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Dr. David
Dr. David, Board Certified Physician
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I am asking for a second opinion from a dermatologist. About

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Hi,I am asking for a second opinion from a dermatologist.About 4 weeks ago I was outside in cold weather. It was about -20 degrees C (-4 F) cold, but very dry air and no wind. Went back inside after about 40 minutes.My thighs where red all over, and perhaps swollen, like a sunburn. After a while the skin started to feel like pins and needles. The day after I only had a few patches of red skin left but I had a burning sensation. I was outside the evening before without any symptoms, also for about 40 minutes, and my face did not react to the cold weather. I was warmly dressed, but did not wear long-johns.Today, I still get sensations, which vary over time, with burning, prickling mostly on my thighs, especially on the inside. Almost nothing on my lower legs. The skin is soft and not numb and I don't think it is dry.I have read about other people had similar symptoms, but they disappeared after maybe a few hours, not weeks. I am worried it is related to Vasculitis and maybe peripheral neuropathy.What I want to understand is if my sensations are due to actual nerve damage or if the nerves respond to damages from e.g. the skin or blood vessels. Again, my skin looks fairly normal, although it can get a bit reddish if I apply moisturisers on it. Also from time to time Livedo Regularis can be seen, but not very intense. Livedo regularis is mostly visible where I have the symptoms, on the front of and inside of the thighs. But this is perhaps just a coincidence.The biggest problem is that my skin, or nerves, are very sensitive to textiles, like jeans, then it feels like I am wearing wool against the skin. Very uncomfortable! Otherwise the skin does not itch. I discussed this with a pharmacist, who experienced something similar but in the face. She had burning sensations and pins and needles for about 2 weeks after which it disappeared. Not sure it is related to what I have.I am now on anti depressive medicin to deal with anxiety and maybe to decrease the sensation. The medicin is called Amitriptylin. I have asked this question elsewhere, but I want a second opinion.So why did I get red, maybe swollen thighs, and still, today, burning and hypersensitive skin? And is it permanent, or will it disappear?

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

after extreme temperature changes, it is very normal and common for your skin to flush and have increased blood flow

cold weather causes blood vessel contraction to save on heat loss out of the body

warmer weather can cause blood vessel dilation.

your symptoms don't sound like vascultiits or neuropathy here

Customer: replied 7 months ago.
Ok, so you don't think there are any nerve damages? My skin was soft when I came back indoors, so not numb or white, just red and swollen. I read somewhere that nerve damage could cause the damage, but then again, I did not have any symptoms the day earlier.

no, I don't think there is nerve damage

I think it is normal blood vessel dilation and flushing after big temperature changes.

Customer: replied 7 months ago.
But this happened 4 weeks ago, the skin was red when I came back indoors. Then I went to bed, and it was almost gone the day after. This was March 16. But still today, I have burning sensations on thighs, and my skin is sensitive to textiles.
Customer: replied 7 months ago.
The burning sensations may have decreased a bit, but the skin on my thighs are still sensitive to textiles like e.g. jeans.
Customer: replied 7 months ago.
The sensations are mostly on my inner thighs, where I also have signs of Livedo, but that may just be a coincidence.
So to clarify, the skin was red and swollen just over one night, 4 weeks ago, but the burning sensations continued.

do you have bad anxiety symptoms

bad anxiety symptoms can often magnify symptoms and make you worried about them.

the thigh can be a sensitive area

I don't see nerve damage or skin damage there.

Customer: replied 7 months ago.
I have anxiety but why should I get anxiety symptoms in the exact place where my skin was red?
Customer: replied 7 months ago.
Are you a dermatologist?

excessive anxiety symptoms can magnify small symptoms in your thigh and make you worried about them.

the redness in the area is from normal blood flushing and perfusion in the area.

your skin is very fair in the area

Customer: replied 7 months ago.
I understand that anxiety can magnify the symptoms that I already have. But the question is what is causing my symptoms in the first place. The redness disappeared 4 weeks ago and now I have hypersensitive skin. I don’t think it is just in my head.

the second photo looks less red and the skin is dry.

you should use moisturizer on the skin twice a day to decrease dry skin.

Customer: replied 7 months ago.
maybe. Do you mean that I can get these sensations from dry skin? The skin looks fairly normal, but I can not say for sure. Or can the skin be dry or damaged without no visible signs?

yes, you can get these sensations from dry skin.

the skin will not be damaged without visible signs

you are letting your anxiety get out of control with worry about the skin on your thing

you should put some moisturizer on your skin twice a day

I bet that will help your thigh skin.

Let me know if you have other questions.
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Customer: replied 7 months ago.
again, there are no clear visible signs, except maybe a little dry, that’s it. A neurologist said it may be nerve damage so of course I have anxiety for this.

no, you don't have nerve damage

you have bad anxiety symptoms which need treatment.

Customer: replied 7 months ago.
ok so how do you explain why I have anxiety symptoms at the same place as my skin turned red after cold exposure? I don’t have the symptoms anywhere else.
Customer: replied 7 months ago.
I am not saying you are wrong, I want to believe you of course. Of course nerve damage sounds strange, since then many people should get this, but since a neurologist mentioned it got worried of course.

it is normal for the skin to turn red after cold exposure.

this is a normal reaction of skin to cold.

Customer: replied 7 months ago.
but the burning sensation on the skin and hypersensitive skin can not be normal several weeks after on the location where my skin turned red. I have had red skin earlier from cold weather, but any symptoms then disappeared after maybe an hour or so.
The neurologist referred to this paper:
He say that it may be nerve damage and that it can take months before it gets better, unless it is permanent damage.
And a third doctor said it could be Vasculitis, but that should not give me these symptoms.My anxiety came days after being exposed to the cold weather, when the skin looked normal but I still had burning sensations.
I did not have any anxiety before this happened and I did not feel stressed. Now it's been 4 weeks since that evening.

the skin can burn and be sensitive if dry if you are not putting moisturizer on the skin after you wash and bathe.

put some moisturizer on the skin there 2-3 times a day

I bet it will help