Cold and Heat

  • Clarissa Barlem HohmannEmail author
  • Renan Rangel Bonamigo


The skin has a fundamental role in preserving human body homeostasis. This balance is influenced by cutaneous blood flow, basal metabolic rate, shivering, and sweating. The degree of cutaneous injury is also influenced by the type of heat or cold source, the duration of exposure, temperature, skin thickness, and individual predisposition. The skin has the capacity to adapt to some changes in temperature, but sometimes these changes can cause severe damage and induce skin diseases. The etiopathogenesis of many diseases caused by cold remains poorly understood, but research suggests that the disruption in the regulation of dermal blood flow has an important role. Burns are very common in our daily life and can be indubitably dangerous. It is crucial that doctors in general know how to manage burns, and it is also important that people in general know how to deal with this problem, because in many cases this knowledge can help to minimize damage in primary care. This chapter highlights the epidemiology, clinical presentation, and current therapeutic approach to the most important diseases associated with heat and cold, namely frostbite, acrocyanosis, chilblains, cold urticaria, cryoglobulinemia, cold panniculitis, burns, and erythema ab igne.


Frostbite Acrocyanosis Chilblains Cold urticaria Cryoglobulinemia Cold panniculitis 




A bacterial skin infection characterized by a swollen, red area of skin that feels hot and tender.


Also known as pernio or perniosis, these are skin lesions resulting from abnormal response to cold temperature and characterized by erythematous or purplish lesions localized on fingers, toes, ears, and nose.


Immunoglobulins that precipitate in vitro at temperatures below 4 °C, and dissolve after rewarming at 37 °C.


Defined by freezing, cold thermal injury, which occurs when tissues are exposed to temperatures below their freezing point for a sustained period of time.


An inflammation of the subcutaneous adipose tissue. Cold panniculitis is a form of traumatic panniculitis caused directly by cold exposure.

Raynaud phenomenon

An intermittent ischemia of the fingers or toes characterized by severe pallor and often accompanied by paresthesia and pain, induced by cold and relieved by heat.


