Every winter my fingers and toes develop painful, red, swollen areas with a sensation that feels like a cross between a burn and a deep itch. These symptoms last several weeks until eventually the skin blisters and cracks. The cracked skin then becomes susceptible to infection and becoming extremely chapped.
These symptoms started about seven years ago, but it was only about four years ago when I noticed a pattern. The swelling occurred in the same places every winter after being exposed to the season’s first major cold spell. After doing some online research and speaking to a nurse, I realized that I had developed a condition called chilblains, also known as pernio.
Pernio is extremely uncomfortable and annoying. It makes small everyday tasks – such as wearing shoes or washing dishes – painful. What I couldn’t understand is how I managed to develop this frustrating condition. While researching chilblains I learned that the condition is caused by a circulatory abnormality. That confused me because I’m an active person with good circulation and no other known health problems.
There really isn’t a cure for pernio; only management. The best way to prevent chilblains is to limit your exposure in the cold. This was frustrating news for me because I’ve always loved outdoor activity. Winter doesn’t slow me down and, in fact, gives me even more reason to be outside because I absolutely love skiing. That’s when it dawned on me. Lifelong, repeated exposure to the cold is another factor that may cause chilblains.
I grew up in a mild Mediterranean climate in California but skied every year. Perhaps it was because I didn’t live by the snow that I would ski as much as possible – even if it meant feeling uncomfortable due to the cold. I can’t remember how many times my hands and feet hurt to the point of feeling extremely painful for long periods of time. Because I lived primarily in a mild climate I didn’t have the proper gear or even know how to really dress for the cold.
About seven years ago I moved from California to Upstate New York. I loved the winters and began skiing more frequently. My other outdoor passion is horseback riding. The cold weather never interfered with these activities. I have distinct memories of riding and skiing on many single-digit days. The fact that my hands and feet would get uncomfortably cold was just part of the sport. In my mind, it was better than being inside and resenting wintertime. That’s why when the only advice I could find for preventing chilblains was to limit my time outside when it was cold, I knew that it just wasn’t a realistic option. At the same time I had to become more proactive about preventing and treating my condition.
I made some changes to my routine. When I go downhill skiing I always bring at least two pairs of mittens and a pair of gloves. I use the gloves for everything but the actual skiing. They’re useful for activities that require use of my fingers such as carrying equipment and backpacks. When I ski I use mittens that allow my fingers to have skin-to-skin contact. Some mittens have internal glove liners but those aren’t as warm for the fingers. Skiing is an activity where you have several minutes of intense activity followed by a period of time where you just sit on a chair lift. Consequently, after several runs my mittens will be damp from sweat and then start to chill. If you’re susceptible to chilblains, they’re more likely to develop with moisture and radical changes in temperature. So, at lunchtime, regardless of how my hands feel, I always switch to my second pair of warm, dry mittens. I also bring a second pair of gloves when I horseback ride so I can do the same thing. If it’s cold enough, I will even ride in mittens! I purchased a pair of large mittens so there’s ample space to hold the reins between my fingers. It’s awkward, but you get used to it. Conversely, cross-country skiing is very aerobic. I only use gloves, even in single-digit temperatures. You generate a lot of heat cross-country skiing and mittens just cause my hands to sweat too much. As for my feet, I use thin wool socks and invested in a pair of ski boots that fit very well. SmartWool® makes a great wool sock that is thin and breathable yet warm. If it’s really frigid outside I’ll use toe warmers.
Your extremities will stay warmer if your core is warm. For that reason I purchased a few sport shirts, ski pants, sweaters, and underlayers of varying cold ratings. This way I can keep my core body comfortable in a wide range of temperatures by mixing and matching various layers. There are still many times when I get really cold. It’s unavoidable. I resist the temptation of taking a hot shower as soon as I get home. That rapid change of temperature seems to encourage chilblains, and I can actually feel the pain and burning in my fingers – a sure sign that chilblains are developing. Instead I wait until I feel gradually warmer by sitting under a blanket, and then I’ll go shower.
Moisturizer also seems to help. I keep a bottle of lotion or oil in the car, ski locker, tack box, purse, ski jacket, and even by my computer at work. Keeping the skin at a constant level of hydration makes developing chilblains less uncomfortable and also seems to shorten the time until they go away.
Finally, I monitor any chilblains that do develop. If the skin shows signs of cracking I use petroleum jelly and adhesive bandages (eg, Band-Aid® bandages) to keep the skin moisturized and protected. This prevents infection. Even though it doesn’t look like much, cracked, infected skin on a chilblain is very painful. You have to be diligent about the bandages and petroleum jelly. Every time you wash your hands you need to change your coverings and reapply the moisturizer. Sometimes my hands will be covered in up to seven bandages at one time for a couple of weeks. It’s annoying and time consuming but the relief makes it worthwhile.
I still get chilblains every year but they happen less often and with less severity than a few years ago. I believe it’s because of the reasons I described above. In a way I just see them as part of who I am. My lifestyle helped create them, but there isn’t anything I would change. It’s important to keep things like this in perspective. They are a painful annoyance but I’m just grateful they aren’t something worse.