What is the best treatment for chilblains?
Posted: Nov 08, 2020
Chilblains are what is called a vasospastic condition of the foot, though they can occasionally affect other parts of the body. Vasospastic means that there is a spasm of the tiny muscles that surround the small blood vessels. They happen when the foot gets cold and the small blood vessels close to conserve heat, which is quite normal. As the foot warms up, those blood vessels normally open up. In a chilblain due to the vasospasm those small blood vessels remain closed for longer. As a result of this, metabolites and waste products build up in the skin causing an inflammatory reaction that is the chilblain. The blood vessels then suddenly open up resulting is more inflammation and tissue damage. At this stage they are red and are often itchy. Later on as waste products build up and they become more chronic, they take on a dark blue appearance. While the mechanism by which they occur is known, exactly what causes the issue in not clear. Chilblains are more common in females suggesting that there may be hormonal influences on how the circulation reacts to changes in the temperature.
The best treatment for chilblains is to not get them in the first place. Prevention is best done by not allowing the feet to get cold. Keep them in good socks and shoes and avoid going out in the cold if possible. If the foot does get cold, then it is important that it be allowed to warm up slowly in order for the circulation to properly adapt to the changes in temperature. One of the worst things to do after the feet are cold is to put the foot immediately in front of a heat source. The other way to prevent chilblains, mainly if the person who usually gets them severely, is to use medicine that help keep the blood vessels open. While this does seem to work quite well, it does come with side affects as it affects all blood vessels, not just those in the feet.
Once a chilblain does occur, then the feet need to be protected from further damage and breaking down into an open wound. The measures mentioned above to prevent them still need to be done or the problem may become a chronic one. There are various creams that can be used to be rubbed in to help stimulate the circulation and encourage healing. There is some controversy around just which is the most effective ones to use, as there is not a lot of evidence supporting the use of one over another. Despite chilblains being a relatively common problem, it is surprising just how little research has been done on it.
All of these issues around just what does work and what does not work was covered in detail in a recent episode of PodChatLive in which the hosts chatted with a Podiatrist from Melbourne, Australia, Joseph Frenkel who has a special interest in dermatology. There was a considerable consensus on the lack of evidence as to which is the better approach to treating chilblains.
Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.