Cold Comforts 

Is there an effective way to get rid of chilblains? I have some boring little ones, located mostly on my right hand, with a couple on the left. The doctor says I possibly have bad circulation, but they will probably go away if I eat properly and avoid sudden changes in temperature. Well, that hasn’t done a thing. Websites offer such unhelpful advice as “Do not place feet directly on radiators” and suggest leg warmers and thermal underwear. Is there anything else I could try? I feel that I can’t just attribute them to the lousy climate in England.

'Catherine Seale, via the Internet

The average reader isn’t wondering how to get rid of chilblains, Catherine. She’s wondering what the hell chilblains are. Didn’t they go out with gout, consumption and lumbago? Obviously not. (For that matter, gout, consumption and lumbago haven’t gone away, either. Gout, a particularly painful form of arthritis, is caused by knifelike crystals of uric acid in the joints. Consumption is now known as tuberculosis, and lumbago or lower-back pain, is now more commonly described in terms of the underlying condition, e.g., a slipped disk, or else called “lower-back pain.”)

Chilblains, also called perniosis or pernio, are a skin inflammation, most commonly seen on the fingers and toes, caused by prolonged exposure to low'but not freezing'temps and damp. They’re considered rare in the United States (less than 0.01 percent of the population is afflicted), where we’ve got good central heating. They’re more common in England (10 percent annual incidence), where, no disrespect intended, you don’t.

Chilblains form because blood vessels constrict from the cold, and when said constriction lasts for an extended time the vessels don’t respond quickly enough to rewarming, causing blood to leak into the surrounding tissues and damage the skin. Your skin doesn’t have to freeze, as with frostbite'it just has to stay cold and damp for a while. Chilblains often show up in the form of swelling and discoloration and sometimes blisters, sores and painful nodules under the skin. They can itch something fierce and scratching can lead to a secondary infection. If they’re bad enough they can cause numbness and long-lasting temperature sensitivity due to autonomic nerve damage.

Some blame hot-water radiators for chilblains due to their allegedly uneven heat distribution, but that hasn’t been proven and I’m doubtful. There may even be a genetic predisposition to them'research suggests a possible link between chilblains and “abnormal proteins that tend to sludge in cold temperatures.” I’ve seen speculation that chilblains are more common, presumably due to lack of insulation, in people who are excessively thin'another problem we don’t have much in the United States.

Now, about making your chilblains go away. Topical steroids are used to fight itching and swelling. Keeping the affected parts warm and dry helps prevent further damage. Your doctor might also prescribe heparin ointment to improve circulation. Unfortunately, though, in most cases the only remedy is time.

Since there’s no surefire treatment for chilblains, it’s better to avoid getting them in the first place. Again, staying warm and dry is the main thing; when your extremities do get exposed to cold, make sure to warm them back up gradually. (That’s why those Websites tell you not to put your feet on the radiator.) Ultraviolet light has been proposed as a way to prevent outbreaks, but studies show mixed results. If you smoke, quit'both for the obvious health reasons and because smoking can interfere with circulation in small blood vessels.

In fact, since circulation is key, one folk remedy is to maintain a low but steady blood alcohol level, on the theory that alcohol’s well-known properties as a vasodilator will flush the chilblains away. You won’t find many physicians recommending this course of treatment, and needless to say, I’m not licensed to prescribe. Considering the matter from a practical perspective, though, I’d suggest you think about spending some time on, say, the Mediterranean island of Ibiza. The climate is warm, there’s plenty of natural UV to be had on the beaches (if you’re one of the pasty types the U.K. is famous for, you’ll want to pack plenty of sunscreen), and from what I hear of Ibiza’s legendary nightlife, the blood alcohol thing will more than take care of itself.

Questions We’re Still Thinking About

As a child, I was taught that the point of toothbrushing is to prevent the bacteria in food particles from producing an acidic environment that would cause tooth decay. Later, in sex ed, I learned that semen is alkaline. So what I’m wondering is, does having a little bit of semen in my mouth before I go to sleep also prevent tooth decay? It’s more fun than using a toothbrush.

'Creative Hygiene in Santa Barbara

Frankly I don’t have the faintest idea, C. But please don’t let that stop you from spreading this theory around.