Cold urticaria is an inflammatory skin change that develops as a response to its cooling. It manifests itself in the form of red itchy spots, the surface of which is prone to peeling and cracking. Cold urticaria is localized on the face, ears, neck, hands, knees or thighs. It may be accompanied by a runny nose and conjunctivitis. Diagnosis includes skin pH-metry and dermatoscopy, additional examinations of the patient to identify chronic infectious foci or gastrointestinal disorders. Treatment consists in eliminating cold exposure, correcting concomitant disorders, prescribing antihistamines and drugs that improve blood circulation.
L50.2 Urticaria caused by exposure to low or high temperature
Cold urticaria is an inflammatory reaction of the skin in response to exposure to cold. In addition, cold can provoke a number of pathological reactions in the human body. So, when exposed to cold, a skin reaction may develop in the form of urticaria, cold rhinitis and cold conjunctivitis. A clinical form of bronchial asthma is known, in which attacks are provoked by inhaling frosty air (cold asthma).
Currently, practical dermatology continues to study the causes and mechanisms of the development of cold urticaria. Three theories of its origin are leading:
- The first theory connects the occurrence of cold urticaria with spasm of peripheral capillaries, which occurs when exposed to cold. As a result, the blood supply to the surface layers of the skin is disrupted with the development of an inflammatory reaction.
- The second theory indicates that when the temperature of the skin decreases in some people, proteins that are part of its cellular structures combine. The formed compounds act as a strong irritant, provoking the production of histamine and other inflammatory mediators with the development of cold urticaria. However, such protein compounds are not stable and tend to disintegrate when the skin warms.
- The third theory of the appearance of cold urticaria suggests that it is associated with insufficient fatty coating of the skin surface, which is why excessive evaporation of moisture occurs under the influence of cold. Dehydrated skin cells peel off, cracks form. This theory is supported by the more frequent occurrence of cold urticaria in people with dry and sensitive skin, as well as with aging of the skin (in elderly patients).
It is noted that disorders in the immune system associated with:
- gastrointestinal diseases (stomach ulcer, intestinal dysbiosis, chronic cholecystitis, hepatitis, pancreatitis);
- foci of chronic infection of ENT organs (sinusitis, chronic tonsillitis, otitis media);
- inflammatory processes of the genitourinary sphere (chronic cystitis, pyelonephritis, salpingitis, vaginitis, etc.).
Cold urticaria is characterized by the appearance of dry, flaky dark red or bard spots 2-5 cm in size on open areas of the skin. Their occurrence is accompanied by severe itching and burning. Over time, cracks appear on the surface of the spots, crusts form. The skin of the face, auricles, neck and hands is most often exposed to cold damage. Sometimes rashes of cold urticaria are localized on closed, but most sensitive to cold, areas of the skin — on the knees and inner thighs.
Manifestations of cold urticaria can be accompanied by sneezing and watery discharge from the nose (cold runny nose), burning sensation in the eyes and lacrimation (cold conjunctivitis), which take place in a warm room.
The diagnosis of cold urticaria is established when typical spots on the skin are detected and there is a clearly traceable connection between their appearance and exposure to cold. To exclude gastrointestinal pathology and the presence of chronic foci of infection, a dermatologist can give a referral to a gastroenterologist, otolaryngologist, urologist or gynecologist. Diagnostic tactics include:
- Dermatological examination. Dermatoscopy of the elements and measurement of the pH of the skin is carried out.
- Instrumental methods. If appropriate indications are identified, the patient is performed abdominal ultrasound, gastroscopy, duodenal probing, rhinoscopy, pharyngoscopy, kidney ultrasound, gynecological ultrasound.
- Laboratory tests. Fecal and urine back-seeding, fecal analysis for dysbacteriosis, pharyngeal smear, etc. are examined.
Cold urticaria is differentiated from psoriasis and dermatitis of other etiologies: atopic, drug-induced, simple and allergic contact dermatitis. Cold urticaria must be distinguished from cold urticaria, which manifests itself by the appearance of intensely itchy vesicular rash elements on the skin.
The therapy of cold urticaria, as well as the prevention of its occurrence, consists mainly in protecting the skin from the effects of cold. First of all, these are warm clothes, gloves, hats and scarves. To protect the skin, applying a greasy nourishing cream to exposed areas of the skin helps 30-40 minutes before leaving a warm room for the cold.
Patients should also avoid contact with cold water and exclude the intake of cold foods (drinks, ice cream). To combat dry skin, humidify the indoor air and use special cosmetic products for daily skin care.
In the treatment of cold urticaria, antihistamines, vitamins (C, A, PP, E), medications that improve microcirculation and peripheral blood circulation are used. It is important to eliminate the infectious focus and eliminate violations in the work of the gastrointestinal tract.