The Cold Truth About Raynaud’s

woman wearing slippers and holding a mug

The heart of winter is around the corner. For many people, that means it’s time to break out the boots and argue with family about the appropriate time to take down holiday lights.

But if you have Raynaud’s, you know that the cold weather can be a bit more stressful.

What is Raynaud’s?

Raynaud’s is a disorder of the blood vessels, generally in the fingers and toes. “When you are exposed to cold (e.g., cold weather, holding a glass of an iced drink), or in some individuals, emotional stress, the blood vessels narrow, keeping the blood from getting to the surface of the skin,” explains Paula S. Barry, MD, physician at Penn Family and Internal Medicine Longwood.

This causes the affected areas to turn white and blue. When blood flow returns, the skin turns red, and may throb or tingle. In very rare, severe cases, the loss of blood flow can cause ulcers or tissue death, but usually, Raynaud’s is not dangerous—it’s just painful and frustrating.

The Two Types Of Raynaud’s

The first step towards understanding Raynaud’s is finding out which type you have: primary or secondary.

Primary Raynaud’s is typically referred to as “Raynaud’s Disease” and it occurs on its own, for no known reason. While it can be frustrating, it’s generally less severe than secondary Raynaud’s. “It is due to an increased or elevated vascular response to a stimuli. Although it can occur in both sexes it is more common in women,” says Dr. Barry.

Secondary occurs from an underlying cause, like disease, injury, or certain medications. It’s usually diagnosed in people between ages 35 and 40. Many times, this type of Raynaud’s is called “Raynaud’s Phenomenon.”

So, what exactly are these underlying causes?

“When Raynaud’s is due to a disease, it often happens in people with a connective tissue disease—one that affects blood flow to tissues and organs,” Dr. Barry explains.

The most common connective tissue diseases that cause Raynaud’s include:

  • Lupus
  • Sjögren’s syndrome: Dryness in the eyes and mouth.
  • Scleroderma: Tissues and skin can harden.
  • Rheumatoid Arthritis

Other conditions that can cause secondary Raynaud’s include carpal tunnel syndrome, which affects nerves in the wrists, and certain diseases of the arteries, which causes narrowing of the blood vessels in the arms and legs.

You don’t need to have a disease to get secondary Raynaud’s. Certain blood pressure, migraine, cancer medications, birth control pills, and over-the-counter cold medications, can all be the culprit.

And, people who work with tools that vibrate (e.g., jackhammer) or are around certain chemicals (e.g., vinyl chloride) are at further risk for developing this disorder.

Smokers also have an increased risk of Raynaud’s —As well as heart attack, stroke, and lung cancer.

Recognizing Raynaud’s

Physicians don’t make a habit of sticking patients’ hands in ice water, however, they might make an exception if they think you have Raynaud’s.

Although a diagnosis is often made based on a patient’s description, the ice water test or cold immersion test has been done in certain centers. It doesn’t always work— some people only have episodes when their whole body has been exposed to cold—but it can be a good gauge. If your fingers take more than 20 minutes to get back to a normal temperature, you may have Raynaud’s.

Dr. Barry further explains, “The mainstay of diagnosis is a thorough history and physical examination by a physician. The age of onset as well as duration of symptoms are important questions that your physician may ask. In addition, the symmetry of symptoms can shed light on a diagnosis.”

If you don’t like needles, you may be in luck as there is no blood test to identify this disorder. However, your luck might change pretty quickly if your physician chooses to order blood tests to rule out other diseases (e.g., lupus, Sjögren’s syndrome) that could be causing the Raynaud’s.

There’s also the nailfold capillaroscopy (KAP-ih-lar-OS-ko-pe). Don’t worry—the test is much easier to perform than it is to say.

During the test, your physician will put a small drop of oil at the base of one of your fingernails. They will then look at your nail under a microscope. If your arteries appear abnormal, you could have a disease linked to Raynaud’s (e.g., scleroderma).

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Feel Better Soon

There’s no cure for Raynaud’s, but there are plenty of treatments to reduce the number and severity of episodes.

If you have primary Raynaud’s, you may be able to manage the disease with lifestyle changes:

  • Invest in a good pair of gloves or mittens, thick socks, and hand or foot warmers if you’re going to be in temperatures under 60° Fahrenheit.
  • Avoid triggers, like stress or certain medications.
  • As soon as you feel an episode coming on, soak your hands in warm water.
  • Limit repetitive hand motions, like playing the piano or typing.
  • Increase physical activity and exercise.
  • Increase the temperature of air conditioning or wear warm clothes when in an air-conditioned space.

“If lifestyle modifications do not work, medications that improve blood flow to the toes and fingers (e.g., calcium channel blockers, prescription skin creams) can often do the trick,” says Dr. Barry.

In rare cases, Raynaud’s can become severe. If it causes skin sores or gangrene—decay or death of body tissues—you may need antibiotics or surgery to remove the damaged tissue. In very serious cases, it might be necessary to remove the affected toe or finger. But don’t panic—this is extremely rare.

Secondary Raynaud’s can also be treated with lifestyle changes, but it often requires a little more advanced medical treatment, including the use of medication.

If you think you’re experiencing symptoms of Raynaud’s, talk to your primary care provider.

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