Chilblains: Why Cold Weather Causes Painful Foot Lesions

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Are Chilblains?

Chilblains (pernio) are abnormal inflammatory skin responses to cold, damp weather — producing painful, itchy, red-to-purple patches or raised bumps on the feet (and sometimes fingers, ears, and nose). Unlike frostbite, chilblains don’t require freezing temperatures — they develop from prolonged exposure to cold, damp air typically between 32°F and 60°F (0°C–15°C), the exact temperature range common in Michigan falls and springs.

Chilblains are often confused with frostbite, Raynaud’s phenomenon, or other cold-related conditions — but they have distinctive features that make them recognizable. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, chilblains are a regular fall and winter presentation in our practice.

Why Do Chilblains Develop?

The exact mechanism isn’t fully understood, but the leading theory involves an abnormal vasomotor response to rewarming after cold exposure:

• Cold causes vasoconstriction in the small vessels of the feet
• When the foot is rewarmed — particularly if rapidly rewarmed after prolonged cold exposure — the small blood vessels dilate rapidly
• This rapid dilation causes inflammatory mediators to leak from blood vessels into surrounding tissue
• The resulting inflammation produces the characteristic lesions

Chilblains are not caused by the cold alone — the combination of cold-induced vasoconstriction followed by rapid (or repeated) rewarming cycles is what triggers them. This is why people who go from cold outdoor environments to warm heated buildings repeatedly are most susceptible.

Who Gets Chilblains?

Risk factors include:

• Female sex (women are significantly more susceptible)
• Low body weight or poor peripheral circulation
• Raynaud’s phenomenon (already have abnormal cold vasoreactivity)
• Autoimmune conditions (lupus, antiphospholipid syndrome — lupus pernio)
• Living in cold, damp climates — Michigan, particularly the upper Midwest
• Wearing inadequate footwear in cold or wet conditions
• COVID-19 (“COVID toes”) — a chilblains-like condition that became widespread during the pandemic and may have a distinct mechanism

Symptoms of Chilblains in the Feet

• Red, pink, or purple discoloration of the toes or heels — often with a mottled appearance
• Itching — often intense, particularly as the foot warms
• Burning or stinging sensation
• Swelling of the affected areas
• In severe cases: blisters and skin ulceration over the lesions
• Lesions appear hours to a day after cold exposure
• Recurrence with each cold exposure in susceptible individuals — seasonal pattern

Distinguishing Chilblains from Other Conditions

• Frostbite: Requires exposure to freezing temperatures; produces true tissue death (necrosis), waxy appearance, blisters, and black eschar in severe cases; much more severe
• Raynaud’s: Triphasic color change (white-blue-red) with cold or stress; does NOT produce the fixed lesions/patches of chilblains; reverses when warm
• Lupus pernio: Similar to chilblains but more persistent, may occur in warmer weather, and associated with systemic lupus — skin biopsy differentiates
• COVID toes: Similar appearance to chilblains, often in young people without traditional risk factors; appeared during COVID-19 pandemic; may involve endothelial/immunologic mechanisms distinct from classic pernio

Treatment

General Measures

• Gradual rewarming — never rub or apply direct heat to chilblained skin (hot water bottles, heating pads can cause burns on hypersensitive, inflamed skin)
• Keep feet warm and dry — insulated, waterproof footwear; thick wool socks
• Avoid repeated cold-to-warm temperature cycling when possible
• Elevate affected feet to reduce swelling

Topical Treatment

• Topical corticosteroid cream (hydrocortisone, triamcinolone) reduces inflammation and itching
• Bland emollients (Vaseline, aquaphor) protect and moisturize the skin
• Antihistamines for itching relief
• Silver-containing dressings for any ulcerated lesions

Medication for Recurrent or Severe Cases

• Nifedipine (calcium channel blocker): The evidence-based first-line treatment for recurrent or severe chilblains. Produces vasodilation that prevents the triggering vasoconstriction-rewarming cycle. 20–60mg daily during the cold season significantly reduces frequency and severity.
• Pentoxifylline: Improves microvascular blood flow; used for chilblains in some protocols
• Hydroxychloroquine: For lupus pernio or chilblains refractory to other measures

Prevention for Michigan Winters

• Insulated, waterproof footwear rated for cold weather
• Wool or thermal socks — never cotton in cold/damp conditions
• Avoid tight footwear that restricts circulation
• Warm up gradually — spend a few minutes in a cool transitional environment before entering a very warm building
• Hand warmers in gloves and shoes for extended outdoor exposure
• Begin nifedipine prophylaxis before the cold season in patients with reliable recurrent chilblains

If you develop persistent, painful lesions on your feet after cold weather exposure, have them evaluated at Balance Foot & Ankle. We’ll confirm the diagnosis, assess for underlying conditions, and provide the treatment that resolves your chilblains and prevents their return next winter.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Cold-Weather Foot Lesions

Chilblains are painful inflammatory lesions triggered by cold exposure that can mimic other conditions. Dr. Tom Biernacki at Balance Foot & Ankle accurately diagnoses chilblains and provides treatment to relieve symptoms and prevent recurrence during Michigan winters.

Learn About Our Foot Pain Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Nyssen A, et al. “Chilblains.” Vasa. 2020;49(2):133-140.
2. Almahameed A, Pinto DS. “Pernio (chilblains).” Current Treatment Options in Cardiovascular Medicine. 2008;10(1):55-63.
3. Takci Z, et al. “Perniosis: a review of the literature.” Dermatology. 2015;230(2):113-120.