DEAR DOCTOR K:
When I’m out in the cold, my fingers quickly go from cold to numb and often turn whitish. This goes beyond normal feelings of cold. What could be going on?
What you’re describing — cold, white (sometimes even bluish), numb fingers — are the hallmarks of an illness called Raynaud’s phenomenon.
When I first learned about Raynaud’s in medical school, I called it the “almost patriotic” illness. That’s because its colors are white, blue and red, in that order:
WHITE. When people with Raynaud’s go out into cold weather, the first thing that happens is that small arteries in the fingers go into spasm. This reduces or cuts off the flow of oxygen-rich blood to the fingers. Without a steady supply of blood circulating through them, the affected fingers turn white. (I’ve put an illustration of the process , below.) Raynaud’s can also affect the toes, nose, lips, ears, nipples and other body parts.
BLUE. When the spasm ends, the arteries reopen, allowing blood to flow again. Oxygen leaves the blood rapidly, to supply your fingers and toes with the oxygen they’ve been missing. Blood depleted of oxygen turns blue or purple, and so do your fingers and toes. They may also throb or tingle.
RED. After your fingers and toes get the oxygen they need, less oxygen leaves the blood. So it, and your fingers and toes, turn pink or red.
Prevention is the best medicine for Raynaud’s. Try to stay out of the cold when possible. When you have to go out, bundle up. Keeping the whole body warm can help prevent blood vessels in your skin from constricting. Wear insulated gloves when you go inside.
In some people, the response to cold air can be extreme. They may get Raynaud’s when reaching into a refrigerator or freezer. Air conditioning can do it for others. Wearing gloves before reaching into the refrigerator or freezer may be necessary.
You can cut an attack short by running your hands under warm (not hot) water. Or wave your arms in circles to get the blood flowing. Reusable gel warming packets are another option.
For people who get Raynaud’s attacks when they feel stressed, relaxation techniques, such as deep breathing, usually help.
Another treatment option is thermal biofeedback in which you “think” your fingers warm. This technique uses sensors placed on the fingers that feed temperature information to a video screen. You learn techniques to try to warm your fingers, aided by feedback from the sensors.
Some people may need to take a medication to prevent or control attacks. Drugs that widen blood vessels, such as calcium-channel blockers, are often effective.
Finally, certain medications can trigger Raynaud’s. Culprits include beta blockers, some migraine medications and ADHD medications. Your doctor may be able to substitute other medications or change the dose. Some over-the-counter cold medications also constrict blood vessels.
It’s no fun to have Raynaud’s. I know — I have it. But you can prevent it, or shorten the episodes, with proper planning.
How Raynaud’s progresses
In a Raynaud’s attack, fingers turn white (A) as small arteries in the fingers (arterioles) tighten, restricting the flow of blood to the skin. As oxygen in the blood is depleted, the fingers turn blue (B) and become painful. Eventually, the arterioles relax, and blood once again enters the fingers, warming the skin and turning it red (C).