be making her chilblains worse by warming her feet up too quickly. The cold weather causes the blood vessels near the surface of the skin to constrict – to help the body maintain its core temperature – and they only expand again once warm conditions are restored. However, heating up the skin too quickly, as Mandy is doing with her hot water bottle or radiator, means the blood flows more quickly to her feet than the blood vessels can handle, which means that some blood leaks into surrounding areas. This is what causes the swelling, itchiness and discolouration associated with chilblains.

As well as ensuring she warms up her feet gradually when she gets home in the evening, there are some simple measures that Mandy can take to reduce the chance of getting chilblains in the first place. Staying active can help improve circulation, keeping her feet well moisturised will stop the skin becoming dry and cracked, and avoiding tight fitting footwear that puts pressure on – and therefore restricts blood flow to – certain areas of the feet can all help. Clothing should be warm and designed to avoid draughts – for example, long socks and boots under trousers.

If Mandy gets a chilblain, a cream containing warming ingredients such as menthol, capsicum and salicylates that is licensed for this indication may be applied, assuming the skin is not broken. However, there is little evidence that such products work. If Mandy suffers from severe, recurrent chilblains, she should pharmacy CHILBLAINS scenario visit her GP as she may need to be prescribed nifedipine, which improves circulation by causing blood vessels to widen.

The bigger picture

Chilblains occur when the skin reacts to a change in temperature. They tend to affect extremities such as the toes, fingers, nose, heels and ears. A few hours after being exposed to the cold, the affected area feels itchy, and the discomfort can be greater if the sufferer is in a warm environment. The skin may swell and redden, or even turn blue, and sometimes sores or blisters develop. These breaks in the skin can lead to the skin becoming infected.

People with poor circulation (including conditions such as Raynaud’s phenomenon or systemic lupus erythematosus), those with a poor diet or who are underweight or smoke, and individuals who are regularly exposed to cold and damp conditions are more likely to suffer from chilblains than others. Women tend to be affected more than men, and the elderly and children are also more likely to get chilblains than other age groups.

Extend your learning

• People with diabetes are not only prone to chilblains, but may not notice they have them and are therefore at increased risk of them becoming infected. Find out more about the reasons for this at: Diabetes UK: Feet 
• Raynaud’s phenomenon is a circulatory disorder that may affect as many as 10 million people in the UK. Find out more about it at: Raynaud's and Scleroderma Association: Raynaud's
• Systemic lupus erythematosus (SLE) is mentioned above. Do you know about this condition? If not, find out at: Arthritis Research UK: Systemic lupus erythematosus (SLE) 
• Nifedipine is mentioned above as a possible treatment for severe chilblains. Revise your knowledge of this drug, including what else it is used for and its side effects by looking it up in section 2.6.2 of the British National Formulary.