Chilblains (Perniosis): Symptoms, Causes, Treatment and Prevention
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Chilblains, also called perniosis, are inflamed, swollen skin patches that can blister on the hands and feet after exposure to damp air that is cold but not freezing [1]. They usually clear up in two to three weeks and do not usually cause permanent injury, though recurrence each cold season is common [1]. Keeping the skin warm and dry eases symptoms [2].
What the research says
Most patients improved with simple measures such as warming, drying, and quitting smoking. In a retrospective review of 104 patients with pernio at Mayo Clinic (79% women; mean age at diagnosis 38.3 years), conservative treatment gave a complete response in 23 of 28 patients (82%) with follow-up data. The toes were affected in 82% and the fingers in 30%. Most patients had no underlying systemic condition, although 4% had a connective tissue disease and 3% had a blood cancer. It was a single-center retrospective study (PubMed: Cappel and Wetter, Mayo Clin Proc, 2014) [3].
Evidence for drug treatment is limited. A systematic review of 11 placebo-controlled or comparative trials (576 patients combined) found moderate evidence supporting nifedipine and pentoxifylline for severe or refractory idiopathic chilblains. Other therapies, including corticosteroids, had inadequate evidence or nonsignificant results compared with placebo (PubMed: Pratt et al., J Cutan Med Surg, 2021) [4].
Chilblain-like lesions seen during the COVID-19 pandemic were mostly not linked to a positive test. A systematic review of 128 studies covering 4,982 cases found a mean age of 25 years and a slight female predominance (55%). Only 19% (347 of 1,838) of those tested were positive for SARS-CoV-2. About 80% of cases resolved (979 of 1,224), and 47% (204 of 432) resolved without treatment (PubMed: Starkey et al., Clin Dermatol, 2023) [5].
What Is Chilblains?
Chilblains, also known as perniosis, is a condition that causes inflamed, swollen patches and blistering on the hands and feet. It is caused by exposure to damp air that is cold but not freezing, an important distinction from frostbite, which occurs in below-freezing temperatures [1].
One of the defining features of chilblains is the delay. Symptoms may show up a few hours after being in the cold, rather than immediately [1]. Most people recover fully within two to three weeks, especially if the weather gets warmer, and the condition does not usually result in permanent injury [1].
However, chilblains have a frustrating habit of returning. You may get the symptoms each cold season for years [1]. The good news is that chilblains can be prevented by limiting time in the cold, dressing warmly, and covering exposed skin [1].
Quick facts | Key information |
Medical name | Perniosis |
Where it appears | Usually the hands and feet |
What causes it | Exposure to cold, damp air that is not freezing |
When symptoms appear | A few hours after cold exposure |
Typical duration | 2 to 3 weeks |
Recurrence | Can return each cold season for years |
Permanent injury | Usually does not result in permanent injury |
What are the symptoms of chilblains?
Chilblains affect the skin in visible and uncomfortable ways. The five main symptoms are small itchy areas on the skin, sores or blistering, swelling, pain or stinging, and changes in skin color [1].
The itchy areas are most often found on the feet or hands, though chilblains can appear on other exposed areas. The combination of itching, swelling, and stinging pain is what makes chilblains so uncomfortable during the coldest months of the year.
Symptom | What to look for |
Small, itchy skin areas | Most often on the feet or hands |
Sores or blistering | Can develop on the affected patches |
Swelling | Inflamed, puffy skin in the affected area |
Pain or stinging | Discomfort that can make cold weather miserable |
Skin color changes | The affected skin may turn red, purple, or darker |
When should you see a doctor about chilblains?
Most chilblains improve on their own within two to three weeks. However, certain signs mean it is time to seek medical care. Seek medical care for chilblains if your symptoms are long lasting or go away and then flare back up, if you think you might have an infection, or if symptoms are not improving after two weeks of home care [1].
You should also see a doctor if your symptoms extend into the warm season, because chilblains are tied to cold exposure and should not persist in warmer weather.
One more situation deserves special attention. Seek medical care if you are not sure whether you were in below-freezing temperatures, because you might have frostbite instead of chilblains [1]. Frostbite is a more serious cold injury that requires prompt treatment.
Seek medical care if... | Why it matters |
Symptoms are long lasting or go away then flare | Persistent symptoms may signal an underlying issue |
You think you might have an infection | Infected skin needs medical treatment |
Symptoms don't improve after two weeks of home care | You may need prescription treatment |
Symptoms extend into the warm season | Chilblains should resolve as the weather warms |
You are unsure whether you were below freezing | You might have frostbite, not chilblains |
What Causes Chilblains?
