Chilblains are small, inflamed patches of skin that typically appear red or purple on the fingers and toes after cold exposure. They start as itchy, swollen spots roughly the size of a fingertip and can progress to darker, more painful lesions if left untreated. Most cases clear up on their own within one to three weeks.
Early Appearance
In their earliest stage, chilblains show up as small, itchy red areas on the skin. They’re often slightly swollen, giving the affected area a puffy look. The patches tend to have defined edges and feel tender or warm to the touch, even though they’re triggered by cold. On lighter skin, they’re easy to spot as bright red or pinkish patches. On brown and black skin, the redness can be much harder to see, and the patches may appear more purple or dusky from the start.
Most people first notice chilblains on their toes, especially the smaller ones. Fingers are the second most common location, followed by the ears, heels, and nose. Any skin that’s regularly exposed to cold and damp conditions is vulnerable.
How They Change Over Time
If chilblains aren’t warming up and resolving, they progress. The initial red patches become increasingly congested and take on a dark blue appearance. At this stage, the itching often shifts to a more burning or stinging pain. The swelling becomes more pronounced, and the skin may feel tight.
In more severe cases, the surface of the skin can blister. These blisters may eventually break open, leaving shallow raw areas that are slow to heal. Cracked or broken skin over a chilblain raises the risk of infection. Signs to watch for include increasing redness spreading beyond the original patch, pus or oozing, golden crusting, or pain that worsens rather than improves over several days.
For most people, chilblains resolve within one to three weeks without lasting damage. But if you’re prone to them, they tend to come back every year when the weather turns cold and damp. Recurring chilblains that appear season after season are considered chronic, and a doctor may recommend preventive treatment to reduce how often they develop.
Chilblains vs. Raynaud’s Phenomenon
Both conditions affect the fingers and toes in cold weather, but they look quite different. Raynaud’s causes a distinctive three-phase color change: the skin first turns white (as blood flow cuts off), then blue, then bright red as circulation returns. This cycle happens in episodes and reverses completely between attacks. Chilblains, by contrast, produce a persistent discoloration. The red or purple patches stick around for days or weeks rather than cycling through colors in minutes.
It’s possible to have both conditions. People with Raynaud’s are actually more susceptible to developing chilblains because their blood vessels already overreact to cold temperatures.
Chilblains vs. COVID Toes
During the early pandemic, many people developed discolored, painful, itchy lesions on their toes that were quickly labeled “COVID toes.” These looked nearly identical to classic chilblains: red to purple patches, swelling, and sometimes blistering on the toes and fingers. Many infectious disease specialists now believe that COVID toes are simply chilblains triggered by changes in blood vessel behavior during infection, possibly from small clots or narrowing of the tiny blood vessels in the toes. The treatment is the same regardless of the trigger.
Conditions That Look Similar
A few other conditions can mimic the appearance of chilblains, which is why persistent or unusual-looking lesions are worth getting checked out. Chilblain lupus erythematosus is an autoimmune condition that produces red to purple, thickened plaques on the fingers, toes, nose, and ears. It looks similar to regular chilblains but tends to be more persistent, doesn’t always have a clear cold trigger, and may be accompanied by other signs of lupus like joint pain or fatigue.
Lupus pernio, a skin manifestation of sarcoidosis, can also cause red-purple, firm nodules on the nose, cheeks, ears, and fingers. The key distinguishing feature of ordinary chilblains is that they’re clearly triggered by cold exposure and resolve relatively quickly once the skin warms up and stays warm. Lesions that persist beyond three weeks, appear in warm weather, or keep worsening despite staying warm deserve a closer look from a doctor.
What Causes the Discoloration
The characteristic color of chilblains comes from what’s happening in the small blood vessels beneath the skin. When your extremities get cold, those tiny vessels constrict to preserve core body heat. In people prone to chilblains, rewarming causes these vessels to expand too quickly. Blood leaks into the surrounding tissue, producing the swelling and red-to-purple discoloration. The darker blue or purple color that develops in worsening chilblains reflects increasing blood congestion in the tissue.
This is why the classic advice for preventing chilblains focuses on gradual warming. Jumping from a cold environment straight onto a radiator or into a hot bath forces those small blood vessels to open rapidly, which is exactly the situation that triggers the problem. Warming up slowly, keeping extremities consistently insulated, and avoiding the cold-to-hot cycle are the most effective ways to keep chilblains from forming in the first place.