Chilblains is a condition characterised by painful, itchy and red swellings of the skin, affecting mainly toes, fingers and ear, caused by exposure to cold, which causes narrowing of the blood vessels and consequently poor circulation. Chilblains is self-limiting condition meaning it resolves itself without any treatment. Prolonged chilblains may require a GP intervention. Chilblains treatment may involve symptomatic management of pain and avoidance of cold and damp conditions to prevent further events of chilblains. Today I will review the availability of chilblains cream for symptomatic management of chilblains.
Summary of the post:
- Chilblains: main symptoms
- How to prevent chilblains?
- Chilblains treatment: chilblains creams and ointment
- Use of steroid cream for chilblains
Chilblains: main symptoms
- Red, itchy, painful skin affecting toes, finger, ears, but can also affect the face.
- Skin which is swollen
- Burning sensation in the affected area
How to prevent chilblains?
Chilblains can be prevented by keeping warm in cold weather. Main recommendations for the prevention of chilblains:
- Stay warm
- Wear a hat, gloves, leggings, and thick socks
- Use multiple layers of clothes
- Use hand warmers and/or feet warmers.
- Carry a hot drink (in a travel mug) with you. It will warm you up from the inside.
- SAFE, NATURAL LONG-LASTING HEAT - Odorless, Disposable, Single-Use Item, Do Not Apply Directly to The Skin. TSA Approved. Made in the USA using domestic and imported materials.
- TO ACTIVATE - Remove warmer from outer package, shake to activate. Warmer heats up in 15-30 minutes. If heat decreases, expose warmer to air and shake. After use, dispose with regular garbage. Ingredients will not harm the environment.
- MULTIPURPOSE WARMERS - Single use air-activated heat packs that provide everyday warmth and are ideal for keeping your body warm when the temperature gets cold. They?re available in several styles designed for your hands, feet, and body.
The gradual warming of the skin is recommended; however, direct heat should be avoided (NICE, 2019). Keep the affected area dry and avoid cold to prevent the condition from getting worse.
Pain management involves taking over the counter medicines such as paracetamol and ibuprofen. Decongestants such as pseudoephedrine (e.g. Sudafed) should be avoided as it can cause blood vessel constriction, which can lead to poor circulation.
1. Chilblains cream – Balmosa cream
Balmosa cream contains a mixture of:
- methyl salicylate, and
- oleoresin capsicum
All of the above active ingredients produce a sensation of warmth when applied to the skin. Balmosa cream can be used by adults and children who are 12 years and above.
Although there is no specific evidence for Balmosa cream use in chilblains treatment, individually some of the active ingredients are known to cause dilation of the blood vessels, which increases the flow of the blood to the affected areas and hence regulate the body’s temperature.
Balmosa chilblains cream: active ingredients and their role
- Through unknown mechanisms, menthol promotes vasodilation (Craighead et al., 2017). Vasodilation (opening of the blood vessels) improves blood flow, which regulates body temperature.
- Camphor is an organic compound produced from camphor tree (The Cinnamomum camphora) and has applications in cream, balms, lotions, and ointments. An experimental study in humans showed increased skin blood flow when camphor was applied to the skin. A similar effect was seen for the application of menthol to the skin (Kotaka, 2014).
- Methyl salicylate (related to Aspirin) may have a role in pain and has anti-inflammatory properties; however, no evidence exists to support this. Once absorbed in the body, methyl salicylate can be changed into salicylic acid, which has anti-inflammatory properties.
- Capsicum is used in the formulation for pain management.
Where to buy Balmosa cream?
Balmosa cream is not commonly displayed on pharmacy shelves; however, some pharmacies keep it in stock for the public to buy. If needed Balmosa cream can be ordered by some pharmacy teams on one to one basis from leading pharmaceutical suppliers for the same or next day delivery. Balmosa cream can be purchased online for example Amazon.co.uk
2. Boots Chilblains Cream
Boots Chilblains Cream (Boots Pharmacy) is another option to help with the treatment of chilblains. Boots Chilblain cream contains two active ingredients:
- Benzyl alcohol
- Eucalyptus Oil
The main actions of the above two ingredients are:
- improved local circulation and feeling of warmth (Eucalyptus oil)
- reduction of pain/discomfort caused by chilblains – weak, local anaesthetic action (Benzyl alcohol)
Boots Chilblains Cream is available in Boots Pharmacy stores.
3. Snowfire Ointment Stick for chilblains
Although SNOWFIRE is not classified as cream, but ointment, I still wanted to include this option in the treatment/prevention of chilblains simply because of the number of positive reviews for this product.
SNOWFIRE Ointment Stick is recommended for dry skin, chapped hands and chilblains. SNOWFIRE ointment contains a combination of essential oils, which may be of some benefit to help with chilblains.
4. Gehwol cream for chilblains
Gehwol Foot Cream is advertised to strengthen the skin and to prevent blisters protect against aching feet, cold feet, chilblains and frostbite. The main active ingredients found in Gehwol cream are:
- Manuka Oil,
- Zinc Oxide,
- Aloe Vera and Jojoba Oil.
