A chilblain is a patch of inflamed, swollen skin that develops after exposure to cold, damp conditions. Unlike frostbite, which requires freezing temperatures, chilblains can form in mild cold, typically when temperatures hover between 32°F and 60°F (0°C to 15°C). They most commonly appear on the toes and fingers, and symptoms usually clear up within two to three weeks.
What Happens Under the Skin
The exact cause of chilblains isn’t fully understood, but the leading explanation involves how small blood vessels react to temperature changes. When your skin gets cold, the tiny capillaries near the surface constrict to conserve heat. If the skin is then rewarmed too quickly, those small vessels expand faster than the larger vessels feeding into them can accommodate. This mismatch creates a bottleneck effect: blood leaks into surrounding tissue, triggering inflammation, swelling, and that characteristic itchy, burning discomfort.
Not everyone who gets cold develops chilblains. The condition appears to reflect an exaggerated vascular response in certain people, which is why some individuals get them repeatedly every winter while others never experience them at all.
What Chilblains Look and Feel Like
Chilblains typically appear as small, red or purplish patches on the skin, most often on the toes, fingers, heels, or ears. The affected areas swell and feel intensely itchy, sometimes with a burning or stinging sensation. As they progress, the skin may turn a deeper blue-red and develop blisters in more severe cases. The patches are tender to the touch and can be painful, especially when your feet or hands warm up after being cold.
They tend to show up a few hours after cold exposure rather than immediately. You might not notice anything while you’re outside, only to find itchy, swollen toes after you come indoors and warm up. This delayed onset is one of the features that distinguishes chilblains from frostbite, which causes numbness, hard or waxy skin, and visible tissue damage during the cold exposure itself. Chilblains are uncomfortable and annoying, but they don’t destroy tissue the way frostbite does.
Who Gets Them
Chilblains are more common in people who live in cool, humid climates (think the UK, parts of Northern Europe, and the Pacific Northwest) rather than in extremely cold regions where people tend to dress more heavily and heat their homes to higher temperatures. Women are affected more often than men, and people with a low body weight or poor circulation are at higher risk.
Certain underlying conditions make chilblains more likely. Raynaud’s phenomenon, where fingers and toes turn white or blue in response to cold, shares some of the same vascular sensitivity. Lupus and other connective tissue disorders are also associated with chilblain-like lesions. If you develop chilblains frequently or severely, especially in warmer months, it can sometimes signal an underlying autoimmune condition worth investigating.
Smoking, which constricts blood vessels and impairs circulation, also increases susceptibility. So does wearing tight shoes or gloves that restrict blood flow to the extremities.
The “COVID Toes” Connection
During the early pandemic, reports of red, swollen toes in people with COVID-19 led to widespread speculation that the virus caused chilblain-like lesions. The term “COVID toes” became common. However, a study published in the Proceedings of the National Academy of Sciences found that SARS-CoV-2 infection rates among people diagnosed with “COVID toes” (9.5%) were nearly identical to the background infection rate in the general population (8.5%) at the time. The researchers concluded that the virus was likely not the cause.
A more plausible explanation: pandemic lockdowns changed people’s behavior. More time spent at home barefoot or in socks on cold floors, combined with less physical activity and heightened media awareness, likely drove the surge in reported cases. The spike in chilblains was real, but the viral connection appears to have been coincidental.
Treatment and Recovery
Most chilblains heal on their own within two to three weeks, provided you avoid further cold exposure. The goal during that window is to keep the affected areas warm, dry, and protected. Loose, warm socks and layered clothing help. Resist the urge to scratch, as broken skin can lead to infection.
Gentle, gradual rewarming is important. Placing cold hands or feet directly on a radiator, in hot water, or next to a fire can worsen chilblains by accelerating the rapid blood vessel expansion that caused the problem in the first place. Instead, warm up slowly by moving into a heated room, layering blankets, or using lukewarm (not hot) water.
For people with severe or recurring chilblains, doctors sometimes prescribe a blood pressure medication that works by relaxing and widening blood vessels. This can improve blood flow to the affected areas and reduce the severity of episodes. Topical creams to manage itching and inflammation may also be recommended.
Preventing Recurrence
If you’ve had chilblains before, prevention centers on keeping your extremities consistently warm rather than allowing them to get cold and then rapidly rewarming. A few practical strategies help:
- Layer your socks and gloves. Moisture-wicking base layers underneath insulating outer layers keep skin dry and warm without restricting circulation.
- Avoid tight footwear. Shoes that squeeze your toes restrict blood flow and increase vulnerability. Choose footwear with enough room for thick socks.
- Warm up gradually. When you come indoors from the cold, let your body temperature rise slowly. Avoid putting cold extremities directly against heat sources.
- Keep your whole body warm. Cold core temperature triggers your body to redirect blood away from your fingers and toes. Wearing a warm hat and insulated jacket protects your extremities even though they’re not directly covered.
- Stay active. Regular movement improves overall circulation. Even wiggling your toes and fingers while sitting can help maintain blood flow.
People who live in older, drafty homes or work in unheated spaces are particularly prone to recurring chilblains. Keeping indoor temperatures consistent and wearing warm slippers or socks around the house, especially on cold floors, makes a meaningful difference for those who are susceptible.