How to diagnose and treat winter rashes

In the winter months, the air outside doesn’t just get colder. It also gets drier. Cold air holds less moisture than warm air, leading to lower humidity and the kind of conditions that can dry out your skin and contribute to a winter rash. Heating our homes also makes the air in our home less humid. These dry, irritated patches of skin can be red, flaky, itchy, and sometimes painful.  They often return winter after winter, even if you never experience skin rashes during warmer months.

Without treatment, winter rashes can last all season and can negatively impact your well-being. But with proper diagnosis and treatment plan, most skin rashes can be managed successfully. Recognizing the signs of winter rashes and beginning treatment early can help alleviate symptoms, keep the rash from spreading, and help you get back to enjoying the cooler weather.

What does winter rash look like?

Although they occur during the colder months, winter rashes look a lot like their summer counterparts. Common symptoms of winter rash include:

• Redness
• Swelling
• Itchiness
• Bumps
• Blisters
• Flaky skin

“Winter rash is most common in the hands and feet, as these are the most likely to be exposed to cold air,” says Marie Jhin, MD, a board-certified dermatologist and president of Premier Dermatology in San Carlos, California. The hands and feet are also the ends of our bodies, with less blood flow, which puts these parts of the body at risk for feeling and reacting to the cold air. 

A common spot for rashes on skin that isn’t directly exposed to cold air is the shins. “The skin in your shins is thin, and while the blood goes down to our legs well, it doesn’t go back well, so that skin can get very dry,” says Sandra Marchese Johnson, MD, a board-certified dermatologist at Johnson Dermatology in Fort Smith, Arkansas. 

Winter rashes can also be found in the limbs, chest, back, or other body parts, and they can affect just a small patch of skin or be widespread across the body.

Causes of winter rash

Winter rashes often occur because cold, dry air, and chilly breezes can strip the skin of the layer of natural oils and dead skin cells that help protect it. For some people, that might mean little more than dry skin that’s a little itchy and flaking, but for others, cold temperatures can trigger more serious skin rashes, especially in people who have a history of other types of rashes. Common causes of winter rashes include the following skin conditions.

• Eczema (atopic dermatitis): Low humidity, frequent bathing, and using harsh soaps can dry out the skin and trigger eczema or make it worse, resulting in dry, itchy skin that can be red and flaky. Eczema can show up anywhere on the body, but is most common at wrists, elbows, and knees.
• Cold urticaria (hives): People whose skin is sensitive to the cold can develop hives, which are red welts on the skin that may be itchy, swollen, or accompanied by a burning sensation. Some people may experience swollen lips or swelling in the throat, or they may feel faint or lightheaded. Hives are most common on skin that has been directly exposed to cold air. To avoid this, wear gloves, hats, scarves, and a warm coat.
• Rosacea: The dry air, bright sunlight, and cold winds of winter can bring on rosacea. This common skin rash causes red flushing or blushing and tiny visible blood vessels in the skin of the face. The full name for this condition is acne rosacea because rosacea can have small, pus-filled bumps.
• Psoriasis: People with psoriasis may find that the condition gets worse in the winter due to low humidity and fewer hours of sunlight each day. Depending on which type of psoriasis a person has, they may develop itchy, scaly patches of skin, cracked skin that can bleed and itch, swollen joints, soreness, or a burning sensation.
• COVID-19: Rashes are an uncommon symptom of coronavirus, but in the winter “some people with the virus have COVID toes,” according to Dr. Johnson. “This is when your toes turn blue when they get exposed to cool, damp air.” Best treatment for this is avoidance: Get the COVID-19 vaccine (and booster), wear a mask, and socially distance.
• Viral infections: There are several viral infections that can cause skin rashes. These include chickenpox, shingles, mononucleosis, measles, fifth disease, and roseola. Each of these rashes looks different from the other. A trained provider will help diagnose.
• Allergies (contact dermatitis). In addition to cold urticaria, which is essentially an allergy to cold weather, cold temperatures and dry skin can make people more susceptible to contact dermatitis, a red, itchy, flaky rash that develops on skin that comes in contact with something to which the person has an allergy.

