Idiopathic chilblains (IC) is a localized inflammatory disorder affecting acral areas, with unclear pathophysiology and pathogenesis. This study aimed to investigate the vasomotor, autonomic, and inflammatory responses of adults with (HIC þ ) and without (HIC ) a history of IC during cold exposure and rewarming. Sixteen healthy adults (8 HIC þ , 8 HIC ; 10 females, 6 males; aged 19–60 yr) underwent a controlled environmental protocol involving progressive cooling (22–10 C) followed by rewarming (22 C). Skin blood flow (SkBF); finger and toe temperatures (Tf and Tt); mean skin temperature (Tsk); microvascular oxygenation parameters including tissue saturation index (TSI), oxyhemoglobin (O2Hb), and deoxyhemoglobin (HHb); and total blood volume (tHb) were recorded throughout. Serum cortisol, ferritin, vitamin D3, antinuclear antibodies (ANAs), and scleroderma antibody (SCL-70) were also assessed. Compared to HIC participants, the HIC þ group showed significantly lower SkBF (jdj ¼ 0.43–0.56; P textless 0.05) and Tf and Tt (jdj ¼ 0.07–0.75) during cold exposure, along with reduced O2Hb (jdj ¼ 0.33 at 10 C) and increased HHb (jdj ¼ 0.43–0.46 at 14 and 10 C), suggesting impaired oxygen delivery. No between-group differences were observed in TSI. During rewarming, SkBF (47.06 ± 54.94 vs. 22.69 ± 21.48 PU) and HHb levels (5.53 ± 3.64 vs. 3.07 ± 2.84 μM) in the right finger were higher in the HIC þ than the HIC group (jdj ¼ 0.35–0.54). No significant differences were observed in serum cortisol or thermal perception. No participants developed chilblains or acral symptoms during the 8-wk follow-up. These findings indicate that individuals with a history of IC exhibit heightened cold-induced vasoconstriction and peripheral microvascular hypoxia, which may underlie susceptibility to chilblains and nonfreezing cold injuries.