Introduction

Poor circulation, a condition in which blood flow is restricted or inadequate, plays a crucial role in making certain individuals more vulnerable to chilblains. Typically, the human body is primed to regulate its own circulation, which plays a major role in the body's homeostasis; however, in some cases, diseases make it harder for the body to have adequate circulation. One of these crucial roles is in maintaining adequate thermoregulation for the entire body, including the extremities. If something goes wrong in this mechanism, it can lead to many different cardiovascular issues and disruption to skin integrity. When the body’s circulation is compromised, it becomes harder for blood to reach areas, including fingers and toes, and this is where warmth and oxygen are needed the most. As a result, these areas become more susceptible to damage from the cold, leading to the swelling, redness, and discomfort that characterise chilblains. Poor circulation is therefore recognised as a predisposing factor to these painful episodes, meaning that researchers and medical professionals have to be more proactive in finding out ways in which to better manage a range of circulatory issues.

Chillblains

Aetiology of Chilblains

Chillblains are a type of inflammatory, vascular skin condition that can be of primary or secondary origin. Primary associated conditions usually resolve within a few days to weeks and are often not associated with any other inflammatory condition, whereas secondary chilblains have strong links with a variety of conditions, including autoimmune, haematological and vascular.¹ 

Commonly, chilblains present after a trigger like being exposed to colder climates or very damp conditions, and symptoms will be apparent after around 12-24 hours. Tender, purple lesions usually appear on the extremities (mainly the fingers and toes), which can be very painful to touch or use and often have a burning sensation at onset. (Immune-mediated) Primary chilblains are often seen more commonly in slender females and usually occur at an average age of 30-40 years old.²

Mechanism of Chilblains

As chilblains' onset is of both inflammatory and vascular nature, the process of chilblain presentation involves vasoconstriction of blood vessels called capillaries in the extremities when people are confronted with colder temperatures. These blood vessels squeeze tighter, reducing the amount of blood flow able to reach the affected areas of the body.³ This affects overall circulation, meaning that chilblains are further affected by poor circulation and conditions that can increase the risk of having poor circulation. 

The circulatory system overview

The circulatory system is composed of a system of different blood vessels that all work together alongside the heart to pump oxygenated and deoxygenated blood around the entire body. Capillaries are the smallest vessel type that are part of this system and are the closest vessels to the organs of the body, including the skin.⁴ The system is responsible for a number of different roles in the body, including removal of waste products, delivering oxygen to all areas of the body, ensuring immune cells are transported for adequate immune defense, wound healing and thermoregulation. If normal circulation is disrupted due to a cardiovascular disease or other illness, all of these mechanisms and jobs can be disrupted and will increase the risk of further illness.⁵

Circulatory disorders

Raynaud’s disease

Raynaud's disease is a vascular condition that affects the extremities of the body, in which the small blood vessels (capillaries) go into spasm and constrict in response to changes in the environment, like colder temperatures and damper climates.⁶ When this occurs, the body parts, usually fingers and toes, gradually change colour to white or blue and become very painful or numb and will usually result in a symmetrical attack of both feet/hands. The colour change occurs due to a lack of oxygen delivery to these areas in response to the colder climates, leading to inflammatory changes as the areas attempt to combat the reduction in oxygen. This condition is more common in the elderly, those with venous insufficiency and taller, slender females.²

Peripheral arterial disease

Peripheral arterial disease is another circulatory disease that affects over 200 million people worldwide and is more common in people over 65 years of age. Typically, the circulatory system can’t manage the work load of the body due to weakened vessels and a weakened heart pumping system leading to reduced blood flow, reduced tissue perfusion and eventual damage to other organs and muscles of the body.^7. The disease usually affects the periphery as the heart has to work harder to allow blood to reach these areas and the feet and legs are most commonly affected. 

There are a number of risk factors that can increase a person’s likelihood of developing peripheral arterial disease; These include smoking, alcohol, diabetes, hypertension, obesity, high cholesterol and older age. Due to the vascular changes associated with this condition, capillaries no longer function at the same ability as in a healthy individual, and reduced blood flow occurs due to thickening of vessels. This not only causes symptoms of leg pain on both walking and rest as well as reduced sensation, but also can cause impaired wound healing, oftentimes leading to diabetic foot ulcers and chilblains.⁸

FAQs

What are the risk factors for poor circulation development?

Risk factors for the development of peripheral arterial disease include having disease comorbidities like hypertension, heart failure, smoking, type 2 diabetes, obesity and excessive alcohol usage. For Raynaud’s disease, having a strong genetic link is one of the biggest factors for development, as well as being female, slender and having other autoimmune conditions.

What are some ways people can prevent chilblains?

There are several different options available to people with chilblains that include lifestyle changes, changing environments and using medications. Living in warmer climates or turning the heating up in the house can help promote good circulation. Lifestyle modifications that can also be of benefit include avoiding smoking and caffeine where possible, as these can both aid in reducing risk of development over time.⁹

Summary

Chilblains are common during colder weather for certain groups in the population, but poor circulation makes them more likely to develop and harder to heal. When blood flow is delayed, the capillaries in fingers, toes, and other exposed areas can’t adapt efficiently to changes in temperature, leading to the painful swelling and irritation that occurs with chilblains. Circulatory diseases like Raynaud’s and peripheral arterial disease can make this more difficult to treat, and preventative steps are required in order to protect these areas from cold exposure. 

Taking care of your circulation is not only key to preventing chilblains, but also to protecting your overall health, and those with peripheral arterial disease can help this by identifying any modifiable risk factors in their life like having healthy diets and lifestyles. Further research is needed into how circulation can be helped in chilblains, with any helpful medications or interventions being identified for those affected.