The harsh, chilly winter air is usually quite dry and can suck the moisture from your skin. If you are not careful and do not take preventive measures, it can result in a winter rash also known as cold urticaria or hives.

Cold urticaria or physical urticaria (hives) is an allergic skin reaction to extremely cold temperatures (cold weather/cold water). 

The reaction is characterised by a red, itchy rash that appears on the skin within 5 to 10 minutes of exposure and can last up to 1 to 2 hours.

Signs And Symptoms of Cold Urticaria

  • Reddish, itchy hives on the area of skin affected after exposure to cold.

  • Swelling in the affected area of the skin.

  • Occasionally, headaches, fever, anxiety, tiredness, and difficulty in breathing.

  • Rarely, severe allergic (anaphylaxis) reactions.

 The Affected Population

  • Young adults: Cold urticaria usually affects young adults but can appear at any age with a significant female preponderance (average female: male ratio is 2:1).

  • Underlying health condition: The less common type of cold urticaria, secondary acquired, is often associated with underlying health problems, such as asthma, cancer, or infections.

  • Genetics/inherited traits: Familial cold urticaria is very rare. This type causes painful welts and flu-like symptoms after exposure to cold.

  • Pre-existing skin conditions: Eczema, psoriasis, rosacea, dermatitis, and other allergic skin conditions can make you more susceptible to winter rash.

Causes of Cold Urticaria

The exact cause of cold urticaria is still unknown. It appears that some people may have very sensitive skin, due to their genetic/inherited trait (familial urticaria), a virus, an infection, auto-immune conditions, or chronic illness (such as blood cancer).

In the most common forms of this condition, cold temperature triggers the release of histamine and other chemicals into the bloodstream that cause symptoms (such as redness, itching, or systemic reactions) of allergies.

Diagnosis of Cold Urticaria

Cold urticaria or hives is typically diagnosed based on the presence of characteristic signs and symptoms. 

A specific test done to confirm the diagnosis is the cold stimulation test. It involves placing a cold object (most commonly an ice cube) against the skin of the forearm for about 1 to 5 minutes. 

During the test, people with cold urticaria develop a distinct red and swollen rash within a few minutes of exposure. 

However, if your doctor suspects an underlying condition that might be causing these symptoms, you will be advised to do a few other tests including blood tests.

Treatment of Cold Urticaria

In most people, symptoms of cold urticaria resolve on their own in weeks or months. In others, they may last longer. 

This condition has no definitive cure but treatment and preventive measures can make it manageable.

 A few prescription medications used to treat the symptoms include: 

  • Non-sedative (non-drowsy) antihistamines: These are recommended as a prophylactic (preventive) treatment when exposure to cold can not be avoided.

  • Monoclonal antibodies such as Omalizumab (Xolair): This drug, which is usually prescribed to treat asthma, has been used successfully to treat people with cold urticaria who were resistant or did not respond to the first and second line of drugs.

  • Epipen or epinephrine auto-injector: If you are at an increased risk of a severe allergic reaction (anaphylaxis).

Understanding The Condition

The effective management of this condition involves awareness through patient education, lifestyle modifications, and timely treatment including prescription medications.

Preventing Cold Urticaria

The best way to prevent winter rash is to avoid cold climates and dry air. Other preventive measures include:

1. Take short warm showers. As tempting as it might be to take a long hot shower in winter, it will only make your skin more dry and itchy. Hence, cut down on the shower time, lather up as little as possible.

2. Use mild, unscented, natural soaps. Make sure to opt for soaps with ingredients such as glycerin, goat milk, oatmeal, shea butter, or olive oil. Harsh soaps can dry out your skin.

3. Moisturize well. Oil-based moisturisers are the first line of defence against a winter rash, as they help trap the moisture in your skin. Use moisturisers frequently, especially after bathing and hand-washing. Use petroleum jelly or its substitutes to prevent moisture loss. 

4. Use natural oils as and when required. Olive oil and coconut oil have been known to soothe irritable and dry skin by replenishing the moisture content of the skin.

5. Wear clothes made from breathable natural fibres. Clothes made from cotton and hemp can help reduce skin irritation and overheating.

6. Protect your skin and stay warm. Wear gloves every time you go outside in cold weather and when you wash dishes, immerse your hands in water for an extended period, or clean with chemical products.

7. Invest in a humidifier. These add moisture to the air around you.

8. Do not scratch. If your skin is itchy, moisturise well and use medicated creams. Never scratch as it may cause your skin to crack and bleed. This in turn would lead to an infection as it gives bacteria a perfect opening to get under your skin. 

It is recommended to contact a specialist (allergist/immunologist/dermatologist) if the rash worsens with time or is associated with any other symptoms.


Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.