Understanding Hand Discomfort: Concerns Over Chilblains, Raynaud's, and More
As a 32-year-old woman, I experience a daily issue with a distinctive red and blotchy rash on my right hand, which occasionally also affects my left hand and feet. Despite consulting numerous physicians and continuing to seek medical advice, I have yet to find clarity or effective relief for my condition. This rash seems to flare up in response to exposure to severe or prolonged cold, such as venturing outside during winter, staying in a room with temperatures below 65°F for an extended period, or even sitting close to a fan or air conditioning. The episodes are typically fleeting, lasting no more than an hour, but they are quite distressing. The affected area on the back of my hand displays small, red, blotchy spots that do not elevate. The proximal sections of my fingers and the palms at their bases also turn red, presenting an unusual appearance. This discomfort is intense; I experience a burning sensation akin to pins and needles—similar to the pain I felt when I previously had shingles on my right arm around 13 years ago. The affected skin is hotter than its surroundings, making the overall experience particularly uncomfortable. Over the past year and a half, the frequency and intensity of these episodes have escalated, possibly exacerbated by the harsh winters in Ohio. Despite possessing a high tolerance for pain, I find these episodes increasingly unbearable, often having to pause my work-from-home routine while dealing with the discomfort. Initially, an immunologist diagnosed me with cold urticaria; however, since the rash does not present with raised welts, the daily dose of XYZAL does not seem to alleviate the symptoms, and I cannot replicate the condition by applying an ice cube. In terms of my medical history, I have been diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome). Assessments for conditions such as MS (due to my father's history of the disease) and Lupus have not yielded positive results. My last ANA test showed a 1:80 result, and I have positive anti-strand DNA antibodies, while other lab results appear mostly normal. A brain MRI performed years ago did reveal two T2 hyperintensities, likely related to my history of migraines. Potential diagnoses suggested by my doctors include cold hives—though this does not respond to antihistamines—Raynaud's syndrome—despite my fingers not exhibiting the characteristic whitening or bluing—and chilblains, which do not typically appear on a daily basis. Some have also speculated that this could be an immune reaction stemming from my past shingles episode nearly 15 years ago. If it would assist in the diagnostic process, I can provide a comprehensive list of my symptoms; however, I must emphasize that the pain in my hand has become my primary concern. I do make efforts to avoid cold environments, but this is often impractical. Given my POTS and sensitivity to heat, even managing my surroundings at home with avoidance strategies is not always feasible. I am eager for advice and assistance on this issue!
Answers (1)
2/9/2026, 7:10:43 PM
OpenHealth AI
It sounds like you are experiencing a complex and distressing condition with significant discomfort in your hands, which may involve reactions to cold and possibly other underlying issues. Your history, including the diagnosis of POTS and previous shingles, adds to the complexity of your symptoms. Let's break this down.
Main Points:
- Possible Conditions: Your symptoms could suggest a form of cold-induced vasoconstriction or sensitivity, possibly related to Raynaud's phenomenon, cold urticaria, or chilblains, among other conditions.
- Symptom Management: Since current treatments have not provided relief, focusing on self-management strategies will be crucial.
- Documentation: Keeping a detailed symptom diary may help with further evaluations and understanding of triggers and patterns.
Explanation:
The red and blotchy rash, burning sensation, and discomfort in your hands after cold exposure suggest that your body may be reacting unusually to temperature changes. Raynaud's phenomenon typically presents as color changes and may involve pain, but you mentioned that your episodes don’t exhibit the classic whitening or bluing that is typically associated with it. Cold urticaria usually manifests with raised hives, which you also do not have. Chilblains typically occur after prolonged cold exposure but should not occur daily.
Your symptoms might stem from a combination of conditions related to your autonomic nervous system due to POTS and possibly an increased sensitivity in your skin from your previous shingles episode. This can cause exaggerated responses to temperature changes.
Next Steps:
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Symptom Diary: Start a diary documenting when episodes occur, their duration, any potential triggers (like specific temperatures, activities, or foods), and what alleviates them. This can help identify patterns that may not be immediately obvious and provide information for your healthcare provider.
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Temperature Management: Whenever possible, try to keep your hands warm. Use gloves when outdoors, warm water soaks for your hands, or hand warmers to help increase blood flow. You might also find wearing fingerless gloves indoors helpful when working at a cool desk.
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Lifestyle Modifications: Consider limiting exposure to cold temperatures, even in the home. Perhaps adjusting your workspace to a warmer environment could reduce episodes.
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Topical Treatments: Consider using a topical heat rub or a heat wrap on your hands (if tolerable) to help with that burning sensation during flare-ups. Always ensure that you consult with a healthcare provider before starting new treatments.
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Follow-Up Care: Continue your discussions with specialists. If your symptoms worsen or if you encounter new symptoms, such as changes in sensation or mobility, re-evaluation may be necessary for a more comprehensive understanding.
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Support System: It might be helpful to connect with support groups or communities that focus on chronic pain and similar conditions to share your experiences and gain insights from others facing similar challenges.
Please remember to approach these suggestions gradually, and monitor how your hands respond to different strategies. Stay persistent with your doctors to continue seeking clarity on your condition. Your discomfort is valid, and finding relief is important. If you have any other questions or need further guidance, feel free to ask.
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