The answer

From what she’s described, Lily may actually be making her chilblains worse by warming her feet up too quickly. The cold weather causes the blood vessels near the surface of the skin to constrict to help the body maintain its core temperature, and they only expand again once warm conditions are restored. However, heating up the skin too quickly, as Lily is doing by relying on heat from the radiator, means the blood flows more quickly to her feet than the blood vessels can handle and some blood leaks into surrounding areas. This is what causes the swelling, itchiness and discolouration associated with chilblains.

As well as ensuring she warms up her feet gradually when she gets home in the evening, and avoiding direct heat, there are some simple measures that Lily can take to reduce the chance of getting chilblains in the first place. These include staying active to help improve circulation, keeping her feet well moisturised to stop the skin becoming dry and cracked, and avoiding tight-fitting footwear that restricts blood flow to the feet.

Warm clothing such as gloves, socks and boots can help, as can avoiding cold and damp conditions. Avoiding caffeine and smoking, if relevant, can also help as these may cause blood vessel constriction.

If Lily’s chilblains are severe and chronic and don’t respond to the self care measures, she should be referred to a GP. If no underlying cause is identified and there are no contraindications, she may be prescribed modified-release nifedipine 20-60mg daily. This is an off-label indication and the evidence to support its use is based on a limited number of small studies.