Cold Exposure and Skin Health
Cold application causes cutaneous vasoconstriction, reduces transepidermal water loss (TEWL) transiently, and closes hair follicle and pore appearance. Cryotherapy at −10 to −196°C destroys abnormal tissue via ice crystal formation and osmotic cell death. Repeated cold exposure can cause chilblains (pernio) — erythematous, itchy lesions on extremities.
| Measure | Value | Unit | Notes |
|---|---|---|---|
| Dermatological cryotherapy temperature | −10 to −196 | °C | Liquid nitrogen: −196°C; cryopen/nitrous: −70°C; dry ice: −78°C; contact freezing for lesions |
| Wart clearance rate (cryotherapy) | 70–80 | % | 2–3 treatment cycles; recurrence rate ~25% |
| Skin vasoconstriction on cold contact | Within seconds | Immediate reduction in cutaneous blood flow; reduces redness (erythema) temporarily | |
| Chilblains typical onset temperature | <10°C | ambient | Repeated cold/damp exposure; most common in autumn/spring; fingers, toes, nose, ears |
| TEWL reduction (cold water) | Transient | Cooling skin briefly reduces transepidermal water loss; effect reverses on rewarming | |
| Cold panniculitis onset | Hours to days | post-cold exposure | Fat cell damage from cold; most common in infants and those with excess adipose; erythematous indurated lesions |
Cold affects the skin in multiple, sometimes opposing ways — from beneficial transient vasoconstriction and pore-appearance reduction used in skincare, to medically deployed cryotherapy that destroys pathological tissue, to harmful conditions like chilblains from chronic cold exposure.
How Cold Affects Skin Physiology
Immediate effects (seconds to minutes):
- Cutaneous vasoconstriction → reduced blood flow → pallor → reduced redness
- TRPM8 cold receptor activation → intense cold sensation
- Reduced transepidermal water loss (TEWL) → brief moisture retention
- Reduced inflammatory mediator delivery (vasoconstriction limits access)
After rewarming (minutes to hours):
- Reactive hyperemia → flush, redness → improved color
- Vasodilation opens capillary beds → skin appears more “glowing”
- Inflammatory mediators resume delivery
- No structural change to pores (no muscle to maintain vasoconstriction long-term)
Dermatological Cryotherapy — Medical Applications
| Application | Temperature | Method | Clearance Rate |
|---|---|---|---|
| Common warts | −196°C (LN₂) | Spray/probe, 2–3 cycles | 70–80% |
| Plantar warts | −196°C (LN₂) | Probe, aggressive | 60–75% |
| Actinic keratoses | −196°C (LN₂) | Spray, 1–2 cycles | 75–90% |
| Seborrheic keratoses | −196°C (LN₂) | Spray/probe | 85–95% |
| Keloids | −196°C (LN₂) | Intralesional or contact | 50–70% (partial response) |
The mechanism is distinct from recreational cold therapy: liquid nitrogen destroys cells via ice crystal formation (mechanical membrane rupture), osmotic damage from cellular dehydration, and vascular injury.
Cold-Related Skin Conditions
Chilblains (Pernio)
- Cause: Repeated cold (<10°C) + damp exposure; rapid temperature changes
- Presentation: Red, purple, itchy/painful swollen areas; fingers, toes, ears, nose
- Not frostbite: Occurs above freezing temperatures
- Treatment: Rewarming, nifedipine for severe cases, avoiding cold/damp triggers
Cold Urticaria
- Cause: Mast cell degranulation triggered by cold temperature on skin
- Presentation: Hives (urticaria) on cold-exposed areas; systemic anaphylaxis on total body cold immersion
- Diagnosis: Ice cube test (4–5 min application) — wheal formation confirms diagnosis
- Treatment: Second-generation antihistamines; epinephrine auto-injector for severe cases
Cold Panniculitis
- Cause: Direct cold damage to subcutaneous fat (adipocytes crystallize at higher temps than other cells)
- Who: Primarily infants, people with high subcutaneous fat
- Presentation: Indurated, erythematous plaques hours to days after cold exposure
- Note: Basis for “fat freezing” cosmetic CoolSculpting procedure
Frostbite
- Cause: Tissue freezing (extracellular then intracellular ice crystal formation)
- Temperature: Below −0.55°C in tissue
- Stages: Frostnip (reversible) → superficial frostbite → deep frostbite (irreversible necrosis)
- Treatment: Rapid rewarming in 40–42°C water; no rubbing; avoid refreezing
Related Pages
Sources
- Lucock M et al. (2022) — Cold water facial immersion: effects on skin. Int J Dermatol
- Thai KE et al. (2004) — Cryosurgery of benign skin lesions. Australas J Dermatol
- Belotto R et al. (2020) — Cold and skin conditions. J Eur Acad Dermatol Venereol
Frequently Asked Questions
Does cold water tighten pores or improve skin?
Pores do not have muscles and cannot permanently 'tighten' or 'close.' However, cold water temporarily constricts blood vessels in the skin, which reduces puffiness and the appearance of enlarged pores (since less blood flow means less vascular dilation contributing to pore visibility). The cold-induced vasoconstriction also briefly reduces transepidermal water loss. After rewarming, reactive vasodilation produces a healthy flush. These effects are transient and cosmetically useful but not structurally transformative. Cold water is also useful for hair — cooling hair after washing smooths the cuticle layer, increasing shine and reducing frizz.
What is cryotherapy used for in dermatology?
Dermatological cryotherapy uses liquid nitrogen (−196°C) or other freezing agents to destroy abnormal tissue by forming ice crystals within cells (rupturing cell membranes) and causing osmotic damage. It is used for: common and plantar warts (70–80% clearance rate); actinic keratoses (precancerous sun damage); seborrheic keratoses; molluscum contagiosum; keloids and hypertrophic scars; certain superficial skin cancers. The procedure is well-tolerated, outpatient, and does not require anesthesia for most lesions. It differs fundamentally from recreational cold therapy in temperature, localization, and intent.
What are chilblains and how are they caused by cold?
Chilblains (pernio) are painful, itchy, inflammatory lesions that develop on the skin after repeated exposure to cold and damp conditions — typically at temperatures below 10°C, which is not truly freezing. The mechanism involves repeated cycles of cold-induced vasoconstriction followed by sluggish rewarming, causing microthrombi and inflammatory damage in small blood vessels. They present as red, purple, or blue-tinged swollen areas on fingers, toes, ears, and nose. Unlike frostbite (tissue freezing), chilblains occur at above-freezing temperatures. They are distinct from Raynaud's phenomenon and are not a form of frostbite.