Chilblains: How to Spot and Treat These Painful Bumps (With Pictures)

Have you ever developed red or purple bumps on your fingers or toes after being outside in cold or damp weather? If so, you may have experienced chilblains, one of the most common skin conditions in recorded medical history. 

Thanks to modern heating and clothing, chilblains aren’t as common as they used to be. But that doesn’t mean chilblains have gone away. In fact, chilblains made a recent comeback during the COVID-19 pandemic under the name COVID toes.

Whether it’s the weather, COVID, or even a medical condition causing your chilblains, here’s what you need to know about treating your fingers and toes.

What are chilblains?

Chilblains — also called pernio or perniosis — is a skin condition caused by inflammation in the small blood vessels that lie underneath the skin. 

This inflammation is usually triggered by exposure to cold and damp conditions. The inflammation leads to changes in the skin that are fed by the blood vessels. People develop symptoms like:

• Painful or itchy bumps on their fingers or toes

• Burning over the skin on their fingers or toes

• Swelling of the fingertips or toes

• Red, purple, or bluish skin color changes

These symptoms usually start within a few hours of exposure to cold or damp conditions. And the symptoms may get worse when you’re in a warmer environment, like inside your home or in the shower. 

What do chilblains​ look like?

Chilblains look like small reddish, purple, or bluish patches or bumps on the skin. Sometimes chilblains cause blisters, open sores, and crusting. Chilblains usually develop on the middle or ends of the fingers and toes. 

But they may form on any part of the body that’s exposed to the cold, like the nose and ears. 

Here are some examples of what chilblains look like.

Chilblains cause red bumps over several different toes.

Chilblains cause purple patches on the knuckles and joints of several fingers.

What causes chilblains​?

It’s not clear why some people develop chilblains. But people tend to develop chilblains in two situations.

Exposure to cold and damp conditions

Exposure to damp and cold conditions is the most common trigger for chilblains. Chilbains don’t develop from exposure to freezing temperatures. They are very different from frostbite, a serious cold injury. You may notice chilblains after activities like gardening, fishing, or even washing your car on a colder, but not freezing, day. 

But not everyone exposed to damp and cold conditions develop these painful skin lesions. And it’s not clear why some people are at risk for developing chilblains and others aren’t. Normally, the cold makes blood vessels narrow and then they open back up when conditions warm up. Researchers believe that in some people the rapid closing and opening of the blood vessels triggers an inflammatory response that leads to chilblains.

EXPERT PICKS: WHAT TO READ NEXT

• Is the cold making your eczema worse? Here’s how to treat hand eczema during winter months. 

• Chillblains vs. frostbite: Here’s how to tell whether you have frostbite and what to do next.

• Stay safe from cold exposure: Learn more about hypothermia and how to stay safe in cold conditions.

Medical conditions

People with certain medical conditions are more likely to develop chilblains even if they aren’t exposed to damp and cold conditions. You are more likely to develop chilblains if you have:

• Systemic lupus erythematosus

• Behçet’s disease

• Rheumatoid arthritis

• Scleroderma

• Blood cancers (including leukemia or lymphoma)

Chilblains have also been linked to some viral illnesses including:

• Hepatitis B

• Hepatitis C

• COVID-19

It’s not clear why these conditions are linked to chilblains. Researchers think that some medical conditions can trigger blood vessel narrowing. This narrowing may lead to low oxygen levels and inflammation, which can trigger chilblains. 

How are chilblains​ diagnosed?

A healthcare professional can usually diagnose chilblains by looking at the spots on your skin and asking you about your symptoms. They’ll also ask if you were exposed to cold or damp conditions before your symptoms started.

A healthcare professional may recommend a skin biopsy if it’s not clear whether your symptoms are from chilblains. A skin biopsy is a medical procedure during which a small piece of skin is removed. The piece can be examined under a microscope to see what’s causing the skin changes. A healthcare professional may also order blood work to make sure your chilblains aren’t caused by something else (like lupus). 

How do you treat chilblains​?

Chilblains usually get better on their own within 2 to 3 weeks. There are some things you can do to keep yourself comfortable while you wait for your skin to heal.

Keep your skin dry and warm

Protect your chilblains from any further cold or damp exposure. Make sure to wear protective clothing when you are outdoors or working with water. Keep your hands and fingers dry and warm while indoors. 

Avoid overheating

Resist the urge to apply a heat pack or other forms of direct heat to your chilblains. The heat may damage your skin and make your symptoms worse. Also try to avoid massaging and rubbing chilblains — this can also irritate your inflamed skin.

Try OTC medications 

Over-the-counter (OTC) medications can help ease symptoms. You can try ibuprofen (Motrin) for pain relief. You can also try diphenhydramine (Benadryl) for itching and 1% hydrocortisone cream to ease skin swelling. 

When should you get medical care for chilblains​?

Though rare, chilblains can get infected. You can also develop ulcers (open sores) over chilblains. You should get medical care as soon as possible if you notice:

• Worsening swelling, redness, or pain

• Skin breakdown over your chilblains

• Fever

• Discharge or pus  

You should also get care if your symptoms get worse or your chilblains haven’t gotten better within 2 weeks.

A healthcare professional can make sure you don’t have an infection or skin breakdown. They may also suggest prescription medications to help your symptoms like nitroglycerin cream or nifedipine, an oral medication that can speed up healing time. 

Can you prevent chilblains​?

You can take steps to protect your skin from chilblains by keeping your skin dry and warm. Here are some steps you can take:

• Avoid cold, damp environments when possible.

• Wear socks, gloves, and hats to keep your skin warm and dry. 

• Keep indoor areas warm and dry.

Frequently asked questions

Why trust our experts?

Written by:

Amy Walsh, MD, MDP

I have worked as an emergency physician for 15 years, including care at both rural hospitals and trauma centers. I am the former Global Emergency Medicine fellowship director at Health Partners.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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