Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
After a cold, damp day — particularly in wet winter conditions — some people develop itchy, burning, swollen patches on their toes that turn red or purple. These are chilblains (pernio), an uncomfortable but usually benign condition that confuses patients who expect frostbite to look different, or who don’t realize their level of cold exposure was sufficient to cause this reaction.
Dr. Tom Biernacki, DPM explains what chilblains are, why they happen, and how we manage them — including the cases where chilblains indicate a more serious underlying condition.
The most important clinical decision with Chilblains Feet isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What Are Chilblains?
Chilblains, medically termed pernio, are localized inflammatory lesions of the skin that develop on the toes, feet, and sometimes fingers after exposure to cold and damp — not necessarily freezing — conditions. They’re different from frostbite (which involves actual ice crystal formation in tissues) and occur at temperatures just above freezing in susceptible individuals.
The underlying mechanism involves abnormal vascular reactivity: in susceptible people, cold exposure triggers excessive vasoconstriction (blood vessel narrowing) in the extremities. When the skin subsequently rewarmsrapidly, reactive vasodilation and plasma leakage into surrounding tissues produces the characteristic inflammatory swelling, redness, and itch. Chronic chilblains can progress to small blisters or superficial ulceration.
Key takeaway: Chilblains are caused by wet and cold together — not extreme cold alone. Dry arctic cold rarely causes chilblains; damp British or Pacific Northwest winter cold commonly does. Prevention centers on keeping feet dry and warm, not just above freezing.
Symptoms and Appearance
- Red, purple, or dusky patches on the toes and dorsum of the foot — bilaterally in most cases
- Intense itching — often worsens when the feet are brought into warmth after cold exposure
- Burning sensation — particularly during rewarming
- Swelling of affected areas
- Small blisters or ulcerations in severe or recurrent cases
- Tenderness to touch over the affected toes
Who Gets Chilblains?
Chilblains are more common in: young women and children (thin extremities with less insulating fat), people who are underweight or have low BMI, individuals with Raynaud’s phenomenon, those with autoimmune conditions (lupus, antiphospholipid syndrome — “chilblain lupus” is a specific recognized entity), and people who work outdoors in wet and cold conditions. A sudden increase in chilblain incidence was noted during the COVID-19 pandemic, where “COVID toes” — chilblain-like lesions on the toes — were documented as a cutaneous manifestation in some patients.
Chilblains Treatment
Rewarming
Gradual rewarming is the cornerstone of immediate treatment — bring the feet to room temperature slowly, not rapidly with hot water or direct heat sources, which can worsen the inflammatory response and cause burns in partially numb tissue. Warm (not hot) baths, warm socks, and a warm room are appropriate. Rubbing chilblained skin vigorously worsens the inflammation and should be avoided.
Topical and Symptomatic Treatment
Topical corticosteroids (low-to-medium potency) reduce the inflammatory itch and swelling when applied to chilblain lesions twice daily. Calamine lotion or menthol-based creams provide symptomatic cooling relief from the burning and itching. Keeping the skin moisturized prevents secondary fissuring of affected areas.
Nifedipine for Severe Cases
Nifedipine — a calcium channel blocker — is the most evidence-supported systemic treatment for severe or recurrent chilblains. It reduces vasospasm and promotes peripheral vasodilation, decreasing both the severity and frequency of episodes. It’s prescribed at low doses (20–60mg daily) during the cold season for patients with frequent disabling chilblains. Topical nifedipine gel is also used in some centers. We prescribe nifedipine for patients with seasonally recurrent, severe chilblains that impair quality of life.
Prevention
Prevention is straightforward: keep feet warm, dry, and insulated before cold exposure. Wool or thermal socks, waterproof footwear, and avoiding prolonged cold damp exposure are the primary measures. Start wearing warm footwear before going out in cold weather rather than trying to rewarm feet after the damage is done — chilblains represent an overreaction during rewarming, so preventing excessive cold exposure prevents the cascade entirely.
⚠️ When to see a podiatrist:
- Blistering or open ulcers on the toes from chilblains (wound care needed)
- Chilblains that occur without clear cold exposure (possible underlying connective tissue disease)
- Recurrent severe chilblains causing significant functional limitation (nifedipine candidate)
- Chilblains in a patient with joint pain, rash, or other systemic symptoms (lupus screen)
- Toe lesions with no known cold exposure — rule out other diagnoses including vasculitis
Frequently Asked Questions
How long do chilblains last?
Most chilblain episodes resolve within 1–3 weeks with rewarming and avoidance of re-exposure. Recurrent episodes during the cold season can persist through winter. Chronic chilblains with repeated exposure can take months to fully resolve and may leave temporary discoloration. The key is preventing re-exposure, which prevents the repeated inflammatory cycles that delay healing.
Are chilblains the same as frostbite?
No — frostbite involves actual freezing of tissue with ice crystal formation, causing cellular destruction and potentially permanent damage. Chilblains occur at temperatures above freezing in response to cold and damp, through an inflammatory vascular mechanism without tissue freezing. Chilblains are much milder and heal completely in most cases; frostbite can cause permanent tissue loss.
Sources
- Viguier M, et al. Chilblains. J Am Acad Dermatol. 2001;44(2):235-45.
- Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio in 113 patients. Mayo Clin Proc. 2014;89(2):207-15.
- Kolivras A, et al. Coronavirus (COVID-19) infection-induced chilblains. J Cutan Pathol. 2020;47(11):1011-1016.
PubMed: Chilblains — Diagnosis and Treatment
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.