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Cold hands and feet of Raynaud's phenomenon
often effectively treated at home

By: Daniel Palmquist, M.D.

It’s the time of year when just about everyone is complaining about cold hands and feet. For approximately 28 million people in the U.S., however, cold hands and feet are a symptom of a condition known as Raynaud’s phenomenon.

Raynaud’s is a condition where the body overreacts to cold temperatures by restricting blood vessels so that the blood flow to the surface tissues of the hands and feet is temporarily decreased. Typically fingers and toes are involved, although blood flow to the nose, ears and lips can also be affected.

There are two kinds of Raynaud’s phenomenon. Primary Raynaud’s, the most common form, occurs by itself. Secondary Raynaud’s usually occurs as part of another disease, such as lupus, scleroderma, rheumatoid arthritis or atherosclerosis. Other causes of secondary Raynaud’s include taking certain medications such as beta blockers, using vibrating power tools over the course of a number of years, smoking, frostbite and carpal tunnel syndrome.

Who gets it
Anyone anywhere can have Raynaud’s phenomenon, however women are affected nine times more often than men. Primary Raynaud’s most often develops between the ages of 15 and 25. The disorder is more common in colder climates. Finally, there seems to be some correlation with family history and the condition. About one-third of people with primary Raynaud’s have a close relative who also has the disorder.

Triggers
The cause of Raynaud’s isn’t completely understood, but attacks are most often brought on my cold temperatures. Exposure to cold can be as brief as putting your hands into cold water or taking something out of the freezer. A less common cause of the disease is stress. In some people, stress causes a similar reaction to cold and blood vessels constrict in response.

Symptoms
As the blood supply is restricted to fingers and toes, they become cold and numb and turn white at the tips. As blood flow returns, the digits may ache and feel as though they are throbbing, stinging or tingling. Fingers and toes may turn blue, and then red. An attack can last from just a few minutes to several hours. Symptoms can affect an entire hand, or just one or two fingers (or toes). Different digits may be affected with different attacks.

Typically, Raynaud’s is more of a nuisance than serious ailment. Most people manage it at home; only one out of five with the condition seeks medical treatment.

In rare cases, blood circulation can permanently diminish, causing ulcers or gangrene. If you develop an ulcer or infection from Raynaud’s you should seek immediate medical attention.

Minimizing symptoms
There are a number of things you can do to ward off attacks and lessen symptoms when they occur. Many involve keeping your fingers, toes and entire body warm. When you are outside, wear loose-fitting layered clothing. Wear a hat, mittens, wool or synthetic socks and warm boots. Stay dry.

When inside, use oven mitts to take items out of the freezer. Use mittens or gloves when in the frozen foods section of the grocery store. You may want to wear mittens and socks to bed. Drink warm liquids, and use an insulated cup when drinking cold beverages.

In general, take steps to reduce anxiety in your life. Quit smoking. Avoid caffeine and cold medications that contain pseudoephedrine. Finally, include exercise in your daily routine. It can help to increase circulation.

If you do have an attack, rub your hands together vigorously or hold them under warm (not hot) water. Other techniques that work include putting your hands under your armpits, swinging your arms in circles (windmills), massaging your hands and feet and wiggling your toes.

Diagnosis
Because a flare up of Raynaud’s phenomenon lasts a short time, your health professional probably won’t be able to witness your symptoms. He or she will most often determine whether you have Raynaud’s based on your description of symptoms. To distinguish between primary and secondary Raynaud’s, your doctor may perform a test called a nail fold capillaroscopy to examine the tiny blood vessels near the base of your fingernail under a microscope.

If your doctor suspects that Raynaud’s is an indicator of another condition such as lupus or atherosclerosis he or she may order further tests, such as blood tests. The overall chance that Raynaud’s symptoms indicate another illness is very low.

Treatment
There is no cure for Raynaud’s phenomenon, however, most people are able to effectively control the disease with home treatment to eliminate or minimize symptoms.
Some people find relaxation techniques and biofeedback helpful.

There is no medication that eliminates Raynaud’s, but some medications are used to decrease the severity or frequency of attacks. Certain medications, such as calcium channel blockers work to dilate the blood vessels.

Raynaud’s phenomenon is more than just having cold hands and feet. It’s not the same as frostbite. The cause of the disease isn’t completely understood, but for some reason the body overreacts to cold or stress by constricting blood vessels in the extremities. Raynaud’s can be controlled or lessened by keeping the body, hands and feet warm. There is no cure for the condition; however, most people manage it successfully at home without the need for medical treatment.

Dr. Palmquist is a board certified family practice physician at Raiter Clinic.