Everyone’s fingers turn a little red when they’re chilly. They may even feel a bit numb. But for people with Raynaud’s, a disorder of the blood vessels, the numbness and color changes can be severe, even painful.
“When someone with Raynaud’s is exposed to cold or even emotional stress, the small arteries that supply blood to the skin narrow and spasm in an exaggerated way, preventing the blood from getting to the distal extremities — or the most far-away areas — like the fingers and toes,” says Jessica Gordon, MD, an associate attending physician in the Division of Rheumatology at HSS. This “Raynaud’s phenomenon” or Raynaud’s attack causes the skin’s surface to feel cold and look white or yellow.
If the blood flow is restricted for longer periods of time, those areas may feel numb and turn purplish blue. Eventually the vessels expand again, allowing blood flow to return, which can cause the skin to go very pink or red and burn or tingle. These attacks usually last anywhere from a few seconds to several hours.
While Raynaud’s most often affects the blood vessels in the fingers and toes, it can also affect the ears, nose, face, knees, tongue, and/or nipples. Between 3 to 20% of the population has this condition, which is more common in women, smokers and those who live in colder environments.
There are two types of Raynaud’s: primary and secondary. Primary Raynaud’s, the more common type of the disease, has no underlying cause. “It's just an exaggerated physiologic response,” says Dr. Gordon. It’s generally less troublesome than secondary Raynaud’s and often responds well to lifestyle treatment.
Secondary Raynaud’s has a known cause, which could include one of the following:
While secondary Raynaud’s is less common, it’s also more difficult to treat and often requires medication rather than just lifestyle changes.
Historically, doctors would dip patients’ hands into an ice bath to see what happened to their fingers. “Luckily, we don’t do this anymore because it can be quite painful for individuals with Raynaud’s,” says Dr. Gordon. These days, doctors rely on the patient to tell them what’s going on. “Patients will tell me their fingers turn white or blue whenever they go outside – even if it’s 60 degrees out. Or they’ll say their fingers change color when they put their hand in the freezer to grab a pint of ice cream.” Many people take pictures of their hands when it’s happening, which Dr. Gordon finds helpful to make the diagnosis.
Winter can be tough for those affected by Raynaud’s. The first thing to consider is your outerwear. Be prepared for changes in weather if you’re going to be spending time outside. Dress in layers and include a hat, gloves and warm boots. “It’s all about being ready with the right clothing,” says Dr. Gordon. “Sometimes the change in season from cold to warm, or vice versa, is the hardest because it can be tricky to be prepared for the different weather changes over the course of a day.”
She also offers these suggestions to help you deal with any discomfort:
If lifestyle changes aren’t enough, medications can be helpful. They work by dilating (widening) the blood vessels, reducing the frequency and severity of Raynaud’s attacks. Some people may only need them in the winter, others year-round. It’s important to keep attacks to a minimum to prevent tissue damage. This can include finger ulcers, which can be very painful.
Calcium channel blockers are used most often. They include amlodipine, nifedipine and felodipine. Because they decrease blood pressure, they may not be ideal for those who already have low pressure. Dr. Gordon adds that they may cause dizziness or headaches. “But once you get used to the medicine, those side effects often disappear,” she says.
If Raynaud’s symptoms bother you, or you think you may have an autoimmune disorder that’s causing Raynaud’s, Dr. Gordon recommends a visit to a rheumatologist.