Chilblains in Children: What to Do?
Chilblains in children, also called perniosis or pernio, are reactions that are generated in the distal extremities when exposed to extreme temperatures such as cold.
They occur more frequently in the female and young population, according to studies by Pediatrics . In turn, they’re also observed in people who are exposed to cold climates or who suffer from Raynaud’s phenomenon.
How do chilblains in children appear?
Symptoms and signs appear within 2 to 14 hours after exposure to cold weather. They can be classified as acute or chronic, according to when the lesions appear from the moment of exposure.
The most affected body locations are the ears, hands, feet, or lower legs. The child usually displays the following symptoms:
- Local redness and edema
- Bumps on the skin
- Burning or itching in the first moments
- Ulcers or blisters (in severe cases)
They can be confused with arthritis processes at the time of diagnosis due to their location surrounding the joints of the toes or fingers.
Lesions that start with only local inflammation can ulcerate and are at risk of infection or other complications (depigmentation or abnormal scarring).
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Why do they appear?
In general, the exact cause of this disease is unknown. In most cases, chilblains usually appear as a response of the body to low temperatures (without reaching the threshold of freezing).
When the body is exposed to cold and subsequent heating, the blood vessels under the skin expand faster than the larger veins can accept. As a result, there’s a transfer of blood to nearby tissues and the aforementioned signs appear.
The appearance of pernio erythema has some risk factors that can increase the chances of appearance:
- Wearing tight or inappropriate clothing to protect from the cold
- Being underweight for one’s height
- Having circulation problems
- Having Reynaud’s disease or an autoimmune disorder
- The cold and dry seasons
Management of chilblains in children
Chilblains tend to go away on their own within 2 to 3 weeks. However, if low temperatures continue or if there’s a predisposing factor, ulcers or blisters may appear and there’s a risk that the situation will become chronic.
The best way to treat them is through prevention, avoiding exposure to the cold, and practicing physical exercise. Once the lesions appear, they must remain protected and at warm temperatures, and it’s important to rest. In the same way, certain measures can be taken to accelerate the evolution and calm the discomfort that these produce.
If they don’t go away with these remedies, a doctor may prescribe special creams and medications for blood pressure, dilate the vessels, and improve blood circulation.
1. Adequate body temperature
According to Current treatment options in Cardiovascular Medicine publications, the most important premise is to keep the whole body warm. The affected skin should be gently rewarmed, without rubbing, scratching, or applying direct heat sources.
In addition, another option that can be implemented is the use of socks, gloves, hats (that cover the head and ears), and a scarf. Socks must be 100% cotton and synthetic materials must be avoided.
2. Carry out sports activities to prevent chilblains in children
This painful inflammation is generated by the constriction of the small vessels in the affected areas. Therefore, there’s poor nutrition to the tissues with the consequent decrease in local temperature.
We know that sports activity is good for health and for the body as a whole. Consequently, low-intensity exercise will favor vasodilation and the correct circulation of blood in the blood vessels.
3. Skin moisturizing
Keeping the skin in optimal conditions is extremely important because dry skin is more susceptible to being attacked by external agents. In turn, the skin, when it’s too moist, increases its chances of losing heat. Even under these conditions, scratching the lesion should be avoided so as not to further damage the skin’s surface.
4. Take care of the affected area
The parts of the body where chilblains appear should be kept clean. The best way to do this is with soaps or antiseptic products and lightly bandage them to prevent the appearance of injuries. It’s important that these areas are always kept dry and warm and you should always avoid scratching the skin.
5. Good nutrition to prevent chilblains in children
There’s a greater predisposition to chilblains in children who are below their weight percentile. Therefore, a varied and correct diet is recommended to avoid malnutrition or low weight.
Caffeinated products are discouraged due to their powerful vasoconstrictor effect (coffee, cola, tea, and energy drinks).
6. Suitable environments
The choice of environments in which the child is found is of great importance, as being surrounded by smokers will negatively affect this condition. Nicotine is a vasoconstrictor that not only influences those who consume it actively, but also those who do so passively.
Temperate environments are the most conducive to preventing or being part of the treatment of this type of skin disease.
7. Topical corticosteroid creams to treat chilblains
The use of topical corticosteroid creams should be managed in a time-limited manner. That is, according to reports from the National Organization for Rare Disorders, they must be applied in cases where the itching or inflammation is intense for a maximum of three days.
This medication helps reduce symptoms due to its anti-inflammatory effect. However, when chilblains become complicated, ulcerate, or become infected, oral or local antibiotics will be chosen. In severe cases where the symptoms and signs are more impressive, treatment with oral vasodilators is indicated to improve blood circulation.
In any case, medication to treat chilblains should always be taken under medical prescription.
Also read: White Spots on Children’s Skin
The importance of skincare
The skin acts as a defense barrier against external agents that could cause an injury to it and extend its damage. Although in most cases, chilblains in children are minor conditions that are easily treated and don’t usually present complications, it’s of great importance to keep the skin surface moisturized, protected, and cared for.
These measures, along with protection against the cold, sudden changes in temperature, and an active lifestyle are the best ways to prevent its appearance in children.
However, if you have any doubts or notice small symptoms of its appearance, it’s best to consult a doctor. This way, it can be treated in time and you can prevent the appearance of wounds. This is one of the main complications of pernio erythema due to the possible risk of infection.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
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- Goette DK. Chilblains (perniosis). J Am Acad Dermatol. 1990 Aug;23(2 Pt 1):257-62. doi: 10.1016/0190-9622(90)70209-z. PMID: 2212122.
- Mayo Clinic. Sabañones. Diciembre 2020.
- Prakash S, Weisman MH. Idiopathic chilblains. Am J Med. 2009 Dec;122(12):1152-5. doi: 10.1016/j.amjmed.2009.07.011. PMID: 19958897.
- Simon TD, Soep JB, Hollister JR. Pernio in pediatrics. Pediatrics. 2005 Sep;116(3):e472-5. doi: 10.1542/peds.2004-2681. PMID: 16140694.
- TOBÓN, MARÍA XIMENA, & RODRÍGUEZ, GERZAÍN. (2013). Eritema pernio: una enfermedad misteriosa. CES Medicina, 27(1), 113-126. Retrieved November 30, 2020, from http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-87052013000100013&lng=en&tlng=es.