Health: Bleak winter goes straight to the feet: Each year the onset of cold weather brings suffering to the victims of chilblains. Sometimes patients can do more to help than doctors, says Deborah Jackson

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EARLY in November, Monica Woodward noticed that her feet were turning purple. 'I thought for a moment I had cut myself while trimming my toenails. Then I realised it was the first of my chilblains.'

Mrs Woodward, 49, has suffered from chilblains for 40 years. As the temperature drops, she prepares for the agony of feet that freeze in the cold, swollen toes that itch unbearably as they thaw out, and shoes that no longer fit.

Every winter thousands of people endure a condition which, to quote one expert, 'doesn't excite the medical profession'. This is perhaps because perniosis, or chilblains, is a common condition, but not dangerous. It is caused by a severe restriction of the small blood vessels just below the surface of the skin which occurs when the weather turns cold. Little research has been done, and the only reliable and permanent 'cure' is to move to a warmer climate.

Doctors are vague about the incidence, underlying causes and treatment of the common chilblain. But results of a survey given to the Independent show that about one in 12 people suffers from the condition. The data comes from Pharmax Healthcare, maker of a painkilling cream for unbroken chilblains.

In October, when 772 women were interviewed, researchers found that chilblains were more common in the damp, chilly North and Midlands than in the South of England, and that most sufferers were female. Women were six times as likely to have chilblains as their husbands or partners.

Mrs Woodward spent five years in the Middle East and four in the Far East, during which time her chilblains stayed away. Returning to Willenhall, in the West Midlands, she is cruelly reminded of winters past.

'I remember when I had my second child I could not get my feet into a pair of shoes I possessed. My hands were covered in chilblains and I couldn't do anything.

'We didn't have central heating in those days. Now I do, and I live in a small house, but I still suffer. I'm already at the stage this year where there's one pair of shoes I can't wear, and at the end of the winter there will be more. It wears off in March or April - which seems a long time away.'

The Pharmax survey suggests that one-third of chilblain sufferers do not attempt to treat their condition. If chilblains ulcerate or become unbearably itchy, a patient may go to one of a variety of specialist clinics.

Edward Housley, a consultant angiologist (specialist in blood vessels), sees many chilblain sufferers in his clinic at the Edinburgh Royal Infirmary. He advocates a practical approach to cold-related illnesses, and prefers to leave a chilblain alone and concentrate on the circumstances that caused it.

'Chilblains are a kind of subacute frostbite. The best thing is not to go to your GP. He'll put you on drugs, which will give you side-effects. Avoid treatment and use common sense.

'I'm amazed at how many young women come to my clinic in the depth of winter wearing no overcoat or gloves, open shoes, a thin layer of clothing, and they show me a chilblain on their hand and say: 'What are you going to do about it?' I say to them: 'What are you going to do about it?' '

Gloves and woolly socks may not be enough for the inveterately cold person, who may have to resort to electrically heated winter wear, body warmers and heaters designed for sports use. But if all else fails, Dr Housley may offer a phenol injection, given by lumbar puncture, for chilblains in the feet. 'It kills the nerve that controls the skin circulation by shutting it down. It works for some years, but there are side-effects, for instance pain in the legs which may last for months.'

Research by Malcolm Rustin, consultant dermatologist at the Royal Free Hospital in London, suggests that vasodilator drugs may be helpful in reducing blood pressure and freeing the circulation. They do, however, have side-effects such as hot flushes, headaches and ankle-swelling. Most patients would rather have chilblains.

'I wouldn't put people on drugs if they weren't reasonably bad,' Dr Rustin says. 'My wife gets chilblains, and she doesn't want to be treated. Incidentally, they don't recognise chilblains in America. We went over there and talked about chilblains and doctors didn't know what we meant.'

Dr Rustin says that many people suffer from chilblains without knowing it, and even GPs can fail to recognise the condition. But if a chilblain sufferer decides to visit a specialist, there is little agreement on which speciality it should be. 'You may be sent to a vascular surgeon, a dermatologist, a rheumatologist, or even a gastro-enterologist,' says Anne Maudsley, director of the Raynaud's and Scleroderma Association, many of whose members suffer from chilblains.