The exact cause of chilblains is unknown [1]. What experts understand is that chilblains may be an unusual reaction of your body to cold followed by rewarming.
Here is the likely mechanism: when cold skin is rewarmed, the small blood vessels under the skin can expand more quickly than nearby larger blood vessels can handle [1]. This mismatch triggers the inflammation, swelling, and itching that characterize chilblains.
It is worth noting what chilblains are not. They are not caused by freezing temperatures, which is frostbite. Chilblains develop in cold, damp air that stays above freezing. This distinction matters for both prevention and treatment.
Cold-weather skin condition | Temperature range | How symptoms appear |
Chilblains (perniosis) | Cold, damp air, not freezing | Delayed by a few hours; itchy, swollen patches on hands and feet |
Frostbite | Below-freezing temperatures | Can damage skin and deeper tissue; needs prompt medical care |
What are the risk factors for chilblains?
Five factors increase the risk of developing chilblains.
The first risk factor is clothing and footwear. Wearing tightfitting clothing and shoes in cold, damp weather may make you more susceptible to chilblains [1]. Tight garments both restrict circulation and expose skin to the cold.
Second, chilblains are most common in females between the ages of 15 and 30 [1]. Being a young woman is a genuine risk factor.
Third, the condition is most common in people with a low body mass [1]. Being underweight raises your risk.
Fourth, geography matters. Your risk of chilblains is higher if you live in an area with high humidity and cold but not freezing temperatures [1]. Cold and humid climates create the exact conditions chilblains need.
Finally, certain medical conditions raise risk. These include Raynaud's phenomenon, connective tissue disease, and SARS-CoV-2 [1].
Risk factor | Details |
Tight clothing and shoes | Tightfitting clothing and shoes in cold, damp weather increase susceptibility |
Being a young woman | Most common in females ages 15 to 30 |
Being underweight | Most common in people with low body mass |
Cold, humid climate | High humidity plus cold, non-freezing temperatures raises risk |
Certain medical conditions | Raynaud's phenomenon, connective tissue disease, SARS-CoV-2 |
What complications can chilblains cause?
Chilblains do not usually cause permanent injury, but repeated episodes can leave a mark on the skin. Symptoms that are long-lasting and develop after repeated exposure to cold and damp conditions can cause scarring and thin skin [1]. This is another reason to take prevention seriously if you get chilblains year after year.
How can you prevent chilblains?
The most effective approach to chilblains is avoiding them in the first place. There are seven prevention steps. Start with the obvious: avoid or limit your exposure to the cold [1]. When you do come in from the cold, rewarm the skin gradually rather than rushing to a heater.
Dress wisely for the weather. Wear layers of loose clothing, and wear mittens, a scarf and a hat, along with warm, water-resistant footwear [1]. Loose layers keep warmth in without restricting circulation. Cover all exposed skin as completely as possible when going outside in cold weather, and keep your hands, feet and face dry and warm throughout the day [1].
Finally, think about your indoor environment and habits. Keep your home and workplace comfortably warm [1], and don't smoke. Smoking narrows blood vessels, which works directly against the circulation your skin needs in cold weather.
Prevention step | Practical guidance |
Limit cold exposure | Avoid or reduce time outside in cold, damp weather |
Rewarm gradually | Warm the skin slowly when coming in from the cold |
Dress in layers | Loose clothing, mittens, scarf, hat, water-resistant footwear |
Cover exposed skin | Protect hands, feet and face as completely as possible |
Keep skin dry and warm | Keep hands, feet and face dry and warm |
Warm indoor spaces | Keep home and workplace comfortably warm |
Don't smoke | Smoking narrows blood vessels and impairs circulation |
How are chilblains diagnosed?
Diagnosing chilblains is usually straightforward. To diagnose chilblains, your health care provider will look at the affected skin and talk with you about your symptoms and any recent cold exposure [2]. Tell your health care provider if you are not sure whether you were in below-freezing temperatures. If you were, you might have frostbite rather than chilblains.
To rule out other conditions, you may need blood tests [2]. Or your health care provider may take a small sample of the affected skin to have it examined under a microscope in a laboratory. This test is called a skin biopsy [2].
