Cold weather, dry air outdoors and indoor heating create a particularly harsh environment for the skin. For most people, this may simply mean increased dryness. For people with atopic dermatitis, eczema, psoriasis or other skin conditions, however, winter can bring genuine flare-ups.
“Winter and cold weather significantly affect the skin, mainly because cold, dry air, combined with low humidity and increased indoor heating, disrupts the skin barrier and increases dryness and irritation,” Sotirios Theocharis, president of the Hellenic Society of Dermatology and Venereology, tells TO BHMA.
From Eczema and Psoriasis to Rosacea
At the top of the list of those most vulnerable are patients with atopic dermatitis and eczema in general. Flare-ups are also more common with seborrheic dermatitis.
“Psoriasis can flare up in a significant proportion of patients during the cold and dry months. However, there is no single rule that applies to all patients, as the disease’s seasonal pattern varies considerably from person to person,” Theocharis notes.
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Rosacea can also be aggravated. The inflammatory skin condition affects the face and can cause visible small blood vessels, inflammatory lesions and a burning sensation.
There are also conditions that are much more directly linked to exposure to cold, such as cold urticaria and the familiar chilblains, also known as pernio. Here, too, a seemingly simple skin lesion can sometimes be a sign that further investigation is needed.
When the Cold Reveals Something More
“There is a particular category we need to keep in mind: chilblain lupus, a form of cutaneous lupus erythematosus in which lesions on the fingers and other areas of the extremities appear or worsen in the cold. Chilblains can also occur secondarily in patients with systemic autoimmune or other diseases. That is why persistent, recurring or atypical lesions require medical evaluation,” Theocharis stresses.
Raynaud’s phenomenon is also of particular interest. According to Theocharis, it affects 2% to 4% of the general population and is characterized by sudden changes in the color of the skin on the extremities.
“It should be investigated for the possible presence of a systemic disease,” he says. The key, however, is not to assign the cold a causal role that it does not have.
“Cold is not, by itself, the cause of all these diseases. In many cases, it acts as a factor that disrupts the skin barrier, causes vasospasm or triggers a flare-up of an existing skin condition.”
No Single Treatment for “Winter Skin Conditions”
Precisely because these are different diseases, there is no single winter treatment.
For dry skin and eczema, the first goal is to restore the skin barrier through the regular use of appropriate moisturizing and emollient products, while avoiding very hot water and irritating cleansers. When inflammation is present, treatment should be determined by a dermatologist.
“For atopic dermatitis, there are now many effective treatments, ranging from topical therapies to phototherapy and modern targeted systemic treatments. In psoriasis, treatment is tailored according to the extent and severity of the disease and may include topical treatments, phototherapy or systemic therapy, including newer biologic and other targeted treatments,” he says.
For chilblains, by contrast, the first step is protection from the cold and gradual rewarming of the extremities. Persistent or recurring lesions require evaluation for a possible underlying disease. In cases of chilblain lupus, cooperation between a dermatologist and a rheumatologist may even be necessary.
The Mistakes We Make When It Gets Cold
Everyday prevention is much simpler. Warm clothing, gloves and socks, protection for the face and ears, and avoiding prolonged exposure to very low temperatures form the first line of defense.
“Proper skin moisturization is equally important. Gentle cleansers are recommended, along with applying a good moisturizer immediately after bathing and reapplying it during the day when there is dryness. Bath water should not be very hot, and baths should not be prolonged,” Theocharis says.
Another mistake is trying to warm up frozen hands or feet abruptly with very hot water or by placing them against a radiator.
“Rewarming should be gradual,” he warns.
As for diet, he dismisses the idea that there is a special diet that protects the skin during winter.
“There is no specific ‘winter diet’ that prevents skin diseases.”
A balanced diet is sufficient, while arbitrary food restrictions or supplements are not recommended without a specific indication. One exception is psoriasis, for which there is evidence that weight loss in overweight or obese patients may reduce the severity of the disease.
Have skin conditions increased?
Theocharis is cautious on this point as well. In everyday clinical practice, dry skin, eczema and worsening of chronic skin conditions are frequently observed during the colder months.
That, however, is not enough to conclude that dermatological diseases overall have increased in recent years, as comparable epidemiological data would be required.
“What is certain is that the winter months are a period when many patients with chronic skin conditions need greater care and adjustments to their daily skin-care routine.”
The message he says people should take away is simple:
“Cold does not cause most skin diseases by itself, but it can disrupt the skin barrier, trigger flare-ups and, in some cases, reveal an underlying vascular or autoimmune disorder.”