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Winter Weather Skin Conditions: The Trifecta

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As most of us know from the warnings that abound, accidents and emergencies spike during the holidays. But health conditions prompted by the winter weather itself also pop up, and can make life pretty uncomfortable. As someone said to me the other day, “I have the trifecta of cold weather maladies: cold uriticaria, rosacea, and Raynaud’s disease. How about a story?” All of these skin conditions are triggered by extreme weather, particularly the cold. Sometimes they can be severe, or indicate underlying health problems, but mostly they’re just uncomfortable, unsightly, and annoying.

1. Raynaud’s disease

This cold weather malady occurs when blood vessels spasm and constrict, causing circulation to slow, as the result of cold weather. Emotional stress can also trigger symptoms to flare up. Researchers aren’t exactly sure why the disease develops in some, but the blood vessels appear to be over-reactive to harsh conditions in sufferers. In some people, symptoms can be triggered simply by running one’s hands under cold water.

Dr. Michael Stern, an emergency doctor at New York-Presbyterian/Weill Cornell, says that “the symptoms of Raynaud’s are really impressive. It looks like someone took all the color out of the fingers, or blanched them. And the demarcation line between the affected and the healthy skin is remarkable.” In severe cases or with prolonged exposure to cold weather or stress, the constricted vessels can significantly compromise oxygen, so the fingers can turn a deep purple blue. When the skin warms up, says Dr. Stern, “it first gets really red, swollen, and tingly. So you get three phases of color. It’s really quite fascinating, from a color perspective, but Raynaud's is unsettling and painful for those who suffer from it.”

In extreme cases, blood vessel constriction can lead to a dangerous lack of oxygen, which can result in ulcers, tissue death or gangrene, and (rarely) amputation. Again, these occurrences are very rare.

Most people can manage symptoms by layering clothing and making sure to wear warm gloves, socks, and and shoes. Others may need medications like calcium channel blockers, alpha-blockers, or vasodilators, all of which open up the blood vessels in various ways and increase circulation. Birth control pills, certain over the counter meds like Sudafed, and beta blockers for high blood pressure can make the condition worse, so you may want to avoid them or discuss with your doctor what alternatives might exist.

Dr. Stern adds that “smoking and caffeine are big no-no’s for Raynaud’s, because they cause vasoconstriction, which can worsen the symptoms.” People who think they might have Raynaud’s disease should definitely see a doctor, since it can be associated with several other, more serious conditions, like rheumatoid arthritis, lupus, and scleroderma.

2. Cold Uriticaria

Otherwise known as cold hives, cold uriticaria results in red welts on the skin that can be itchy and uncomfortable. Dr. Stern points out that the interesting thing about this condition is that it’s essentially an allergic reaction to cold weather. Cold uriticaria is histamine-mediated, just like allergies to peanuts or strawberries. The welts that develop can be up to an inch or so in diameter. “They can be itchy, bothersome, and worrisome; some people have cold uriticaria chronically. For some it’s inherited, but for the vast majority, it’s acquired, meaning that people can just develop it at some point in their lives.”

Unfortunately, treatment methods are not terribly effective or numerous. For most allergies, antihistamines work – not so for cold uriticaria. “The immune system is one of the least well-understood areas of medicine, so it’s a bit of a mystery why antihistamines aren’t more effective,” he says. Some people with mild cases may be helped by antihistamine cream. But the best thing is prophylactic measures, says Dr. Stern: simply avoiding prolonged exposure to the cold is the best way to fight it.

Other people, with very severe cases, may go into anaphylactic shock, and need to carry an epinephrine pen with them. Most people fall somewhere in the middle, and can cope with the hives until they disappear on their own.

3. Rosacea

This condition, in which the face flushes and reddens, is much more common than cold uriticaria, according to Dr. Stern. The added issue with rosacea is that it can be triggered by any type of extreme weather: extreme temperatures, hot or cold; wind; and sunlight. “The perfect storm for rosacea,” says Dr. Stern, “is the brisk cold, a Northeast wind, and the blazing sun.”

Rosacea mainly affects the face, cheeks, and nose, and people often feel like they’re blushing. Tiny, spidery blood vessels, called telangiectasias, may also be visible in the face. “There are several subtypes of rosacea,” had adds. “Sometimes people can have manifestations of redness along with bumps and pustules. Another subset has a reddish, bulbous nose. Others just have an eye manifestation, in which they get dry, irritated eyes and eyelids.”

Certain foods and drinks worsen the condition: caffeine, alcohol, spicy foods, wine, cheese, and yogurt – in short, any foods that contain histamine should be avoided if you have rosacea.

Interestingly, the tetracycline class of antibiotics is one clinical treatment for rosacea, and studies have found that it can be quite effective for some. Other medications, including a compound similar to vitamin A, may also help. Dermatologists may do skin peels and other specialized treatments, but many people with rosacea swear by sunscreen and hats, says Dr. Stern. And of course, staying out of extreme weather as much as possible.

If you suffer from cold weather skin problems, it may be worth visiting your doctor just to rule out any serious underlying conditions. In many cases, these issues tend to clear up when the weather breaks; in the meantime, they can be frustrating and disturbing. Protecting your skin from the elements as much as possible is generally the way to go.