Raynaud's disease is a disorder of the blood vessels in which small arteries that supply the toes and fingers suddenly contract in cold weather. While similar to chilblains, it is a separate condition. Scleroderma is also cold-related and affects the connective tissue of the skin and sometimes the internal organs. There is also a condition called acrocyanosis, which Dr Housley says is 'a clever way of describing a condition we don't know much about. Acro means end, and cyanosis means blue. It is very common in young women, and may be connected with the hormones.'

Dr Housley regards the typical chilblain sufferer as a thin young woman or pubescent schoolgirl. He even connects chilblains and cold extremities with the slimmer's disease, anorexia nervosa.

'These women don't have the layer of fat under the skin which most of us have. Their core temperature can't be maintained in the winter months. Yet teenagers are seen wearing mini-skirts in the middle of winter, and schoolgirls are sent out on to hockey pitches wearing a short skirt and socks.'

This winter the Raynaud's Association Trust has produced 50,000 copies of a leaflet offering information for chilblain sufferers. It gives basic advice on the themes of keeping warm, taking exercise and removing damp clothes after going out. The leaflet also warns against reheating frozen parts on a radiator or hot-water bottle, which can cause skin damage and make chilblains worse.

The association has members of all ages. Ms Maudsley is aware that chilblains may become more serious in old age.' The trouble for older people is that it turns them into hermits,' she says. 'They are too cold to go out, so they stay in and run up extra heating bills. Once your hands and feet are cold, it takes ages to get any life into them. People cannot even open doors with their hands.

'One survey suggests that 20 per cent of women have Raynaud's disease at some time in their lives. Many of those remember getting chilblains when they were young. It can get so bad that people have to change their way of life and their jobs. I suffer from Raynaud's disease myself - I used to be a physical education teacher, but there's no way I could work outside. I remember getting dreadful chilblains when I was a girl, and my grandmother wrapping them in lamb's wool.'

Only 25 per cent of chilblain sufferers consult their doctors, according to the Pharmax survey. So it is not surprising that there are plenty of home remedies and old wives' tales to choose from.

Mrs Woodward remembers wearing woollen or cotton socks as a child, as nylon was believed to aggravate chilblains. Her mother also used to rub her feet with surgical spirit to harden them - 'that didn't work'. Wearing sensible, well-fitting shoes, massaging with vapour rub, and sampling a catalogue of pharmaceutical preparations all failed to ease the pain.

Holistic remedies may be more successful. David Pearce, a traditional acupuncturist at the Bath Natural Health Clinic, claims to be able to cure chilblains without inducing side-effects. 'Acupuncture works on the circulation in a very real way,' he says. 'In traditional Chinese thinking, the flow of energy precedes the flow of blood. I have had quite a few patients who suffered with chilblains, and after acupuncture they cleared up.

'A traditionally trained acupuncturist will treat the person, not the symptom. If chilblains are caused by poor circulation, it's important to find out why the circulation is poor. The number of treatments depends on the person. In acupuncture, where the chilblains occur may be as significant as the fact you have got them.'

Members of the Raynaud's association were asked recently which alternative therapies had helped them, and some wrote glowingly of reflexology. This holistic approach, via the feet, would understandably be soothing to anyone with difficulty getting life into the toes.

The lack of data and research on such a common problem is frustrating for sufferers, who may be seen as complaining about nothing. There is also the problem of embarrassment. 'Your feet look absolutely revolting, a horrible purply colour,' Mrs Woodward says.

Ms Maudsley says: 'We have to get across to people that this isn't just complaining about the cold, it's much more than that. The winter is sheer agony for some people.'

For a copy of the 'Chilblains' information leaflet, send an sae to the Raynaud's and Scleroderma Association, 112 Crewe Road, Alsager, Cheshire ST7 2JA.

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