  1. 1.
    Hutchison RL. Frostbite of the hand. J Hand Surg Am. 2014;39(9):1863–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Mohr WJ, Jenabzadeh K, Ahrenholz DH. Cold injury. Hand Clin. 2009;25:481–96. doi: Scholar
  3. 3.
    Zafren K. Frostbite: prevention and initial management. High Alt Med Biol. 2013;14:9–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Hallam MJ, Cubison T, Dheansa B, Imray C. Managing frostbite. BMJ. 2010;341:c5864. doi: Scholar
  5. 5.
    Handford C, Buxton P, Russell K, Imray CEA, McIntosh SE, Freer L, Cochran A, Imray CHE. Frostbite: a practical approach to hospital management. Extrem Physiol Med. 2014;3:7. doi: Scholar
  6. 6.
    Imray C, Grieve A, Dhillon S. Cold damage to the extremities: frostbite and non-freezing cold injuries. Postgrad Med J. 2009;85:481–8. doi: Scholar
  7. 7.
    Bilgiç S, Ozkan H, Ozenç S, Safaz I, Yildiz C. Treating frostbite. Can Fam Physician. 2008;54:361–3.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Jurkovich GJ. Environmental cold-induced injury. Surg Clin N Am. 2007;87:247–67.CrossRefPubMedGoogle Scholar
  9. 9.
    Snoap T, Gallagher E, Snoap A, Ruiter T. Bilateral frostbite of the hands. Eplasty. 2015;15:ic37. eCollection 2015PubMedPubMedCentralGoogle Scholar
  10. 10.
    McIntosh SE, Opacic M, Freer L, Grissom CK, Auerbach PS, Rodway GW, Cochran A, Giesbrecht GG, McDevitt M, Imray CH, Johnson EL, Dow J, Hackett PH. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S43–54. doi: Scholar
  11. 11.
    Woo EK, Lee JW, Hur GY, Koh JH, Seo DK, Choi JK, Jang YC. Proposed treatment protocol for frostbite: a retrospective analysis of 17 cases based on a 3-year single-institution experience. Arch Plast Surg. 2013;40(5):510–6. doi: Epub 2013 Sep 13CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Das S, Maiti A. Acrocyanosis: an overview. Indian J Dermatol. 2013;58(6):417–20. doi: Scholar
  13. 13.
    Das S, Roy AK, Maiti A. Remittent idiopathic necrotizing acrocyanosis – a rare entity. Indian J Dermatol. 2010;55(1):95–6. doi: Scholar
  14. 14.
    Nousari HC, Kimyai-Asadi A, Anhalt GJ. Chronic idiopathic acrocyanosis. J Am Acad Dermatol. 2001;45(6 Suppl):S207–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Glazer E, Pacanowski JP, Leon LR. Asymptomatic lower extremity acrocyanosis: report of two cases and review of the literature. Vascular. 2011;19(2):105–10. doi: Scholar
  16. 16.
    AlMahameed A, Pinto DS. Pernio (chilblains). Curr Treat Options Cardiovasc Med. 2008;10:128–35.CrossRefPubMedGoogle Scholar
  17. 17.
    Prakash S, Weisman MH. Idiopathic chilblains. Am J Med. 2009;122(12):1152–5. doi: Scholar
  18. 18.
    Lutz V, Cribier B, Lipsker D. Chilblains and antiphospholipid antibodies: report of four cases and review of the literature. Br J Dermatol. 2010;163(3):645–6. doi: Epub 2010 Apr 26CrossRefPubMedGoogle Scholar
  19. 19.
    Goette DK. Chilblains (perniosis). J Am Acad Dermatol. 1990;23(2 Pt 1):257–62.CrossRefPubMedGoogle Scholar
  20. 20.
    Long WB 3rd, Edlich RF, Winters KL, Britt LD. Cold injuries. J Long-Term Eff Med Implants. 2005;15(1):67–78.CrossRefPubMedGoogle Scholar
  21. 21.
    La Shell MS, Tankersley MS, Kobayashi M. Cold urticaria: a case report and review of the literature. Cutis. 2005;76(4):257–60.PubMedGoogle Scholar
  22. 22.
    Siebenhaar F, Weller K, Mlynek A, Magerl M, Altrichter S, Vieira Dos Santos R, Maurer M, Zuberbier T. Acquired cold urticaria: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol. 2007;32(3):241–5. Epub 2007 Mar 13CrossRefPubMedGoogle Scholar
  23. 23.
    Buss YL, Sticherling M. Cold urticaria; disease course and outcome – an investigation of 85 patients before and after therapy. Br J Dermatol. 2005;153(2):440–1.CrossRefPubMedGoogle Scholar
  24. 24.
    Page EH, Shear NH. Temperature-dependent skin disorders. J Am Acad Dermatol. 1988;18(5 Pt 1):1003–19.CrossRefPubMedGoogle Scholar
  25. 25.
    De la Borbolla JM, Tapies S, Mbongo C, Lafuente A, Gastaminza G. Cold urticaria: its importance in the operating room. J Investig Allergol Clin Immunol. 2010;20(5):446–7.PubMedGoogle Scholar
  26. 26.
    Sciallis GF 2nd, Krych EH. Localized cold urticaria to the face in a pediatric patient: a case report and literature review. Pediatr Dermatol. 2010;27(3):266–9. doi: Scholar
  27. 27.
    Magerl M, Pisarevskaja D, Staubach P, Martus P, Church MK, Maurer M. Critical temperature threshold measurement for cold urticaria: a randomized controlled trial of H(1) -antihistamine dose escalation. Br J Dermatol. 2012;166(5):1095–9. doi: Scholar
  28. 28.
    Claudy A. Cold urticaria. J Investig Dermatol Symp Proc. 2001;6(2):141–2.CrossRefPubMedGoogle Scholar
  29. 29.
    Weinstein ME, Wolff AH, Bielory L. Efficacy and tolerability of second- and third-generation antihistamines in the treatment of acquired cold urticaria: a meta-analysis. Ann Allergy Asthma Immunol. 2010;104(6):518–22. doi: Scholar
  30. 30.
    Perez-Alamino R, Espinoza LR. Non-infectious cryoglobulinemia vasculitis (CryoVas): update on clinical and therapeutic approach. Curr Rheumatol Rep. 2014;16(5):420. doi: Scholar
  31. 31.
    Terrier B, Cacoub P. Cryoglobulinemia vasculitis: an update. Curr Opin Rheumatol. 2013;25(1):10–8. doi: Scholar
