Chilblains, Boils, and Carbuncles: Three Painful Skin Problems
Painful Skin Bumps
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 neighbouring hair follicles are infected, the resulting swelling is called a carbuncle. Boils and carbuncles are red to begin with but eventually develop a white centre 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 from the word “blain”, which is an old term for a swelling or open sore. Chilblains usually appear several hours after a body part has been chilled and then rewarmed. The more rapid the rewarming, the more likely their development.
Normally, 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 vessels in the skin expand and there is increased blood flow to the area. The extra blood cools the body down as heat is radiated out of the blood and through the skin to the outside world.
The mechanism of chilblain formation isn't understood very well. It's known that in susceptible people blood vessels in the skin behave abnormally as they expand in the warmth after being chilled and that inflammation is involved. The expanding vessels become leaky, allowing fluid, white blood cells, and other materials to leave the blood vessels and enter the surrounding tissue. The area becomes red due to increased blood flow, swollen due to fluid buildup, and painful as the fluid presses on the nerves in the area.
A Doctor Discusses Chilblains
Some common situations and conditions which increase the susceptibilty to chilblain development are listed below.
- 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 indoors after being outside in the cold.
- They tend to occur in cold and damp environments and are most common in the autumn and winter.
- They are found more frequently in children and the elderly than in other age groups.
- More women suffer from chilblains than men.
- People with circulatory problems are more susceptible to developing chilblains.
- Chilblains sometimes run in families.
An Experience With Chilblains
Chilblains are red or purple patches of skin that are 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. These must be covered with a dressing to prevent infection.
Although they are often unpleasant, chilblains generally aren't a serious health problem and don't cause any permanent damage. They should be watched carefully, however. Severe chilblains may develop ulcers (sores with tissue breakdown). The ulcers may become infected. Ulcers require medical attention.
Chilblains may not need any special treatment. In some circumstances they do, however. If they are itchy, it's important to avoid scratching them, since this may damage the skin and increase the risk of infection. A doctor or pharmacist should be able to recommend a cream or lotion that will reduce itching and pain. Padding over chilblains helps to protect them from pressure. Most people find that their chilblains disappear after a week or two if they're treated carefully.
If your 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, lupus, or Raynaud's disease (also called Raynaud's syndrome or phenomenon or simply Raynaud's) have an increased risk of developing chilblains. If a chilblain develops an ulcer or an infection due to a blister, crack, or scratches, it's important to see a doctor as soon as possible.
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. It's also helpful to wear thick gloves, socks, hats, scarves, and other protective clothing in cold weather and waterproof clothing and footwear in the rain. Shoes that are wet shouldn't be worn until they are dry. Footwear should fit well, since the friction created by ill-fitting shoes can lead to chilblain development in susceptible people.
The body should be warmed gradually after being chilled. If you tend to develop chilblains, don't warm yourself by sitting in front of a fire or a heater or by using a heating pad or a hot water bottle. Use a gentler technique of warming up, such as by changing or adding clothing. Other strategies that may help are to follow a healthy diet and to exercise regularly in order to improve circulation. Avoid smoking, since nicotine constricts blood vessels.
Raynaud's disease increases the chance of chilblain development. It's a condition in which small blood vessels going to the skin of the fingers or toes (or another part of the body) periodically spasm and become narrower. As a result, less blood is delivered to the area, causing it to feel cold. My sister has the disorder, although she doesn't develop chilblains. She wears fingerless gloves indoors during an episode. This makes her cold fingers feel warmer while still enabling her to manipulate things. This strategy for reducing extremes in temperature may be helpful for people with Raynaud's who get chilblains. It's sometimes recommended for this purpose.
Boils and Carbuncles
A boil is generally caused by Staphylococcus aureus bacteria, which often live on our skin. If the bacteria get 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. The boil gradually becomes filled with a thick liquid called pus, which contains dead white blood cells, bacteria, tissue debris, proteins, and serum. At this point it becomes softer and more painful. It also develops a white or yellow centre, or "head". If several hair follicles next to each other are infected, a group of boils may form. Each boil in the group has 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 their development. Regular washing reduces the buildup of bacteria on the skin and reduces the chance of a boil appearing.
Staphylococcus aureus sometimes lives peacefully on the skin without causing problems. It's a common cause of skin infections, however, including boils and carbuncles.
Boil Information from a Doctor
Treating a Boil
Doctors say that small boils can be treated at home. They mustn't be squeezed or pierced (lanced) to let the fluid out, except by a doctor, because these treatments can cause the infection to spread. Instead, a warm and wet washcloth should be placed over the affected area for at least ten minutes at a time and for several times a day. Multiple washcloths should be used during a treatment so that the boil is continually being covered with moist heat, as the doctor in the above video describes.
The heat on top of a boil increases blood flow to the area. This is helpful because the blood carries white blood cells and antibodies that can fight the bacteria. The warm soaking will eventually cause the boil to open and release its pus, which will relieve the pain. Once the fluid in a boil has drained the body can generally heal the area itself. The boil should be washed regularly once it has opened and covered with a sterile dressing between washes.
Preventing the Transfer of Bacteria
It's important to prevent the transfer of bacteria in a boil to other parts of the skin or to other people. Hands should be washed thoroughly after treating a boil, since Staphylococcus aureus can cause food poisoning as well as skin problems. 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. If these precautions don't work and new infections appear, a doctor's advice should be sought.
Seeking Medical Attention
There are some boils and carbuncles that need medical attention. You should seek 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 a doctor immediately.
Like chilblains, boils and carbuncles are unpleasant but generally minor problems. Occasionally these skin ailments can be more serious, however, so they should always be treated with care and attention.
Questions & Answers
© 2011 Linda Crampton