Zink oxide is widely available in different skin products, and act as a mild antiseptic ingredient. Combination of plant oils acts as a barrier by creating an occlusive effect on the skin. In addition, jojoba oil is a good ingredient to support repair of the skin and also has a proven anti-inflammatory effect (Lin et al., 2018).
Can you use topical steroid cream to treat chilblains?
Topical steroid creams such as hydrocortisone or clobetasone (Eumovate) are typically licensed and used for the treatment of various skin conditions, including eczema. Topical steroid creams are effective in management in those conditions. Steroid creams reduce redness, itchiness and have an anti-inflammatory effect.
From the description, it seems like topical steroids cream could help with chilblains; however, steroid creams or ointments are not licensed for this purpose.
Are steroid creams effective in the treatment of chilblains?
I found only one study (Souwer et al., 2017), which looked at the effectiveness of steroid cream in the treatment of chilblains. A group of 34 Dutch participants used betamethasone valerate 0.1% cream (a prescription-only steroid) or placebo cream (cream, which does not have any active ingredients) to treat chronic chilblains. Although this study was small in size, it was well designed.
What was the outcome at the end of 6 weeks trial?
Topical steroid cream (betamethasone 0.1% cream) was no better in the treatment of chronic chilblains as compared to placebo cream (no active ingredient). It was concluded that betamethasone should not be used in the treatment of chilblains unless more evidence becomes available to support this use.
Chilblains alternative treatment: drugs
In severe or prolonged cases of chilblains, a GP may prescribe a drug called nifedipine (NICE, 2018). Nifedipine is usually used in the treatment of high blood pressure and angina. Nifedipine causes the dilation of blood vessels, improving circulation in the affected areas.
Nifedipine, however, is not commonly prescribed or recommended to the treatment of chilblains. This is because chilblains is a self-limiting condition, goes on its own without treatment with self-care measures. The evidence supporting the use of nifedipine is insufficient. In fact, one small study showed no additional benefit in the treatment of chilblains when nifedipine was compared to a ‘dummy’ pill (Souwer et al., 2016).
Chilblains treatment: when to see GP
As mentioned before, chilblains should go on its own. Seek GP advice i:
- Chilblains do not go away after 2-3 weeks.
- There are signs of infection in the affected area, e.g. puss present for which a GP may prescribe an antibiotic cream or oral antibiotic.
- If you are a diabetic patient
Chilblains cream – Conclusion
Chilblains usually goes on its own without any specific treatment. Creams reviewed in this post may help with symptoms of chilblains; however, there is no evidence to support their use in the treatment of chilblains. Prevention rather than treatment is a crucial factor to consider by customers who are regularly affected by chilblains.
What cream is best for chilblains?
Balmosa Cream is one of the best creams for chilblains due to its unique composition of ingredients, which produce a sensation of warmth and cause dilation of the blood vessels, which increases the flow of the blood to the affected areas.
Is Sudocrem good for chilblains?
Sudocrem is used as an antiseptic cream rather than to prevent or treat chilblains. Many other creams are better than Sudocrem for treatment and prevention of chilblains.
Craighead, Daniel H., Nathaniel B. McCartney, James H. Tumlinson, and Lacy M. Alexander (2017). Mechanisms and time course of menthol-induced cutaneous vasodilation. Available at: https://dx.doi.org/10.1016%2Fj.mvr.2016.11.008 Accessed on 27/11/2019
Kotaka, Tomohiko, Shoji Kimura, Makoto Kashiwayanagi, Jun Iwamoto (2014). Camphor Induces Cold and Warm Sensations with Increases in Skin and Muscle Blood Flow in Human. Available at: https://doi.org/10.1248/bpb.b14-00442Accessed on 27/11/2019
Lin TK, Zhong L, Santiago JL. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017;19(1):70. Published 2017 Dec 27. doi:10.3390/ijms19010070 Available at: https://dx.doi.org/10.3390%2Fijms19010070 Accessed on 12/12/2020
NICE, (2018). Scenario: Management of chilblains. Available at: https://cks.nice.org.uk/chilblains#!scenario Accessed on 25/11/2019
Souwer IH, Bor JH, Smits P, Lagro-Janssen AL. Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial. Ann Fam Med. 2016 Sep;14(5):453-9. doi: 10.1370/afm.1966. PMID: 27621162; PMCID: PMC5394377. Available at https://doi.org/10.1370/afm.1966 Accessed on 08/11/2020
Souwer IH, Bor JH, Smits P, Lagro-Janssen AL. Assessing the effectiveness of topical betamethasone to treat chronic chilblains: a randomised clinical trial in primary care. Br J Gen Pract. 2017;67(656):e187-e193. doi:10.3399/bjgp17X689413 Available at https://dx.doi.org/10.3399%2Fbjgp17X689413 Accessed on 08/11/2020