Chilblains, Boils and Carbuncles - Three Painful Skin Problems

Chilblains, boils and carbuncles are swollen and painful areas on the skin which can make life miserable for the sufferer. Chilblains are red or purple bumps that sometimes appear when the skin warms up after being cold. They generally form on fingers, hands, toes, feet, ears, earlobes and the nose, although they may also appear on the ankles, calves or thighs of horse riders. Some people are prone to developing chilblains while others never get them. A boil, or furuncle, is caused by a bacterial infection in a hair follicle and can appear anywhere on the skin and in anyone. When several neighboring hair follicles are infected the resulting swelling is called a carbuncle. Boils and carbuncles are red to begin with, but eventually develop a white center that is filled with pus. They become more and more painful as the amount of pus increases.

Chilblains are sometimes known as pernio or perniosis. The name “chilblain” is derived from the chilled skin that leads to the chilblain formation and “blain”, which is an old word for a swelling or open sore. Chilblains appear several hours after a body part has been chilled and then rewarmed.

When our body gets cold the blood vessels near the surface of the skin constrict, which reduces blood flow to the skin and decreases heat loss from the body. When the body warms up the blood vessels in the skin expand and there is increased blood flow to the area, which provides nutrients to the skin and also cools the body down as heat is radiated out of blood and through the skin to the outside world.

The mechanism of chilblain formation isn't understood very well. It’s thought that in susceptible people the blood vessels in the skin behave abnormally as they constrict in the cold and as they expand in the warmth when the body part changes temperature. The area becomes inflamed as it warms and the expanding blood vessels become leaky, allowing fluid and materials to leave the blood vessels.

Chilblains are most likely to form if the skin is warmed rapidly, such as when a person sits close to a hot fire after coming in out of the cold. They tend to occur in cold and damp environments and are more common in the autumn and winter. They are found more frequently in children and the elderly than in other age groups, and more women suffer from chilblains than men. People with circulatory problems are also more susceptible to developing chilblains, although even apparently healthy people can be affected. Chilblains sometimes run in families.

Symptoms

Chilblains are red or purple patches of skin that are inflamed and usually swollen. They are painful and may produce an intense itching or burning sensation. They sometimes form blisters, or produce dry skin with cracks as they dry out. Although they are often very unpleasant, chilblains generally don't cause any permanent damage and aren't a serious health problem. However, severe chilblains may develop ulcers (open sores with skin breakdown), which can become infected.

Treatment

If you develop chilblains and you've never experienced them before, you should ask your doctor or a pharmacist for the name of a cream or lotion that will reduce itching and pain. Most people find that their chilblains disappear after a week or two. Try to avoid scratching the itchy area to prevent damaging the skin. Padding over chilblains helps protect them from pressure.

If chilblains last for a long time or disappear and then recur you should see a doctor, since they may have formed due to an underlying health problem. For example, people with diabetes or Raynaud's disease (also called Raynaud's syndrome, or simply Raynaud's) have an increased risk of developing chilblains. If a chilblain develops an ulcer or an infection it's important to see a doctor.

Prevention

It's easier to prevent chilblains than to treat them. To reduce the chance of chilblain development it's helpful to avoid extreme temperature changes and to wear thick gloves, socks, hats, scarves and other protective clothing in cold or wet weather. Wear shoes that fit well, since the friction created by ill-fitting shoes can lead to chilblain development in susceptible people. Warm the whole body gradually when you go indoors. Don't warm a body part in front of a fire or heater, or with a heating pad or hot water bottle. A healthy diet and regular exercise improve circulation. Avoid smoking, since nicotine constricts blood vessels.

A boil is generally caused by Staphylococcus aureus bacteria, which often live on our skin. If the bacteria get down into a hair follicle (the tube in the skin from which a hair emerges) the follicle and nearby skin tissue may develop an infection.

At first a boil is a red, warm and firm bump that hurts when touched. As the boil becomes filled with a thick liquid called pus (which contains dead white blood cells, bacteria, tissue debris, proteins and serum) it becomes softer and more painful, and develops a white or yellow center, or "head". If several hair follicles next to each other are infected there may be a group of boils, with each boil having its own head. The group is called a carbuncle.

A boil or carbuncle can develop anywhere on the skin, but the most commonly affected areas are the face, the neck, the armpits, the thighs and the buttocks. Anyone can develop boils, but people with impaired immune systems are especially susceptible to boil development. Regular washing reduces the buildup of bacteria on the skin and reduces the chance of a boil appearing.

Small boils can be treated at home. A boil mustn't be squeezed or pierced to let the fluid out (except by a doctor) because these treatments can cause the infection to spread. Instead, a warm, wet washcloth should be placed over the affected area for at least ten minutes, several times a day. Several washcloths should be used during a treatment so that the boil is continually being covered with moist heat. The heat increases blood flow to the area, which is helpful since the blood carries white blood cells and antibodies that can fight the bacteria. The warm soaking will eventually cause the boil to release its pus, which will relieve the pain. Once the fluid in a boil has drained the body can heal the area itself. The boil must still be washed regularly, however.

It's important to prevent the transfer of bacteria to other parts of the skin or to other people. Hands should be washed thoroughly after treating a boil, especially since Staphylococcus aureus can cause food poisoning. Washcloths and towels mustn't be shared with other people and should be washed in very hot water before being used again. Sheets and clothing that come into contact with the boil should also be washed in hot water. Dressings must be disposed of carefully.

There are some boils that need medical attention. You should ask for a doctor's advice if a boil is very large or if it doesn't disappear within two weeks. You should also seek medical help if you have numerous boils or if a boil is located on your face or spine. If other symptoms are present, such as a fever, chills, fatigue, red lines extending from the boil or swollen lymph nodes, or if you feel unwell, it's important to visit your doctor.