  32. 32.
    Cacoub P, Comarmond C, Domont F, Savey L, Saadoun D. Cryoglobulinemia vasculitis. Am J Med. 2015;128(9):950–5. doi: Epub 2015 Mar 30CrossRefPubMedGoogle Scholar
  33. 33.
    Ghetie D, Mehraban N, Sibley CH. Cold hard facts of cryoglobulinemia: updates on clinical features and treatment advances. Rheum Dis Clin N Am. 2015;41(1):93–108, viii–ix. doi:
  34. 34.
    Fabrizi F, Dixit V, Messa P. Antiviral therapy of symptomatic HCV-associated mixed cryoglobulinemia: meta-analysis of clinical studies. J Med Virol. 2013;85(6):1019–27. doi: Scholar
  35. 35.
    Lauletta G, Russi S, Conteduca V, Sansonno L. Hepatitis C virus infection and mixed cryoglobulinemia. Clin Dev Immunol. 2012;2012:502156. doi: Epub 2012 Jul 10CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s dermatology in general medicine. 7th ed. McGraw-Hill; 2008.Google Scholar
  37. 37.
    Quesada-Cortés A, Campos-Muñoz L, Díaz-Díaz RM, Casado-Jiménez M. Cold panniculitis. Dermatol Clin 2008;26(4):485–9, vii. doi:
  38. 38.
    Huang FW, Berk DR, Bayliss SJ. Popsicle panniculitis in a 5-month-old child on systemic prednisolone therapy. Pediatr Dermatol. 2008;25(4):502–3. doi: Scholar
  39. 39.
    Lipke MM, Cutlan JE, Smith AC. Cold panniculitis: delayed onset in an adult. Cutis. 2015;95(1):21–4.PubMedGoogle Scholar
  40. 40.
    Polcari IC, Stein SL. Panniculitis in childhood. Dermatol Ther. 2010;23(4):356–67. doi: Scholar
  41. 41.
    Torrelo A, Hernández A. Panniculitis in children. Dermatol Clin 2008;26(4):491–500, vii. doi:
  42. 42.
    Pekki A, Sauni R, Vaalasti A, Toivio P, Huotari-Orava R, Hasan T. Cold panniculitis in Finnish horse riders. Acta Derm Venereol. 2011;91(4):463–4. doi: Scholar
  43. 43.
    Ter Poorten JC, Hebert AA, Ilkiw R. Cold panniculitis in a neonate. J Am Acad Dermatol. 1995;33(2 Pt 2):383–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Holla RG, Prasad AN. Cold panniculitis neonatorum. Indian Pediatr. 2009;46(1):75.PubMedGoogle Scholar
  45. 45.
    Rojas Y, Finnerty CC, Radhakrishnan RS, Herndon DN. Burns: an update on current pharmacotherapy. Expert Opin Pharmacother. 2012;13(17):2485–94. doi: Epub 2012 Nov 2CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Lloyd EC, Rodgers BC, Michener M, Williams MS. Outpatient burns: prevention and care. Am Fam Physician. 2012;85(1):25–32.PubMedGoogle Scholar
  47. 47.
    Li H, Guo Y, Yang Z, Roy M, Guo Q. The efficacy and safety of oxandrolone treatment for patients with severe burns: a systematic review and meta-analysis. Burns. 2016;42(4):717–27. doi: Epub 2015 Oct 9
  48. 48.
    Grunwald TB, Garner WL. Acute burns. Plast Reconstr Surg. 2008;121(5):311e–9e.CrossRefPubMedGoogle Scholar
  49. 49.
    Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol. 2012;66(5):e159–65. doi: Epub 2010 Aug 17CrossRefPubMedGoogle Scholar
  50. 50.
    Wasiak J, Cleland H, Campbell F, Spinks A. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev. 2013;3:CD002106. doi: Scholar
  51. 51.
    Zbuchea A. Up-to-date use of honey for burns treatment. Ann Burns Fire Disasters. 2014;27(1):22–30.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M. Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ. 2010;340:c241. doi: Scholar
  53. 53.
    Gauglitz GG, Williams FN, Herndon DN, Jeschke MG. Burns: where are we standing with propranolol, oxandrolone, recombinant human growth hormone, and the new incretin analogs? Curr Opin Clin Nutr Metab Care. 2011;14(2):176–81. doi: Scholar
  54. 54.
    Halim AS, Khoo TL, Mohd Yussof SJ. Biologic and synthetic skin substitutes: an overview. Indian J Plast Surg. 2010;43(Suppl):S23–8. doi: Scholar
  55. 55.
    Huynh N, Sarma D, Huerter C. Erythema ab igne: a case report and review of the literature. Cutis. 2011;88(6):290–2.PubMedGoogle Scholar
  56. 56.
    Arnold AW, Itin PH. Laptop computer-induced erythema ab igne in a child and review of the literature. Pediatrics. 2010;126(5):e1227–30. doi: Epub 2010 Oct 4CrossRefPubMedGoogle Scholar
  57. 57.
    Miller K, Hunt R, Chu J, Meehan S, Stein J. Erythema ab igne. Dermatol Online J. 2011;17(10):28.PubMedGoogle Scholar
  58. 58.
    Riahi RR, Cohen PR. Laptop-induced erythema ab igne: report and review of literature. Dermatol Online J. 2012;18(6):5.PubMedGoogle Scholar
  59. 59.
    Blumetti TP, Affandi AM, Fernandez-Peñas P. Erythema ab igne as a differential diagnosis of chronic graft versus host disease (GVHD). Int J Dermatol. 2012;51(10):1226–7. doi: Epub 2012 Jul 27CrossRefPubMedGoogle Scholar
  60. 60.
    Giraldi S, Diettrich F, Abbage KT, Carvalho Vde O, Marinoni LP. Erythema ab igne induced by a laptop computer in an adolescent. An Bras Dermatol. 2011;86(1):128–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Clarissa Barlem Hohmann
    • 1
    Email author
  • Renan Rangel Bonamigo
    • 2
    • 3
    • 4
  1. 1.Brazilian Society of DermatologyPorto AlegreBrazil
  2. 2.Dermatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  3. 3.Sanitary Dermatology Service of the Department of Health of Rio Grande do Sul State (ADS-SES)Porto AlegreBrazil
  4. 4.Graduate Pathology Program of Federal University of Health Sciences of Porto AlegrePorto AlegreBrazil

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