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What are Chilblains? Recognizing, Preventing, and Treating Non-Freezing Cold Injuries

Fall is upon us, but the season for non-freezing cold injuries is all year long here in the Pacific Northwest!  What are non-freezing cold injuries?  You've heard of frostbite, which happens when our skin and underlying tissues freeze after exposure to sub-freezing temperatures. When the temperatures are in the mid-thirties or forties, frostbite isn't a concern but we still need to take care to prevent non-freezing cold injuries.  Chilblains have been seen even in southern California, as this scholarly paper with gruesome pictures explains. 

While non-freezing cold injuries are not life-threatening, they can be painful, long-lasting, and difficult to treat.  In extreme cases they can even result in the loss of digits or limbs, and deserve a healthy respect from anyone working or recreating in cold environments for long periods of time.   

Types of non-freezing cold injuries

There are a few different types of non-freezing cold injuries, including Raynaud's Syndrome and immersion foot, but in this post we're going to focus on chilblains.

Chilblains, or perniosis, is a common non-freezing cold injury most frequently found on the fingers and toes but can also appear on the nose and ears.  According to this analysis, the word “chilblains derives from two Old English words "chill" ( cold ) and "blegen" (sore)”.   When we expose our tissues to cold and wet conditions for a long period of time, the decreased blood flow can result in damage to our capillary beds.  Signs and symptoms include:

  • Redness
  • Swelling
  • Itchiness
  • Pain
  • Blistering (in more serious cases)

Some individuals are more likely to experience chilblains, including those with family history of chilblains, circulation problems, autoimmune disorders, tobacco smokers, and people who live in poorly insulated/drafty houses or work/recreate in cold environments.  If you've ever had cold toes for a few hours (while skiing, for example, or paddling a kayak) which got hot, red, itchy, and swollen when they warmed back up, then you know exactly what chilblains feels like! 

How to Prevent Chilblains

Unlike frostbite, which can happen very quickly, chilblains takes time to occur.  Typically symptoms start between 2 and 24 hours after initial exposure to cold temperatures.  The best prevention for chilblains is keeping hands and feet warm and dry.  Staying well fed and hydrated will help your body provide warm blood flow to the extremities.  Dress for the conditions, and rewarm your hands and feet when they get cold.  Carrying a change of socks is an easy way to help keep rewarmed feet dry and warm.  Specialized equipment like neoprene gloves or pogies can help winter paddlers and cyclists protect their hands.  Stay active to keep your core body temperature up.  On overnight trips, have a pair of dry socks in your sleeping bag to wear each night, so that for at least 8-12 hours each day your feet and hands are warm and dry.   

How to Treat  Chilblains

If left unchecked, chilblains can become worse over time or with repeated exposure.  In extreme cases this can lead to tissue death and even the loss of fingers or toes.  The best treatment for chilblains is preventing the problem before it starts.  Once chilblains start though, the treatment is theoretically quite simple: keep the affected areas warm and dry.  In the real world this can be really challenging depending on environmental conditions, though, and you may have to stop the activity or evacuate the patient to a more controlled environment while healing occurs.  The injuries will typically heal within a few days of rewarming, but can become chronic if exposed again and again. 

Chilblains can turn a fun outing into an uncomfortable situation, so if you spend time outside in cool and wet weather, stay alert and keep those hands and feet warm and dry!

To learn more about, and gain practice treating cold injuries and emergencies, take a Wilderness First Aid course with CPR Seattle. 

 

By Phil M., CPR Seattle Wilderness First Aid and Wilderness First Responder instructor


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Published on October 4, 2024