What Cold Induced Urticaria Looks Like

All of these pictures are of my daughter and her reactions to temperatures that are colder than her.  Her diagnosis has changed multiple times with the most current being stated as Chronic Cold Induced Idiopathic Urticaria with Angioedema. Basically this means that she has an autoimmune inflammatory allergic type of reaction caused while in the cold.  The pictures below are all of different ages.  When I say cold, I am not necessarily speaking of freezing temperatures.  A person with this condition has a low threshold for temperature tolerance.  In my daughter's case, anything colder than her can cause a reaction - even sweating.  Her threshold during the winter is based on any temperature below 70 degrees.  She can breakout while outside, and inside in air conditioned buildings.  There are other symptoms which cannot or should not be displayed here such as asthma, anaphylaxis, extreme tiredness, headaches, low blood sugar, dehydration, low blood pressure, low body temperature, vomiting, stomach pains, flushing appearance, and other forms of urticarias.  For my daughter, she is allergic to both heat and cold.


One of the first identifiers that a reaction is about to begin is that her face loses most of its red or pink coloring.  The bottom eye lids turn a purple color.


       





Red flares begin to show on her ears, face, and joints; elbows, knuckles on her hands, knees and ankles.  Starting on the joints only are not typical for all sufferers of Cold Urticaria.










Here is how they appear on the elbows when they first begin to swell just prior to becoming wheals.







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People with this condition do not have to  be cold to breakout.  This welt was caused by direct exposure to cold air.

Warm sunny days with a light breeze can cause a reaction on exposed skin.

Skin not directly exposed to cold can also have a reaction.

With a large enough reaction, it can look as though the person was bit by many mosquitos or fire ants.  It feels the same way too.  Reactions on the surface of the skin starts with a burning sensation and then added to that is intense itching.

Eventually, when exposed long enough, swelling occurs in the affected area.









Though my daughter's reaction typically begin on the joints, the reactions spread to all areas in between.  Every area of the body is affected.

The appearance of the reactions can change in appearance depending on the type of medication taken to prevent them.  As you can see in this picture, some people may have an associated discoloration (blue tint) to the skin during a reaction.  Some can be much more severe than this.







This reaction originally looked just like the pictures of the arms above, completely covered.  After dipping in a warm bath, this is what the reaction looks like as it goes away.

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 This is angioedema.  The difference is that the reaction is deeper in the tissue (where there are no nerve endings).  These reactions do not itch or burn and they don't go away for more than 24 hours.
Again, you can see the blue tint in the skin.  In this case, it is known as Acrocyanosis.

These reactions are flat, they don't wheal up.  In my daughter's case, they usually had a white halo around them.

After the reaction goes away, a scarring effect occurs.  These are like water stains left on a table after a glass is removed.  These usually remain for a couple days until full healing has occurred.