Diagnosis step | What happens |
Skin examination | Provider looks at the affected skin |
Symptom history | Discussion of symptoms and recent cold exposure |
Ruling out frostbite | Tell your provider if you are unsure about below-freezing exposure |
Blood tests | May be needed to rule out other conditions |
Skin biopsy | Small skin sample examined under a microscope in a lab |
How are chilblains treated?
Chilblains can be treated at home with self-care, including keeping your hands and feet warm and dry [2]. Many cases never need anything more. If your symptoms don't clear up with self-care, your health care provider may suggest medicine.
The first option is a topical corticosteroid. If your chilblains symptoms include sores, applying a corticosteroid such as triamcinolone 0.1% cream might help clear them up [2]. The second option is blood pressure medicine. For symptoms that don't respond to other treatment, your health care provider might prescribe a blood pressure medicine such as nifedipine (Procardia). It is a type of calcium channel blocker that treats chilblains by improving blood flow [2] [4].
Treatment | Used when | How it works |
Home self-care | First step for chilblains | Keeping hands and feet warm and dry |
Topical corticosteroid | Symptoms include sores | Triamcinolone 0.1% cream may help clear sores |
Blood pressure medicine | Symptoms don't respond to other treatment | Nifedipine (Procardia), a calcium channel blocker that improves blood flow |
Which lifestyle and home remedies help chilblains?
Chilblains symptoms usually clear up in two or three weeks after cold exposure [2]. In the meantime, seven practical tips can ease your symptoms.
The most important rule concerns rewarming. Rewarm the skin slowly and gently, without massaging, rubbing or applying direct heat [2]. This is the opposite of what feels natural, but rubbing and direct heat can worsen the reaction. Avoid cold exposure whenever possible while you heal, and keep the affected skin dry and warm, but away from sources of heat.
For itching, apply lotion, such as hydrocortisone cream available in drugstores [2]. Keep any blisters and sores clean and covered, and avoid scratching the affected skin [2]. Finally, if you smoke, try to quit. Smoking can narrow your blood vessels and slow wound healing [2].
Home remedy | Do | Don't |
Rewarming | Rewarm slowly and gently | Massage, rub, or apply direct heat |
Cold exposure | Avoid it whenever possible | Stay out in the cold longer than needed |
Skin care | Keep affected skin dry and warm | Place skin near heat sources |
Itching | Apply lotion like hydrocortisone cream | Scratch the affected skin |
Blisters and sores | Keep them clean and covered | Leave them open or uncovered |
Smoking | Try to quit | Continue smoking, which narrows blood vessels |
How can people cope with chilblains and find support?
Living with recurring chilblains can be frustrating, especially when symptoms return each cold season. The practical approach is to build cold-weather habits around prevention: layered loose clothing, covered skin, gradual rewarming, and smoke-free circulation.
Keeping the affected skin warm and dry remains the foundation of both treatment and coping. Because chilblains do not usually cause permanent injury, most people can manage the condition with consistent self-care while it runs its two-to-three-week course.
How should you prepare for an appointment about chilblains?
You may start by seeing your primary care provider. Or you may be referred to a doctor who specializes in skin conditions called a dermatologist or one who specializes in blood vessels called a vascular specialist [2].
What you can do. Before your visit, list any symptoms you have noticed. List your key medical and personal information, including any major stressors, recent life changes or vacations to places with weather that differs from where you live. List all medications, vitamins and supplements you take, including doses. And list questions to ask your health care provider.
Questions to ask your provider. What is the most likely cause of my symptoms? Are there other possible causes? Do I need any tests? Is this condition short term or long lasting? What treatments do you recommend? What side effects can I expect from treatment? What are the alternatives to the primary approach that you're suggesting? Do I need to restrict my activities in any way? I have other health conditions. How can I best manage them together? Do you have any brochures or other printed material I can take with me, and what websites do you recommend?
What to expect from your doctor. Your health care provider is likely to ask when you first noticed your symptoms, whether your symptoms get worse in response to quick changes in temperature, whether anything seems to improve your symptoms, whether you have ever had these symptoms before, and whether you have been diagnosed with Raynaud's phenomenon.
In the meantime. Try to keep the affected area warm and dry before your appointment.
Conclusion: Chilblains Usually Resolve With Patience and Warmth
Chilblains are uncomfortable but manageable. They appear a few hours after exposure to cold, damp (but not freezing) air, most often on the hands and feet, and usually clear up in two to three weeks without permanent injury. The keys are gentle rewarming without rubbing or direct heat, keeping the skin warm and dry, and preventing repeat episodes with layered clothing and smoke-free circulation. If symptoms last beyond two weeks, extend into warm weather, or you are unsure whether frostbite is involved, see a health care provider. Prescription options like topical corticosteroids and nifedipine can help stubborn cases clear up.
