Cold Hands
When fingers turn white, then blue, then red, it’s a likely sign of Raynaud’s phenomenon, blood vessel spasms often caused by sudden cold.
By Rear Adm. Joyce Johnson, D.O

Raynaud’s can be initiated by emotional stress or cold temperatures and can affect fingers, toes, nose, and ears. In the classic response, sudden exposure to cold causes the small arteries just under the skin of the hands to constrict (to move blood to the body’s core to reduce heat loss). When these small vessels constrict, circulation around the skin is reduced, and the hands turn white and feel cold.

Next, the spasm begins to resolve, and some blood circulation returns to the smaller vessels. As the body uses the much-needed oxygen in the now-circulating blood, the hands turn blue and feel numb. As the vessels continue to dilate, circulation rebounds, and the hands turn bright red. This stage might feature painful tingling and throbbing.

Most Raynaud’s attacks last about 15 minutes. Most patients have their first attack between ages 15 and 40, and more women than men are affected. Episodes can worsen in frequency and intensity over time. Diagnosis depends on the signs and symptoms. Medical evaluation includes a search for a primary cause and might include a series of blood and other tests.

Treatment begins by addressing the underlying cause (if one has been identified), usually related to vascular disease, such as carpal tunnel syndrome. Injuries to the hands and feet, diseases of the arteries (atherosclerosis, diabetes), and autoimmune diseases (scleroderma, lupus, rheumatoid arthritis) all can lead to Raynaud’s. Smoking is a significant contributor. Medications that affect the vascular system, such as beta-blockers for high blood pressure or drugs containing ergotamine for migraine headaches, can contribute to Raynaud’s, as can the estrogen in birth control pills. Even over-the-counter cold medications containing pseudoephedrine are contributors. Hobbies and jobs involving chronic vibration of the hands also can be a cause.

Prevent attacks by dressing warmly and avoiding sudden exposure to cold. Some people wear mittens and socks to bed. Wear loose clothing on hands and avoid high-heeled, constricting shoes and tight rings or other jewelry.

Stopping smoking is essential to treatment and contributes to prevention. In severe cases, medications that dilate blood vessels are prescribed. If Raynaud’s is triggered by stress, consider biofeedback and other techniques to reduce stress. During an attack, certain exercises can increase circulation. Warming your hands will shorten the spasms.

Raynaud’s is a chronic, repetitive problem, and over time it can reduce circulation. A severe episode can cause permanent blockage of the arteries, but typically the immediate effects of Raynaud’s end when an attack does.

— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources online at www.moaa.org/wellness.