Cold Urticaria

Key Points
Uncommon form of urticaria (Hives)
Exact cause unknown, but condition occurs by exposure to cold temperatures
Consists of small welts surrounded by bright red flares on the skin of the area, or swelling of hands or lips when in contact with cold

Cold Urticaria is a form of Hives, caused by exposure to cold temperatures. The rash consists over very small welts surrounded by bright red flares on the skin of the area. The rash will appear rapidly, and can last up to 30 minutes. Upon formation, the rash is often very itchy, and can form anywhere on the body that is exposed to cold temperatures. Severe cases may be accompanied by fainting, chills, rapid heartbeat, and swelling of the limbs and/or torso. Very rarely, affected persons may experience swelling of the tongue and throat which can block breathing.

The exact cause of cold urticaria is unknown. It is thought that, perhaps due to a hereditary trait, viral or other illness, the skin cells in the affected person become extremely sensitive, and exposure to extreme cold triggers the release of histamines, causing the reaction. While cold urticaria can occur in any gender or age group, persons with and underlying illness or viral infection, children, and those with a family history of cold autoinflammatory disorders are at increased risk for developing Cold Urticaria.

Differential Diagnosis (Other conditions with similar appearance)

Urticaria (Various types)
Atopic Dermatitis
Contact Dermatitis, Allergic
Pityriasis rosea
Drug eruptions
Scabies
Erythema multiforme
Urticarial Vasculitis
Anaphylactoid Purpura)

Diagnosis
Key Points
Diagnosis based on skin appearance
Cold exposure in a clinical setting will confirm diagnosis
Other tests may be performed if an underlying condition is suspected

Diagnosis of Cold Urticaria is generally based on appearance of the affected area, then confirmed by clinical testing, including cold exposure under the supervision of health care professional. If the reaction is suspected to be related to an underlying condition, further tests may be performed to determine that condition.

Treatment
Symptoms may be prevented or reduced through use of medication
Avoiding exposure to cold temperatures is recommended
*Goal of treatment is to control symptoms
OTC Options: Antihistamines

There is no cure for Cold Urticaria, but its symptoms may be alleviated or even prevented through the use of OTC antihistamines. Health care professionals may also prescribe antihistamines, such as Cyproheptadine, or other medications such as Doxepin, an anxiety medication which also helps alleviate the symptoms of Cold Urticaria.