Dear Dr. K.: In cold months I get episodes when my hands get red, swell, itch and burn for days at a time. The problem was even worse when I visited my daughter in Toronto. Could I be allergic to cold?
The answer to your question is yes, but I don’t think that is the actual cause of your problem.
In the past 20 years there has been an extensive amount of research on a group of conditions called “physical allergy.” One common physical allergy is cold urticaria (hives). But your problem sounds more like a condition called pernio. Unlike cold urticaria which comes and goes quickly, pernio symptoms last for days at a time.
Pernio typically affects the acral parts of the body: hands, feet and nose. These are the areas of the body that tend to be coolest owing to exposure and being at the end of the blood circuit. In most cases pernio is a benign condition with no known cause. But in a few individuals it can be a harbinger of some other disease process. It is known to be more common in smokers, which makes sense because it is known that cigarette smoking narrows blood vessels. Most people with pernio have normal labs, but some show cold-activated proteins such as cold agglutinins or cryoglobulins. These can occur due to an underlying infection such as strep or hepatitis. Other lab results can be abnormal if the cause for the pernio is an autoimmune condition such as vasculitis, lupus, or rheumatoid arthritis.
The onset of pernio can also occasionally be the first sign of a cancer, such as multiple myeloma, breast or colon cancer. Because there is a possibility of underlying disease, it is a good idea to see your primary care doctor and have a good physical.
If no cause is found, pernio is treated by first keeping warm. Smoking cessation is very important. Typical treatments can help, such as cortisone creams and nitroglycerin ointment (it dilates blood vessels). If the symptoms are severe, oral therapies that help blood flow improve include aspirin, minoxidil, nicotinamide and pentoxifylline.