RELATED: Psoriasis vs. eczema vs. dry skin: How to tell the difference

When to see a doctor

Most winter rashes are harmless and can be treated at home with creams and ointments that keep the skin moisturized, but more serious cases may warrant a visit to a dermatologist or other healthcare provider. 

“See a doctor if moisturizers don’t work and the rash keeps getting worse,” Dr. Jhin says.

Scratching at rashes can break the skin and lead to a bacterial infection such as cellulitis or a skin abscess. See a doctor if you notice symptoms of an infection. Symptoms include skin that is red, swollen, warm, or tender to the touch. A skin abscess is when an infection pools the pus into one location. Antibiotics may help an abscess, but the abscess often needs to be drained in a provider’s office.

If cold urticaria or another allergic reaction makes it difficult to breathe or leads to anaphylaxis, call 911 or seek medical attention right away. 

How to treat and prevent winter rash

The first line of defense when it comes to preventing a winter rash is to keep the skin moist and hydrated. Little cuts in the skin is what allows infection in the skin. Limit the skin’s exposure to cold air by covering up. This can often be done with the help of simple home remedies.

1. Use moisturizers

Keep your skin from drying out by applying moisturizing skin care products at least twice a day. “Moisturizers can help keep your skin from drying out,” says Dr. Jhin. “You can also try to use moisturizer and occlude with plastic wrap or wear a sock for a few hours to bring moisture back to the skin. Also, taking a bath and moisturizing the skin right afterward may help.” The American Academy of Dermatology (AAD) also recommends applying moisturizer soon after bathing, while the skin is still damp, to lock in hydration and create a barrier against germs. It’s important to do this right after a bath or shower, otherwise bathing dries out the skin. The AAD also recommends using a fragrance-free cream or ointment, rather than a lotion. Lotions have more water than oil, and oil is better at sealing moisture into the skin. Coconut oil and petroleum jelly also work well.

2. Run a humidifier

When it’s cold, we tend to turn up the heat inside, which can make the air even dryer. Use a humidifier to increase the humidity in your bedroom may help keep your skin from drying out. If you don’t have a humidifier, the National Eczema Association (NEA) recommends just leaving a bowl of water in each room to help increase the humidity. In either case, be sure to clean the humidifier or bowl often to prevent bacteria from aerosolizing in your home.

3. Bathe or shower in lukewarm water

Hot showers or baths can cause skin irritation, so keep the water temperature lukewarm, use a gentle cleanser, and avoid scrubbing the irritated skin. Adding well-ground (colloidal) oatmeal to a bath can help relieve an itchy rash. Afterward, be sure to “soak and seal” by applying a high-oil-content moisturizer within three minutes of getting out of the tub or shower.

4. Don’t forget the sunscreen

Cold temperatures can make us forget that the sun can be very bright in the winter. Sunburns can dry out sensitive skin and make it more susceptible to a rash or skin cancer. The NEA recommends using an alcohol-free sunscreen with an SPF of at least 30 and broad-scale protection against UVA and UVB rays.

5. Avoid rapid changes in temperature

If you’re prone to rashes, going from a warm environment to a cold one, or vice versa, can cause a flare-up. Try to keep your skin temperature even by dressing in layers, and avoid sitting by hot things like fires or radiators. Heat can often trigger scratching, and scratching often harms the skin and can introduce infection under the surface of the skin. 

6. Topical steroid creams

Creams and ointments containing 1% hydrocortisone can help soothe itching and reduce inflammation. Over-the-counter cortisone creams are marketed as Cortizone-10. 

7. Antihistamines

Over-the-counter oral antihistamines can help relieve itching. Three common types are Claritin (loratadine), Zyrtec Allergy (cetirizine) and Benadryl Allergy (diphenhydramine). Zyrtec and Benadryl can both cause drowsiness, so take them with caution if you need to remain alert.