If you found this guide helpful, explore our frostbite guide for more practical winter health information.
Frequently Asked Questions
1. What are chilblains?
Chilblains (CHILL-blayns), also called perniosis, are inflamed, swollen skin patches that can blister on the hands and feet. They are caused by exposure to damp air that is cold but not freezing, with symptoms appearing a few hours after cold exposure. They usually clear up in 2 to 3 weeks.
2. What causes chilblains?
The exact cause is unknown. Chilblains may be an unusual reaction of the body to cold followed by rewarming: small blood vessels under the skin expand more quickly than nearby larger blood vessels can handle, triggering inflammation.
3. What do chilblains look and feel like?
Chilblains appear as small, itchy areas on the skin, often on the feet or hands, with swelling, pain or stinging, sores or blistering, and changes in skin color.
4. How are chilblains different from frostbite?
Chilblains occur after exposure to cold air that is not freezing, while frostbite occurs in below-freezing temperatures. If you are unsure whether you were exposed to below-freezing temperatures, seek medical care because you might have frostbite.
5. How long do chilblains last?
Chilblains usually clear up in 2 or 3 weeks, especially if the weather gets warmer. However, symptoms may return each cold season for years.
6. Are chilblains permanent or dangerous?
Usually not. Chilblains do not usually result in permanent injury. Long-lasting symptoms after repeated cold and damp exposure can cause scarring and thin skin, but most cases resolve fully.
7. How do you treat chilblains at home?
Keep your hands and feet warm and dry, rewarm the skin slowly and gently without massaging, rubbing or applying direct heat, apply lotion such as hydrocortisone cream for itching, and keep blisters and sores clean and covered.
8. When should I see a doctor for chilblains?
Seek medical care if symptoms are long lasting or flare after going away, if you suspect infection, if symptoms don't improve after two weeks of home care, if they extend into the warm season, or if you're unsure about below-freezing exposure.
9. What medicines treat chilblains?
A topical corticosteroid such as triamcinolone 0.1% cream may help if symptoms include sores. For symptoms that don't respond to other treatment, a blood pressure medicine such as nifedipine (Procardia), a calcium channel blocker, may be prescribed to improve blood flow.
10. Who is most at risk for chilblains?
Chilblains are most common in females ages 15 to 30 and in people with low body mass. Risk also rises with tight clothing or shoes in cold damp weather, living in cold humid areas, and medical conditions like Raynaud's phenomenon, connective tissue disease and SARS-CoV-2.
11. How can I prevent chilblains from coming back?
Limit cold exposure, rewarm skin gradually, dress in layers of loose clothing with mittens, scarf, hat and water-resistant footwear, cover exposed skin, keep hands, feet and face dry and warm, keep indoor spaces comfortably warm, and don't smoke.
Helpful Resources
NHS. Chilblains. NHS. https://www.nhs.uk/conditions/chilblains/
Centers for Disease Control and Prevention, NIOSH. Cold and Work: Types, Causes, Preparation. CDC. https://www.cdc.gov/niosh/cold-stress/
Rinnit. Frostbite: Symptoms, the 3 Stages, and How to Rewarm Safely Without Causing More Damage.
References
Mayo Clinic Staff. Chilblains - Symptoms and causes. Mayo Clinic. Oct. 23, 2024. https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097
Mayo Clinic Staff. Chilblains - Diagnosis and treatment. Mayo Clinic. Oct. 23, 2024. https://www.mayoclinic.org/diseases-conditions/chilblains/diagnosis-treatment/drc-20351103
Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc. 2014;89(2):207-215. PMID 24485134. https://doi.org/10.1016/j.mayocp.2013.09.020
Pratt M, Mahmood F, Kirchhof MG. Pharmacologic treatment of idiopathic chilblains (pernio): a systematic review. J Cutan Med Surg. 2021;25(5):530-542. PMID 33653127. https://doi.org/10.1177/1203475421995130
Starkey SY, Mar K, Kashetsky N, Lam JM, Dutz J, Mukovozov I. Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic. Clin Dermatol. 2023;41(1):223-229. PMID 36228990. https://doi.org/10.1016/j.clindermatol.2022.09.010
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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